Is it possible to implement the DIALOG+ routine outcome monitoring system in a psychiatric rehabilitation inpatient setting? A mixed methods feasibility trial in the UK National Health Service

Abstract Background This study aimed to evaluate the feasibility and acceptability of implementing a routine outcome monitoring tool, DIALOG, and an associated intervention, DIALOG+, in psychiatric rehabilitation inpatient care wards in England. Methods This was a mixed-methods feasibility study with cluster allocation. Feasibility data on the implementation of a paper-based format of DIALOG and DIALOG+ were collected over five months. Patient participants completed qualitative surveys, while staff participants engaged in focus groups and interviews about their experiences. Results While staff recruitment and training were feasible ( N = 17), the patient recruitment rate did not meet the pre-established progression criteria. The mean number of DIALOG+ sessions completed over the five-month intervention period was low (1.9 of 10 sessions), and engagement was low (4 of 8 patients completed more than 1 measure). Thematic analysis identified four themes regarding barriers to implementation: [1] affective attitude towards feasibility objectives [2], affective attitude towards the intervention [3], alignment with current practice, and [4] the inpatient setting. Conclusions Feasibility outcomes indicated that DIALOG + in a paper-based format could not be embedded in this setting using this implementation approach. Key implementation barriers included insufficient adherence and limited integration within multidisciplinary team (MDT) meetings. These findings should be interpreted cautiously given the small sample size. Future implementation trials should consider providing dedicated implementation support, training, and supervision to facilitate intervention fidelity and integration into routine MDT practice. Trial registration The study protocol was registered on 20/5/24 in the clinicaltrials.gov repository (NCT06476483). Clinical trial The study protocol was registered in the available repository clinicaltrials.gov, clinical trial number: NCT06476483 on 20/5/2024.