Identifying Factors Influencing the Implementation of Early Intervention Services for Psychosis in Quebec, Canada: A Qualitative Study of Health Care Providers' Perspectives

Abstract

Introduction

Early intervention services for psychosis are clinically and cost-effective. Despite the availability of national and international guidelines and well-identified essential components of high-quality services, the implementation of early intervention services varies greatly. However, factors underpinning this are poorly understood and infrequently studied. In Quebec, the provision of earmarked funding and political support since 2017 has resulted in widespread dissemination of early intervention, which presented a valuable context to examine what shapes and influences the implementation of early intervention for psychosis.

Methods

An online survey was sent to leaders of all early intervention programmes (n = 33) in Quebec to assess service organisation and delivery. The survey's qualitative component included open-ended questions about factors impacting implementation, which are the focus of this report. Deductive and inductive thematic analysis was conducted through multiple iterations to reach consensus.

Results

Twenty-seven programmes responded to the questionnaire. Factors influencing implementation were separated into eight themes: human resources, workload, finances, physical resources, training, service delivery, service users and relationship with management. Every theme and subtheme was represented as a potential barrier or facilitator, with work atmosphere, quality of the clinic's premises, and management buy-in of early intervention more frequently noted as facilitators.

Conclusion

Factors at the organisational, service and staff levels affect the implementation of early psychosis programmes. Despite political support and increased funding, insufficient funding and its consequences, along with limited implementation supports, remain important barriers to successful implementation. Rapid learning health systems can provide effective feedback to programmes to identify strategies to overcome identified barriers and enhance understanding of interactions between the identified factors. Lived experiences perspectives should also be included in future implementation research.