Background: We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training\nintervention to improve patient engagement in activities in inpatient mental health rehabilitation units.\nConcurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units\nand the contextual issues that may have influenced the effectiveness of the intervention.\nMethod: We conducted focus groups with staff working in the inpatient units that received the intervention,\nsampled using a maximum variation strategy.\nResults: The intervention was accepted by staff. However, the skills gained, and changes to the unit�s processes\nand structures that were agreed with the intervention team were not sustained after they left. The main reasons\nfor this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of\nsenior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period;\nreinforcement of skills).\nConclusion: This study illustrates some of the inter-related factors which operate at different levels within and\noutside of NHS organisations that may impact on the success of complex interventions. These factors need to\nbe considered when designing interventions to ensure adequate buy-in from senior staff.
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