Stefan Elbers

226 Summary During these activities, we developed an evidence base, tested ideas and developed two prototype interventions that we merged into one relapse prevention workbook. In our reflection, we concluded that the generative techniques helped participants to provide a detailed description of their experiences and beliefs beyond their initial response. The co-design approach also promoted active participation and equal collaboration between the participants. Limitations included restricted involvement of patients and health care providers in the final stage of the project, potentially affecting the acceptability of the final prototype. Overall, this case study provides an example of how co-design can support the transfer of ideas, mainly derived from patients and health care providers, into a prototype intervention. In Chapter 6, we present the results of a feasibility study of the workbook prototype in a clinical setting. The main objective was to assess the level of acceptability and the applicability of the workbook for patients and health care providers in IMPT programmes. We performed a qualitative study in two different facilities. Health care providers received a brief training session in how to use the workbook but were subsequently free to decide when the workbook would be appropriate for patients whom they treated during the six month study period. Subsequently, eleven patients and four health care providers provided input on the feasibility of the intervention by means of interviews (patients) and a focus group (health care providers). We analysed the data with a deductive thematic content approach and we clustered meaningful data segments into four themes: applicability in existing treatment programmes; acceptability of the workbook content; acceptability of the workbook form; and adaptability. Overall, the workbook was perceived as easy to use and in line with existing treatment components. The results further indicated directions for improvement, but also comprised experiences relevant to its feasibility in a rehabilitation context. However, various limitations – including a high dropout rate and a small sample size – negatively influenced the generalizability of these results. Future studies should not only focus on further revision of the intervention, but also on improvement of the implementation and data collection procedures. One important recommendation from the feasibility study was to transform the workbook into a digital intervention. In a subsequent study project, we developed the AGRIPPA application that contained both relapse prevention strategies. The application also contained an additional information and education module where different IMPT programmes could add their own information materials, such as videos, assignments and website links. Chapter 7 is a description of a multicentre randomized controlled trial protocol with two parallel groups. In a 12-month study period, we were to recruit 158 patients in 6 treatment facilities. Patients in the experimental condition would receive the AGRIPPA mHealth application in addition to the IMPT programme. Patients in the