Table 4 Illustration of how the key findings from the ethnography led to changes in the trial protocol
Theme | Evidence | Implication for planned trial | ||
|---|---|---|---|---|
Non-clinically orientated variation in practice and diagnosis | Differing staff backgrounds | Selection of an appropriate control arm | Stratified Randomisation by Tier | Recruitment of a variety of staff from both Tier 2 and Tier 3 |
Differing staff training experiences | ||||
Staff economy | Staff turnover/job role fluidity | Recruitment of excess staff | ||
Non-clinically orientated variation in practice, staff economy and capacity | Lack of staff capacity/staff stress | Five days of training split over several weeks and planned several months in advance | Self-selected sample | |
Capacity | Feedback from training to team | Cluster randomisation to reduce treatment contamination | ||
Non-clinically orientated variation in practice | Informal staff supervision | |||
Informal learning of therapeutic skills | Group supervision to facilitate learning | |||
Capacity | Headspace | Five days of training split over several weeks and planned several months in advance | ||
Diagnosis | Lack of staff confidence | Use of a structured interview tool to provide a DSM diagnosis by research team | ||
Lack of diagnoses | ||||
Non-clinically orientated variation in practice and staff economy | Speed of patient treatment | Reduce treatment delay and recruitment speed by adding additional study sites | ||
Diagnosis | Comorbidities | Participant inclusion criteria to include comorbidities | ||
Diagnosis and staff economy | Depression treated in both Tiers | Recruitment across Tier 2 and Tier 3 | Stratified randomisation by Tier | |
Non-clinically orientated variation in practice | Staff treatment preferences | Perceptions regarding delivery to be explored in qualitative interviews with staff and patients | ||
Staff economy and capacity | Staff and patient management | Attendance at regular management meeting | Informed recruitment strategy | |