Factors influencing the de-implementation of seclusion and restraint in inpatient mental health settings: a qualitative systematic review protocol

The objective of the review is to consolidate qualitative evidence on the views, experiences, and perspectives of service users and their informal carers, health care providers, managers and decision-makers regarding factors influencing the de-implementation of seclusion and restraint in inpatient mental health settings. Seclusion and restraint, frequently used in mental health settings, are low-value health care interventions associated with numerous negative consequences and lack of therapeutic benefits. Conceptualizing the reduction, substitution, and elimination of these low-value interventions under the lens of de-implementation offers an innovative and promising approach. Qualitative studies exploring the views, experiences, and perspectives of adult mental health service users, their informal carers, health care providers, managers, and decision-makers regarding the de-implementation of seclusion and restraint will be considered for inclusion. Studies conducted in inpatient general mental health settings, excluding subspecialties, will also be considered. This review will follow the JBI methodology for qualitative reviews. The databases to be searched are: CINAHL Complete (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science. Study selection, data extraction, and quality assessment will be conducted independently by 2 authors. Following a meta-aggregation approach, the data synthesis will be guided by the Consolidated Framework for Implementation Research and the Model of Prevention of Seclusion and Restraint Use in Mental Health. Methodological quality will be assessed using the JBI Critical Appraisal Checklist and confidence in the findings will be assessed using ConQual. PROSPERO CRD42024586670.