# Process evaluation of the BASIL+ trial: A behavioural activation approach to addressing low mood and depression among older people with long-term conditions

## TL;DR

The BASIL+ trial evaluated a behavioral activation intervention to reduce depression and loneliness in older adults with long-term conditions during the pandemic.

## Contribution

The study introduces a flexible, telephone-based behavioral activation approach tailored for older adults during social isolation.

## Key findings

- The intervention fostered self-awareness and improved mood among participants.
- Support workers played a crucial role in guiding and supporting participants through the process.
- The collaborative care model provided holistic support, enhancing both mental and physical well-being.

## Abstract

Older adults are at risk of low mood and depression, which can be exacerbated by long-term physical health conditions, leading to poorer health outcomes and increased mortality. The restrictions on social mixing during the COVID-19 pandemic heightened these risks. BASIL+ (Behavioural Activation in Social IsoLation) was a pragmatic randomised controlled trial conducted with patients recruited from general practices in England and Wales. It was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. A behavioural activation intervention, within a collaborative care framework, was delivered by telephone. Participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. A qualitative process evaluation (conducted within the BASIL+ trial), used one-to-one semi-structured interviews to explore the experiences of trial participants, caregivers and BASIL Support Worker experiences. Three main themes emerged from the data analysis: 1) Engagement Dynamic: from Altruism to Self-Realisation; 2) Changing Behaviour and Improving Mood; and 3) Synergistic Nature of the Intervention Components. Findings suggest that the intervention effectively fostered self-awareness among older adults, giving them the confidence and skills to address low mood. Participant engagement with intervention materials varied, highlighting the importance of flexibility in delivery. BASIL+ Support Workers acted as key facilitators, guiding participants through the intervention process, fostering understanding, and providing crucial support. The collaborative care element ensured participants received comprehensive and holistic support, promoting improved mental and physical well-being. These findings underscore the adaptability and flexibility of the BASIL+ intervention, demonstrating its potential to address mental and physical health problems among individuals with varying needs and different starting points. The BASIL+ trial is registered with the ISRCTN registry (ISRCTN63034289).