Table 2 Initial PARTNERS programme theory

Figure 1 represents the way in which the PARTNERS intervention operates at multiple levels with the outcomes derived from one level becoming intervention resources for the next level. In the diagram, mechanisms are broken down into the resources provided and the anticipated reasoning and reactions of the relevant actors.

It is hypothesised that engagement with leadership of primary and secondary care services will lead to agreements that specialist mental health workers will be placed into primary care teams, where they will deliver care to people with a diagnosis of bipolar, schizophrenia or other psychosis who are patients of that practice, according to the PARTNERS model. These agreements are operationalised in the manual and through training delivered to care partners and supervisors.

The manual and training act as resources for care partners and supervisors, supporting them to develop the knowledge and skills required to fulfil their respective roles. For supervisors, this is the provision of regular, protocolised supervision, in which they review whether the care partner is delivering the intervention as intended and provide support and guidance to ensure fidelity to the model. In turn this serves to further develop the care partners’ knowledge and skills.

The care partners’ role consists of a range of activities directly with service users and communication with other people and agencies who can provide support for service users’ health and wellbeing. The support provided by care partners directly to service users is hypothesised to increase their belief in themselves and their ability to control their health and their lives, leading to an increase in service user behaviours which are likely, in turn, to lead to improved health. These include actively engaging themselves with other people and agencies who can provide support for their health and wellbeing. Successfully changing behaviour is also thought to further contribute to the service users’ confidence, creating a virtuous cycle of ongoing improvement.

Care partner liaison with other sources of support is thought to lead to greater understanding in these individuals of how they can best support the service user in improving their health and wellbeing and thus the provision of support that will enable the service user to make desired changes. It is also thought to broaden care partners’ awareness of health and wellbeing needs that service users might have and the range of supports available to meet these.

These mechanisms are thought to operate in contexts, which include the pre-existing characteristics of services, such as cultures and leadership style, and individuals, such as previous experience and attitudes. Thus a care partner may be more able to understand the intervention and deliver it as intended if they have previous training in coaching or a service user may be more likely to respond positively to the coaching approach if they are ready to change.