EMPOWER in Daily Life: A Qualitative Investigation of End User Experience of a blended digital intervention for relapse prevention in schizophrenia in a cluster randomised controlled feasibility trial.

Objectives: To study the end-user experiences of participants randomised to receive a blended digital intervention for relapse prevention in schizophrenia in the context of a cluster randomised controlled feasibility trial. Design: A qualitative interview design with thematic analysis was used. Method: A subsample of EMPOWER participants comprising 16 patients, 5 mental health staff and one carer were interviewed one-on-one. Results: Two overarching themes were constructed that were relevant for understanding end-user experiences within the EMPOWER trial: Affordances and Change Processes. Affordances described the processes underpinning how and why participants interacted with or avoided the various components of the intervention. Affordances spanned all EMPOWER components, including self-monitoring, peer support workers, clinical triaging, self-management messages and diary function. The affordances were Access to Social Connection, Access to Digital, Access to Mental Health Support, the Ability to Gauge Mental Health and Access to Mental Health Information. The affordances framework helped explain the multitude of engagement trajectories featured within the qualitative interviews. If participants sustained usage, affordances acted as a springboard for change processes, including increased self-confidence that patients could self-manage, noticing patterns and changes, and using EMPOWER as a conversation starter. Conclusions: The implementation process of EMPOWER was emergent and was best described by the intervention offering a range of affordances which could act as implementation barriers or facilitators depending on individual needs and wants. Affordances may present a sound theoretical framework for explaining end-user experiences.