Developing a theory of implementation

We’ve been doing some more work on our EMPOWER on our Phase 1 qualitative data.

I (Steph) became involved in the project through my undergraduate dissertation. Having experience of psychosis and an interest in intervention research that actively includes the perspective of people who use services and their families, I have appreciated engaging with the team. I (Andrew) have been supervising Steph throughout her dissertation and introducing her to the delights of Grounded Theory.

As part of the run up to the Cluster Randomised Controlled Trial it was really important for us as a team to engage with key stakeholders to explore with them their views about the EMPOWER Mobile App. Key stakeholders are people with lived experience, their family members and mental health staff.

We’ve been really struck by how much agreement there is between stakeholders regarding Early Warning Signs. All three groups seem to accept the term Early Warning Signs and agree on their function with respect to detection and prevention of recurrence of distressing psychosis. Interestingly all stakeholders talk about the importance of “risk” in relation to Early Warning Signs.

However, each group reflected on risk differently. For people with lived experience, they expressed worries about early warning signs triggering unwanted changes in care such as hospitalization. This was linked to a fear of relapse and possible avoidance of seeking help in the context of early warning signs. Instead they would potentially access other sources of support including family and friends.

For staff, risk was linked to their roles as mental health professionals and the expectations placed on them to have expertise in being amble to monitor, detect and respond to early warning signs. This meant that they emphasized the importance of having a strong relationship with service users that enables sharing of expertise in staying well.

For family members, they expressed worries about witnessing changes in their family members mental health and the dilemma about whether or not to seek help and support of services. They spoke about the risk of this potentially impacting negatively on their relationship with their family member.

We really value these distinctive perspectives. Implementation of any new approach in mental health services needs to take careful consideration of all stakeholders’ views and we hope this work will help us develop the EMPOWER App in a way that is valued by people with lived experience, family members and mental health staff.

Andrew and Steph


Collage by Jacqui Ruddell – see more of her work on