Barriers and facilitators to implement Assertive Community Treatment (ACT) in Japan: a qualitative study protocol...

Assertive Community Treatment (ACT), which was developed in the 1970s in the USA, is a programme that supports people with severe mental illness living in the community through a multidisciplinary team, individual care and outreach approach. It is widely known that ACT effectively decreases hospital stays and improves Global Assessment of Functioning scores. In Japan, empirical studies on ACT were conducted in the late 2000s. Through the introduction of the standardised programme and domestic network, its implementation nationwide was anticipated. However, to date, the implementation of ACT is limited. There has been no comprehensive research in Japan on what inhibits and promotes the implementation of ACT in community mental health settings. Therefore, in this study, we aimed to systematically and comprehensively investigate the factors influencing the implementation of ACT in Japan using implementation research.

A qualitative study will be conducted using semistructured interviews with key stakeholders in the ACT team. Interviews will be conducted face-to-face or online, using an interview guide. The inclusion criteria are present and past ACT teams. Recruitment will be in two steps. A preinterview questionnaire will be sent to the members of the Community Mental Health Outreach Association regarding their basic characteristics and fidelity to the ACT model, and purposive sampling will be performed based on it. The Consolidated Framework for Implementation Research will be used to collect and analyse the interview data according to the qualitative content analysis, with reference to the fidelity category, because this will help to find influencing factors by identifying constructs that appear to distinguish between high-fidelity and low-fidelity teams.

This study has been approved by the Tokyo Medical University Ethics Approval Committee (approval number: T2022-0175). The findings will be shared via peer-reviewed journal publications and presentations to policymakers and service users.