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A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial

Abstract

Purpose

This study aimed to assess the efficacy of a staff-training intervention to improve service users’ engagement in activities and quality of care, by means of a cluster randomised controlled trial.

Method

All residential units with at least 12-h a day staff support (n = 23) were invited to participate. Quality of care was assessed with the Quality Indicator for Rehabilitative Care (QuIRC) filled online by the unit’s manager. Half the units (n = 12) were randomly assigned to continue providing treatment as usual, and half (n = 11) received a staff-training intervention that focused on skills for engaging service users in activities, with trainers working alongside staff to embed this learning in the service. The primary outcome was service users’ level of activity (measured with the Time Use Diary), reassessed at 4 and 8 months. Secondary outcomes were the quality of care provided (QuIRC), and service users’ quality of life (Manchester Short Assessment of Quality of Life) reassessed at 8 months. Generalized linear mixed effect models were used to assess the difference in outcomes between units in the two trial arms. The trial was registered with Current Controlled Trials (Ref NCT02366117).

Results

Knowledge acquired by the staff during the initial workshops increased significantly (p ≤ 0.01). However, the intervention and comparison units did not differ significantly in primary and secondary outcomes at either follow-up.

Conclusions

The intervention increased the level of knowledge of staff without leading to an improvement in service users’ engagement in activities, quality of life, or quality of care in the units.

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Acknowledgements

We wish to thank the Directorate-General of Health of the Ministry of Health for their support, and the professionals and users involved in the intervention: Marta Ferraz, Maria João Casaca, Maria João Gaudêncio, Cláudia Catalão, Helena Carlos, Luísa Felgueiras, Ana Margarida Casimiro, Marta Nunes, Belarmino Ferreira, Sílvia Almeida, and Luís Pereira. We also thank Isabel Fazenda and José Ornelas for being project consultants, Deborah Taylor and Lara Freeman for the training of the PromQual intervention teams, Catarina Pacheco for the baseline assessments and data management, and Ana Rita Silva for confirming databases coherence. We acknowledge the work and support of members of the Maristán network in making these collaborations possible http://redmaristan.org/.

Author information

GC, AP, HK, MK, and JCA designed the study. GC, MF, and GT oversaw data collection. GC and AP conducted the analyses and conceptualized and wrote most of the manuscript. All authors revised the manuscript and approved its final version.

Correspondence to Graça Cardoso.

Ethics declarations

Funding

This study was funded by the Directorate-General of Health of the Ministry of Health, and the funding agency had no role in the design or execution of the study.

Conflict of interest

The authors report no potential conflicts of interests.

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Cardoso, G., Papoila, A., Tomé, G. et al. A cluster randomised controlled trial of a staff-training intervention in residential units for people with long-term mental illness in Portugal: the PromQual trial. Soc Psychiatry Psychiatr Epidemiol 52, 1435–1445 (2017). https://doi.org/10.1007/s00127-017-1416-7

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Keywords

  • Intervention
  • Recovery
  • Residential units
  • Staff training
  • Severe mental illness