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Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with psychosis experience (NEON Trial): a pragmatic randomised controlled trial

Slade, Mike; Rennick-Egglestone, Stefan; Robinson, Clare; Newby, Chris; Elliott, Rachel A; Ali, Yasmin; Yeo, Caroline; Glover, Tony; Gavan, Sean P; Paterson, Luke; Pollock, Kristian; Priebe, Stefan; Thornicroft, Graham; Keppens, Jeroen; Smuk, Melanie; Franklin, Donna; Walcott, Rianna; Harrison, Julian; Robotham, Dan; Bradstreet, Simon; Gillard, Steve; Cuijpers, Pim; Farkas, Marianne; Ben-Zeev, Dror; Repper, Julie; Kotera, Yasuhiro; Roe, James; Llewellyn-Beardsley, Joy; Ng, Fiona

Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with psychosis experience (NEON Trial): a pragmatic randomised controlled trial Thumbnail


Authors

MIKE SLADE M.SLADE@NOTTINGHAM.AC.UK
Professor of Mental Health Recovery and Social Inclusion

Clare Robinson

Chris Newby

Rachel A Elliott

Yasmin Ali

Caroline Yeo

Tony Glover

Sean P Gavan

Luke Paterson

Kristian Pollock

Stefan Priebe

Graham Thornicroft

Jeroen Keppens

Melanie Smuk

Donna Franklin

Rianna Walcott

Julian Harrison

Dan Robotham

Simon Bradstreet

Steve Gillard

Pim Cuijpers

Marianne Farkas

Dror Ben-Zeev

Julie Repper

JAMES ROE JAMES.ROE@NOTTINGHAM.AC.UK
Research Fellow

Joy Llewellyn-Beardsley

Profile image of FIONA NG

DR FIONA NG FIONA.NG@NOTTINGHAM.AC.UK
Principal Research Fellow



Abstract

Background
The Narrative Experiences Online (NEON) Intervention provides self-managed web-based access to mental health recovery narratives (n = 659). We evaluated effectiveness and cost-effectiveness in improving quality of life for adults resident in England with mental health problems and recent psychosis experience.
Methods
Prospectively registered pragmatic parallel-group randomised trial controlling for usual care, recruiting from statutory mental health services and through community engagement activities, with a 52-week primary endpoint (ISRCTN11152837). All trial procedures and the NEON Intervention were delivered by an integrated web-application. Randomisation was through an independently generated list (no stratification). Allocation was masked for statistical staff and the Chief Investigator but not participants. Intervention arm participants received immediate NEON Intervention access. Control arm participants received access after completing primary endpoint questionnaires. The primary outcome was quality of life through the Manchester Short Assessment (MANSA). Serious Adverse Events (SAEs) were collected through web-based safety report forms and identified from health service usage data. The primary analysis was by a prospectively described Intention To Treat principle excluding participants who had registered multiple times, with multiple imputation for missing data.
Findings
Between 9 March 2020 and 1 March 2021, 739 participants were randomised (intervention:370; control: 369), providing more than 90% power to detect a baseline-adjusted difference of 0.25 in the MANSA score. Mean age was 34.8 years (standard deviation (SD) 12.0), 561 (75.9%) were white British, 443 (59.9%) were female, 609 (82.4%) had accessed specialist care mental health services, and 698 (94.5%) had accessed primary care mental health services. Mean baseline MANSA score was 3.7 for control and intervention arms (SD 0.9 and 1.0). 565 (76.5%) participants provided primary endpoint MANSA data with a mean score of 4.1 (SD 1.0) for both arms. We found no significant difference in Quality of Life between the two arms at the primary endpoint (baseline-adjusted difference 0.07, 95% CI −0.07 to 0.21, p = 0.35). The incremental cost-effectiveness ratio (£110,501 per quality-adjusted life-year (QALY)) exceeded the prospectively defined cost-effectiveness threshold (£30,000 per QALY). 158 (42.8%) control arm and 194 (52.4%) intervention arm participants accessed narratives outside of the NEON Intervention. There were no related serious adverse events (SAEs). 116 unrelated SAEs were reported by control arm participants, and 107 by intervention arm participants.
Interpretation
Our findings do not indicate NEON Intervention access for all people with psychosis experience. Future research should consider a) evaluation with current mental health services users; b) optimisation to enable users to find hope-promoting narratives.

Citation

Slade, M., Rennick-Egglestone, S., Robinson, C., Newby, C., Elliott, R. A., Ali, Y., Yeo, C., Glover, T., Gavan, S. P., Paterson, L., Pollock, K., Priebe, S., Thornicroft, G., Keppens, J., Smuk, M., Franklin, D., Walcott, R., Harrison, J., Robotham, D., Bradstreet, S., …Ng, F. (2024). Effectiveness and cost-effectiveness of online recorded recovery narratives in improving quality of life for people with psychosis experience (NEON Trial): a pragmatic randomised controlled trial. Lancet Regional Health – Europe, 2024(47), Article 101101. https://doi.org/10.1016/j.lanepe.2024.101101

Journal Article Type Article
Acceptance Date Oct 4, 2024
Online Publication Date Oct 23, 2024
Publication Date 2024-12
Deposit Date Oct 8, 2024
Publicly Available Date Oct 23, 2024
Journal Lancet Regional Health – Europe
Electronic ISSN 2666-7762
Peer Reviewed Peer Reviewed
Volume 2024
Issue 47
Article Number 101101
DOI https://doi.org/10.1016/j.lanepe.2024.101101
Keywords Recovery narrative; Lived experience narrative; Autobiography; Digital health intervention; Digital health technology; Online trial
Public URL https://nottingham-repository.worktribe.com/output/40552750
Publisher URL https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(24)00268-0/fulltext

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