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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

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.
Author
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
Zeev, Dror Ben
Repper, Julie
Kotera, Yasuhiro
Roe, James
Llewellyn-Beardsley, Joy
Ng, Fiona
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Date
2024-10
Type
Article
Subject
Autobiography, Digital health intervention, Digital health technology, Lived experience narrative, Online trial, Recovery narrative
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NNPC Primary Care Publications
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Citation
Slade M, Rennick-Egglestone S, Robinson C, Newby C, Elliott RA, Ali Y, Yeo C, Glover T, Gavan SP, Paterson L, Pollock K, Priebe S, Thornicroft G, Keppens J, Smuk M, Franklin D, Walcott R, Harrison J, Robotham D, Bradstreet S, Gillard S, Cuijpers P, Farkas M, Ben-Zeev D, Repper J, Kotera Y, Roe J, Llewellyn-Beardsley J, Ng F. 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 Reg Health Eur. 2024 Oct 23;47:101101
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https://mider.dspace7.openrepository.com/handle/20.500.12904/19401
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