Dialog+
DIALOG+ is an intervention developed at the Unit for Social and Community Psychiatry, at Queen Mary University of London and the East London NHS Foundation Trust (ELFT).
DIALOG+ is a technology-assisted and resource-oriented intervention based on solution-focused therapy, patient-centred communication, and quality of life research.[1]. The intervention is delivered on an app and structures communication between a patient and health provider during routine clinical appointments. The DIALOG+ intervention is available on Android[2] and Apple operating systems[3] and is also available as a progressive web application[4].
History
DIALOG+ was developed based on research done in 2002 to explore how to use a technology-assisted intervention to structure communication between patients with psychosis and health providers in 6 European countries[5]. In the early version of DIALOG+ (known as the DIALOG scale), patients provided numerical ratings for their subjective quality of life (SQOL) in 11 areas of the DIALOG scale made up of eight life domains (e.g., physical health) and three treatment aspects (e.g., medication)[6]. The aim of the DIALOG scale was to provide structure to communication between patients and health providers to ensure that patient priorities were identified[7]. However, in the original DIALOG scale, there was no mechanism to address these priorities in a structured way.
The DIALOG scale was further developed with the aim of expanding the original scale to include a therapeutic intervention that addressed the patient-identified priorities. The new intervention, called DIALOG+, incorporated an additional 4-step approach that was based on the principles of solution-focused therapy. DIALOG+ aim to provide clinicians with a manualised therapeutic approach[8] to address the concerns raised or highlighted by the completion of the DIALOG scale. The efficacy of the DIALOG+ intervention was tested in a cluster randomised controlled trial with adults with psychosis in 7 community mental health teams across East London, UK[9].
In 2017, a research programme began to test DIALOG+ in adults with chronic depression[10].
Research Evidence
DIALOG Scale
DIALOG is a measure of subjective quality of life (SQOL)[11] that has been recommended by the National Institute for Health and Care Excellence (NICE, UK) as a measure of patient outcomes[12]. In a cluster randomised controlled trial in six countries (Spain, The Netherlands, UK, Sweden, Germany, and Switzerland), use of the DIALOG scale was found to improve SQOL in patients who reported fewer unmet needs and higher satisfaction with treatment, assessed after 12 months[5].
DIALOG+
In a pragmatic cluster randomised trial of DIALOG+ in London, UK, patients reported improved SQOL at 3, 6, and 12 months, and reduced psychopathological symptoms. In the same trial, DIALOG+ was found to also improve objective social outcomes and reduce the cost of treatment[9]. A separate study exploring the mechanisms by which DIALOG+ works found that patient-reported improvements likely occurred because DIALOG+ provides a solution-focused structure to routine clinical meetings while encouraging self-reflection, expression, and empowerment in patients[13].
Expansion
Clinical Integration
Both DIALOG and DIALOG+ have been implemented across the National Health Service (NHS) in the UK. In the East London NHS Foundation Trust (ELFT), DIALOG+ has replaced part of the Care Programme Approach which provides mental health assessments as part of a patient’s recovery plan and safety plan[14]. Remote delivery of the intervention is currently being trialled[15].
Since 2017, the DIALOG scale has been implemented routinely as a patient outcome and experience measure (PROM/PREM) in East London NHS Foundation Trust[16]. In 2022, DIALOG+ was integrated into all community adult mental health services in all London boroughs to in Milton Keynes[6].
International Expansion
DIALOG+ is currently being tested in research studies in Bosnia and Herzegovina, Colombia, Uganda[17], Peru, Argentina, Pakistan[18], Serbia, Kosovo UN Resolution, Montenegro and North Macedonia[19], Germany[20], and India[21].
Two trials in Colombia are currently exploring how to adapt DIALOG+ for use with adolescents with depression and anxiety[22], and in schools to support mental wellbeing and resilience in post-conflict areas[23]
In Bosnia and Herzegovina, Colombia, and Uganda, an exploratory non-controlled trial aim to examine the effectiveness of DIALOG+ in improving quality of life and mental distress for patients with chronic conditions in primary care services[24].
References
- ↑ "Dialog+". DIALOG+. 28 March 2022. Retrieved 28 March 2022. Unknown parameter
|url-status=ignored (help) - ↑ "DIALOG - Apps on Google Play". play.google.com. Retrieved 2021-10-14.
- ↑ "DIALOG". App Store. Retrieved 2021-10-14.
- ↑ "Welcome". DIALOG+ Welcome Page. 24 March 2022. Retrieved 24 March 2022. Unknown parameter
|url-status=ignored (help) - ↑ 5.0 5.1 Priebe, Stefan; McCabe, Rosemarie; Bullenkamp, Jens; Hansson, Lars; Lauber, Christoph; Martinez-Leal, Rafael; Rössler, Wulf; Salize, Hans; Svensson, Bengt; Torres-Gonzales, Francisco; Van Den Brink, Rob (2007). "Structured patient–clinician communication and 1-year outcome in community mental healthcare". British Journal of Psychiatry. 191(NOV) (5): 420–426. doi:10.1192/bjp.bp.107.036939. ISSN 0007-1250. PMID 17978322. Unknown parameter
|s2cid=ignored (help) - ↑ 6.0 6.1 "CNWL launching DIALOG+ across adult mental health services in 2022 :: Central and North West London NHS Foundation Trust". www.cnwl.nhs.uk. Retrieved 2022-03-28.
- ↑ "DIALOG - Healthy London Partnership". DIALOG. 28 March 2022. Retrieved 28 March 2022. Unknown parameter
|url-status=ignored (help) - ↑ "Resources". East London NHS Foundation Trust. Retrieved 2022-03-28.
- ↑ 9.0 9.1 Priebe, Stefan; Kelley, Lauren; Omer, Serif; Golden, Eoin; Walsh, Sophie; Khanom, Husnara; Kingdon, David; Rutterford, Clare; McCrone, Paul; McCabe, Rosemarie (2015). "The Effectiveness of a Patient-Centred Assessment with a Solution-Focused Approach (DIALOG+) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care". Psychotherapy and Psychosomatics. 84 (5): 304–313. doi:10.1159/000430991. ISSN 0033-3190. PMID 26278784. Unknown parameter
|s2cid=ignored (help) - ↑ "Tackling chronic depression with technological developments". TACK Study. Retrieved 14 October 2021. Unknown parameter
|url-status=ignored (help) - ↑ Priebe, Stefan; Golden, Eoin; McCabe, Rosemarie; Reininghaus, Ulrich (2012-08-17). "Patient-reported outcome data generated in a clinical intervention in community mental health care - psychometric properties". BMC Psychiatry. 12 (1): 113. doi:10.1186/1471-244x-12-113. ISSN 1471-244X. PMC 3499293. PMID 22900667.
- ↑ "Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance". Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance (see pages 32 - 33). 28 March 2022. Retrieved 28 March 2022. Unknown parameter
|url-status=ignored (help) - ↑ Omer, Serif; Golden, Eoin; Priebe, Stefan (2016-02-09). "Exploring the Mechanisms of a Patient-Centred Assessment with a Solution Focused Approach (DIALOG+) in the Community Treatment of Patients with Psychosis: A Process Evaluation within a Cluster-Randomised Controlled Trial". PLOS ONE. 11 (2): e0148415. Bibcode:2016PLoSO..1148415O. doi:10.1371/journal.pone.0148415. ISSN 1932-6203. PMC 4747516. PMID 26859388.
- ↑ "DIALOG+ Application in the NHS". DIALOG+. 28 March 2022. Retrieved 22 March 2022. Unknown parameter
|url-status=ignored (help) - ↑ "Search - NIHR Funding and Awards". fundingawards.nihr.ac.uk. Retrieved 2022-03-28.
- ↑ Mosler, Franziska; Priebe, Stefan; Bird, Victoria (2020-11-09). "Routine measurement of satisfaction with life and treatment aspects in mental health patients – the DIALOG scale in East London". BMC Health Services Research. 20 (1): 1020. doi:10.1186/s12913-020-05840-z. ISSN 1472-6963. PMC 7654159 Check
|pmc=value (help). PMID 33167986 Check|pmid=value (help). - ↑ Priebe, Stefan; Fung, Catherine; Sajun, Sana Z.; Alinaitwe, Racheal; Giacco, Domenico; Gómez-Restrepo, Carlos; Kulenoviĉ, Alma Džubur; Nakasujja, Noeline; Ramírez, Sandra Milena; Slatina, Sabina; Sewankambo, Nelson K. (2019-06-14). "Resource-oriented interventions for patients with severe mental illnesses in low- and middle-income countries: trials in Bosnia-Herzegovina, Colombia and Uganda". BMC Psychiatry. 19 (1): 181. doi:10.1186/s12888-019-2148-x. ISSN 1471-244X. PMC 6567380 Check
|pmc=value (help). PMID 31200671. - ↑ "Partners - NIHR Global Health Research Group". www.qmul.ac.uk. Retrieved 2021-10-14.
- ↑ Jovanovic, Nikolina; Francis, Jill; Maric, Nadja P.; Arenliu, Aliriza; Barjaktarov, Stojan; Kulenovic, Alma Dzubur; Injac, Lidija; Feng, Yan; Novotni, Antoni (2020-05-01). "Implementing a psychosocial intervention DIALOG+ for patients with psychotic disorders in low and middle income countries in South Eastern Europe: protocol for a hybrid effectiveness-implementation cluster randomized clinical trial (IMPULSE)". Global Psychiatry. 3 (1): 83–96. doi:10.2478/gp-2019-0020. ISSN 2451-4950. Unknown parameter
|s2cid=ignored (help) - ↑ Fichtenbauer, Isabelle; Priebe, Stefan; Schrank, Beate (2019-08-14). "Die deutsche Version von DIALOG+ bei PatientInnen mit Psychose – eine Pilotstudie". Psychiatrische Praxis. 46 (7): 376–380. doi:10.1055/a-0961-3328. ISSN 0303-4259. PMID 31412369.
- ↑ "PIECEs". Retrieved 2021-10-14.
- ↑ "Building resilience in adolescence - improving quality of life for adolescents with mental health problems in Colombia (BRiCs study)". UKRI. 14 October 2021. Retrieved 14 October 2021. Unknown parameter
|url-status=ignored (help) - ↑ "Adapting DIALOG+ and building capacity in schools to support mental wellbeing and resilience in post-conflict Colombia during the COVID-19 pandemic". UKRI. 14 October 2021. Retrieved 14 October 2021. Unknown parameter
|url-status=ignored (help) - ↑ van Loggerenberg, Francois; McGrath, Michael; Akena, Dickens; Birabwa-Oketcho, Harriet; Méndez, Camilo Andrés Cabarique; Gómez-Restrepo, Carlos; Džubur Kulenoviĉ, Alma; Muhić, Maja; Sewankambo, Nelson K.; Sikira, Hana; Priebe, Stefan (2021). "Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda". Pilot and Feasibility Studies. 7 (1): 180. doi:10.1186/s40814-021-00914-z. ISSN 2055-5784. PMC 8481761 Check
|pmc=value (help). PMID 34593055 Check|pmid=value (help).
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