Establishing the feasibility of a large scale RCT of Positive Behavioural and Active Support (PBAS): a digital technology for supported living services in learning disability

PBAS is a digital translation of the Active Support (AS) model. AS promotes quality of life (QoL) by increasing activity engagement for adults with learning disabilities (LD). Despite evidence for its effectiveness, AS has limited uptake in services, and there are difficulties associated with implementation. PBAS was developed to overcome these. This study addressed uncertainties in services so a future trial of PBAS could be undertaken. Objectives were to investigate service willingness to adopt PBAS and to participate in a trial; to co-produce an evaluation package, acceptable to staff and service users; to determine the comparator by providing an overview of systems currently used in services; and, to design an economic evaluation for any RCT. Methods A service provider survey was conducted to ascertain willingness to adopt the PBAS app and participate in an RCT, and to discover how activities are currently recorded. Follow-up interviews explored facilitators and barriers. Service user and support staff views were sought to inform the design of an evaluation package. A scoping review of generic health-related QoL outcome measures was undertaken. Results There was a willingness to adopt PBAS (45%) and participate in a future RCT (76%). Concerns were expressed about integration with existing systems, difficulties in use, cost, and demands on staff. Costs were identified as the major barrier to trial participation, alongside staff resistance to technology. Direct observation in peoples’ homes was considered acceptable by service users and staff. A suitable SCR-QoL measure (ASCOT) was identified and a method for costing the app and existing recording systems was devised. Conclusions There was support for a trial. However, the PBAS app was discontinued. Literature on technological innovation suggests the abandonment of new technology with failed attempts is typical. These patterns are replicated in the health and social care sectors and may even be intensified.