Dialog+

On all areas, the patient is asked to rate how satisfied they are on a 7-point scale that ranges from (1) "totally dissatisfied", to (7) "totally satisfied".

Each DIALOG+ session starts with the patient rating their satisfaction on the DIALOG scale. The intervention is hosted on a device that supports the technology, meaning that the patient is more actively involved in the meeting. In the case of face-to-face delivery, a tablet computer can be used to allow for the device to be passed easily between the patient and the provider to aid discussion. The scores are summarised and can easily be compared on the screen, and, if this is a subsequent visit, be compared to scores provided at earlier visits. This gives a rapid overview of the current problems and strengths in the patient's life. As part of the intervention, providers are encouraged to provide positive feedback on highly rated domains or, at subsequent visits, any domains that have shown improvement over previous sessions. After this, the patient selects up to three areas, depending on time available, for further discussion on areas where more help is needed.

Discussion of the area is facilitated by a four-step approach, based on principles of solution focused therapy. The four step approach includes: (1) Understanding, intended to allow the clinician and the patient to understand the patient's situation by assessing why the rating is the one given and, for example, not lower and discussing what is working, (2) Looking forward, where the patient adopts a future perspective and is encouraged to imagine what changes (best case scenario and smallest improvement) they would like to see to their current situation, (3) Exploring options, consider what practical actions might lead to the desired change, this includes looking at things that the patient, the clinician and others can do, and (4) Agreeing on actions, where the clinician and patient agree specific actions that are documented for review at the next session. These actions can be used to make up a tailored care plan for the individual.

The full DIALOG+ intervention builds on the DIALOG Scale, and is supported by mobile application available on Android and Apple operating systems as well as a Progressive Web Application which can be used on any device that has a web browser. The intervention draws on quality-of-life research, patient-centered communication, and principles of solution-focused therapy. It was developed to ensure that patient-clinician communication effectively facilitates and promotes positive change, and time routinely used is clinically effective.

Using DIALOG Scale data

Each of the 11 items on the DIALOG scale is its own individual subscale, meaning every item is meaningful and can be interpreted, not just the mean score of items. The mean average of the eight quality of life domains items can be used as a global measure of SQOL, and the mean of the three treatment aspects can be used as a treatment satisfaction measure. In terms of evaluating treatment, changes in SQOL over time are usually assessed using a paired score, a baseline score established at intake or at the beginning of any new treatment episode, compared to a score at the end of treatment or at discharge. For longer term treatments, interim scores may be obtained monthly, or six monthly, or as appropriate and determined by the nature and duration of treatment. The DIALOG scale and analytical plan are publicly available for use. Although the scale was designed to be used as a therapeutic intervention by structuring communication, it can also be used to measure outcome data on SQOL and treatment satisfaction, with established psychometric properties. And each item of the scale can be used to evaluate treatment on the level of individuals, groups and services. The DIALOG scale is one of three outcome measures recommended nationally in early intervention in psychosis programmes in the NHS.

Fidelity of delivery of the intervention is assessed using the DIALOG+ Adherence Scale.