What did mods involve?

Workstream 1

Discussions with Older Adults, Caregivers, and Healthcare Professionals

In workstream 1, we talked with older adults with multiple physical health conditions and low mood or depression; caregivers who provide informal support for older adults; and a range of healthcare professionals involved in the care of older adults. Our aim was to learn about people's experiences of living with multiple health conditions, their experiences of receiving or providing care or support, and also to gather their thoughts on the proposed MODS intervention.

Consensus Group

We have also formed a MODS consensus group to help us to co-produce the intervention. This group have helped us to think about and reach consensus on how the intervention needs to be developed for MODS, important aspects of the intervention (including the MODS booklet), and who should support people with the intervention. This group is made up of a range of individuals including older adults with multiple physical health conditions and low mood or depression, caregivers and a range of healthcare professionals. The MODS consensus group have met 3 times during Workstream 1 to discuss and reach consensus on the intervention. 

Initial Testing of the MODS Intervention

By talking with these groups of people and working with the MODS consensus group we have developed two iterations of the MODS booklet. We have tested each iteration of the booklet with two small groups of older adults who have two or more long term health conditions (as identified by their GP practice) and who were experiencing symptoms of low mood or depression (as identified by the research team). These older adults worked through the intervention with the support of a ‘MODS support worker’ and provided their feedback on the booklet they received and what it was like to work with the MODS support worker.

Next Steps...

The information we have gathered with these older adults is helping us to further refine the MODS intervention to make this suitable for use with older adults with multiple physical health conditions and low mood or depression. This information will be used to produce the final version of the MODS booklet for use in Workstream 2. We also use this information to help us develop the materials to be used by the MODS support worker, including the training programme.

We have also brought together individuals who represent patients and the public. You can find more specific information about our MODS Patient and Public involvement on the Patient and Public Involvement (PPI) page.  

Workstream 3 

The aim of Workstream 3 was to conduct a definitive Randomised Controlled Trial (RCT) to evaluate the clinical and cost-effectiveness of the MODS Behavioural Activation (BA) intervention compared to usual care. The MODS BA intervention was designed to help support older adults (65+ years) who have two or more long term conditions and depression or low mood; more information on the MODS Behavioural Activation intervention can be found here

The RCT is a two-arm parallel group design. Participants were recruited from GP practices across the UK and were randomly allocated 1:1 to either the MODS BA intervention group or the usual care group. All study participants completed a study questionnaire at study entry (baseline) and at 4,8 and 12 months to test the impact of the MODS BA intervention. The primary outcome measure is quality of life at four months (EQ5D-3L)1.

The trial also included a concurrent process evaluation (Workstream 4 – see below), as well as an economic evaluation to assess the cost-effectiveness of the intervention compared to usual care.

1. EuroQual Group. EuroQol: A new Instrument for the measurement of Health Related Quality of Life. 1990;16:199-208.

WORKSTREAM 4

Workstream 4 evaluated the processes and mechanisms that underpin intervention delivery and to develop a post-trial implementation framework. This was achieved through interviewing different stakeholders (older adult participants, caregivers/supportive others, MODS support workers, health and social care professionals, and commissioners/policymakers) to obtain their perspectives.

Findings from the interviews with different stakeholder groups will be used (triangulated) alongside quantitative findings to identify barriers and enablers to post-trial implementation. A key aim of Workstream 4 is to develop a post-trial implementation framework which considers intervention implementation across a range of health and social care settings.