The development of an intervention to support doctors and medical students in their decision whether to disclose their mental ill health

Abstract

This thesis sought to understand the attitudes and experiences of doctors and medical students in their decision-making about disclosing their mental ill health, and to develop an intervention to aid doctors and medical students in their decision-making about whether to disclose their mental ill health. The idea for this thesis developed from a previous study on which I worked. A nationwide online anonymous surveyed UK doctors regarding disclosure of their own mental ill health to the workplace. Findings highlighted that doctors struggle with disclosure decision-making. My interest in behaviour change interventions led to the idea of this PhD: could an intervention based on behaviour change principles support doctors and medical students in their decision-making about whether to disclose their mental ill health? Doctors and medical students under-disclose their mental ill health. Delaying treatment for mental ill health is associated with negative outcomes. Non-disclosure to the workplace or medical school is an obstacle to doctors and medical students receiving appropriate support and workplace adjustments. This thesis comprises several studies. A literature review sought to clarify existing understanding about disclosure of mental ill health in doctors and medical students. How doctors and medical students experience disclosure decision-making was examined in a qualitative interview study. These two studies formed part of the evidence base for the development of an intervention to aid doctors and medical students in their decision-making about disclosing their mental ill health. The qualitative interview findings confirmed that motivational interviewing (MI) was a feasible method to inform the intervention. Led by MRC guidelines for developing a complex intervention, a web-based intervention was developed collaboratively with expert participants. The intervention appeared acceptable and feasible through testing. Beyond this thesis, funding was secured to develop the intervention into an app for mobile devices. Named ‘Arbour’, the app is undergoing further evaluation