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  • Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation

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Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): a qualitative process evaluation
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  • Published on: 24 April 2017
    Authors' reply to Dr Sandeep Reddy

    Dear Dr Reddy

    Thank you for your letter expressing your “astonishment” at the title and methods of our paper “Cost and outcome of behavioural activation versus cognitive behavioural therapy for depression (COBRA): A qualitative process evaluation”, BMJ Open 2017;7:e014161. Whilst we welcome your comments, we respond by pointing to the Medical Research Council (MRC)’s guidelines for developing and evaluating complex interventions, which state that a process evaluation assists in: understanding how context influences outcome, identifying problems with implementation and providing insights to aid implementation, understanding how an intervention can be optimised, clarifying causal mechanisms, and identifying contextual factors associated with variation in outcomes.[1] In addition, the MRC’s subsequent guidance for the process evaluation of complex interventions recommends the use of qualitative methods to understand experiences of the intervention and unanticipated or complex causal pathways.[2]

    Whilst you are quite correct that our paper did not report the full process evaluation in the comprehensive manner you describe, our qualitative study did indeed provide insights, from patients’ perspectives, on personal, contextual and therapeutic factors that facilitated or hindered the therapeutic process, as well as reporting the mechanisms by which patients believed BA and CBT to have brought about positive change in symptoms of depression and other domains of life...

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    Conflict of Interest:
    All authors report grants from the National Institute
    for Health Research (NIHR) during the course of the
    COBRA study. DAR reports grants from the
    European Science Foundation, funding support from NIHR Collaborations for Leadership in Applied Health Research and Care,
    and NIHR panel membership.
  • Published on: 21 April 2017
    Process Evaluation: Unlikely

    Dear Editors and Authors,

    I am astonished the article and the methodology are titled as a 'process evaluation'? None of what the article describe's in its methodology lends itself to a process evaluation framework. A proper evaluation process involves assessment of the program objectives and how the program activities are tracking towards the objectives. In addition, sophisticated versions of process evaluation assess the theory behind the implementation and if the participants are receiving the benefits stated in the objectives. From what I read in the article, there isn't any of this nor a program logic: textual or illustrated. It is a really poor form to have titled this article as a program evaluation, while it is nothing but a qualitative data collection.

    Sincerely yours,
    Dr Sandeep Reddy

    Conflict of Interest:
    None declared.