Medication optimisation in severe mental illness (MEDIATE): Protocol for a realist review

Ian Maidment, Geoff Wong, Claire Duddy, Rachel Upthegrove, Sherifat Oduola, Katherine Allen, Simon Jacklin, Jo Howe, Maura MacPhee

Research output: Contribution to journalReview articlepeer-review


INTRODUCTION: Severe mental illness (SMI) is associated with significant morbidity and mortality. People living with SMI often receive complex medication regimens. Optimising these regimens can be challenging. Non-adherence is common and addressing it requires a collaborative approach to decision making. MEDIATE uses a realist approach with extensive engagement with experts-by-experience to make sense of the complexities and identify potential solutions.Realist research is used to unpack and explain complexity using programme theory/theories that contain causal explanations of outcomes, expressed as context-mechanism-outcome-configurations. The programme theory/theories will enable MEDIATE to address its aim of understanding what works, for whom, in what circumstances, to optimise medication use with people living with SMI.

METHOD AND ANALYSIS: MEDIATE will be conducted over six stages. In stage 1, we will collaborate with our service user/family carer lived experience group (LEG) and practitioner stakeholder group (SG), to determine the focus. In stage 2, we will develop initial programme theories for what needs to be done, by whom, how and why, and in what contexts to optimise medication use. In stage 3, we will develop and run searches to identify secondary data to refine our initial programme theories.Stage 4 involves selection and appraisal: documents will be screened by title, abstract/keywords and full text against inclusion and exclusion criteria. In stage 5, relevant data will extracted, recorded and coded. Data will be analysed using a realist logic with input from the LEG and SG. Finally, in stage 6, refined programme theories will be developed, identifying causal explanations for key outcomes and the strategies required to change contexts to trigger the key mechanisms that produce these outcomes.

ETHICS AND DISSEMINATION: Primary data will not be collected, and therefore, ethical approval is not required. MEDIATE will be disseminated via publications, conferences and form the basis for future grant applications.


Original languageEnglish
Article numbere058524
JournalBMJ Open
Issue number1
Publication statusPublished - 24 Jan 2022

Bibliographical note

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the
Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits
others to copy, redistribute, remix, transform and build upon this work for any
purpose, provided the original work is properly cited, a link to the licence is given,
and indication of whether changes were made. See:

Funding: This study/project is funded by the National Institute for Health Research
(NIHR; Programme Development Grant: 203683


  • adult psychiatry
  • qualitative research
  • therapeutics


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