Intervention description {11a}
The intervention being tested is an evidence-based app mediated intervention called DIALOG+. The intervention and its training methodology has been adapted during a pilot phase and is now being tested within a cluster RCT.DIALOG+ is used during a routine interaction between a clinician and a patient. It aims to better utilise the resources of the healthcare system by making these meetings more effective and by mobilising other existing resources available to the patient. It consists of a patient-centred assessment (the DIALOG scale) whereby the clinician invites the patient to rate their satisfaction with different life domains and treatment aspects. This is followed by a four-step solution-focused approach to identify the patient’s resources and develop solutions to deal with the patient's concerns. The intervention is available as an app and makes use of a tablet computer (e.g. iPad or Android device) within routine clinical meetings. Clinicians will receive training from the researchers in how to use the intervention, including how to support patients who are unfamiliar with a tablet computer.Each session begins with the patient using the tablet to rate their satisfaction with eight life domains (mental health, physical health, job situation, accommodation, leisure activities, friendships, relationship with family/partner, personal safety) and three treatment aspects (medication, practical help, meetings with professionals). The tablet allows patients to be more actively involved in the meeting, with the tablet easily passed between the clinician and patient. Each satisfaction item is rated on a scale from 1 (‘totally dissatisfied’) to 7 (‘totally satisfied’) and followed by a question on whether the patient wants additional help with that domain.The ratings are then summarised on screen, allowing for comparisons with ratings from previous meetings. Clinicians are instructed to offer positive feedback on any improving or high-scoring domains. The ratings are followed by a four-step solution-focused approach to identify the patient’s existing resources that can be used to address the concerns raised. The four steps are as follows: Understanding (Why is the patient dissatisfied? What went nevertheless well?); Looking Forward (What is the best case scenario? What is the smallest step forward?); Exploring Options (What can the patient, the clinician or others do?); and finally Agreeing on Actions (e.g. homework and referrals).The intervention (both the DIALOG scale and DIALOG+) have already been translated into 16 different languages and for this particular trial, the app has been translated and adapted to use Urdu and Tamil script in Pakistan and India respectively.Both the DIALOG scale in the control group DIALOG+ in the intervention group will be used once a month for 6 months which forms the active intervention period. Patients and clinicians will be actively followed up during this timeframe to ensure the sessions take place. After this period, there will be a 6-month flexible period where patients and clinicians can decide to use the intervention as per their discretion. This period will allow us to assess sustainability without researcher involvement and routine implementation of the DIALOG+ intervention.