A Qualitative Study Investigating the Continued Adoption of Breaking Free Online Across a National Substance Misuse Organisation: Theoretical Conceptualisation of Staff Perceptions


There is evidence for the effectiveness of computer-assisted therapies (CAT) in healthcare; however, implementing CAT can be challenging due to new technologies being perceived as ‘disruptive’. This study used normalisation process theory (NPT) to investigate how Breaking Free Online (BFO), a treatment programme for substance misuse, is embedded as normal practice within Crime Reduction Initiatives (CRI), a health and social care charity. Interviews were conducted with CRI staff regarding their perceptions of the normalisation of BFO. Thematic analyses were used and findings structured around NPT. Results suggest that staff understood the benefits of BFO, particularly for those with a dual diagnosis. However, there was some confusion surrounding job roles and difficulties with the availability of resources. Whilst normalisation of BFO is progressing within CRI, there are still some challenges. Clarification of the roles of staff and peer mentors is an area in which further work is being conducted.

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Author information



Corresponding author

Correspondence to Stephanie Dugdale.

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Competing Interests

Mrs Stephanie Dugdale, Dr Sarah Elison, Mr Glyn Davies and Dr Jonathan Ward are all employees of Breaking Free Online where the Breaking Free Online treatment programme has been developed.

Authors’ Contributions

SD developed the interview schedule and conducted all interviews, in addition to analysing the data and drafting the manuscript content. SE advised on data analyses, manuscript contents and editorial amendments. GD and JW provided guidance on manuscript content and advised on amendments and edits. MD provided final editorial amendments prior to the final manuscript submission. All authors read and approved the manuscript before submission.

Appendix A

Appendix A

Staff questions

How did you first hear about Breaking Free Online?

How is Breaking Free Online being implemented in your service?

  • How are service users introduced to it?

  • Who shows them how to use it?

  • What kinds of support are they given when using the programme?

At CRI, what advertisements/actions are you aware of, to increase BFO use amongst clients? What is your opinion of these?

How easy do you find the programme to use/understand?

How do you think we could change/improve the programme?

What is your opinion of online therapies, such as Breaking Free Online, compared to more usual treatments?

Is there a place for Breaking Free Online within CRI? How well does the programme fit into your service and group work?

Do you think there are benefits of peer mentor support when using Breaking Free Online?

Do you feel that Breaking Free Online is an effective therapy for the management of drugs and alcohol and mental health problems?

Can the techniques learnt from Breaking Free Online be transferred to other contexts/other groups within your service?

Did you receive any support when learning to use Breaking Free Online? Were the instructions on the Breaking Free programme self-explanatory?

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Dugdale, S., Elison, S., Davies, G. et al. A Qualitative Study Investigating the Continued Adoption of Breaking Free Online Across a National Substance Misuse Organisation: Theoretical Conceptualisation of Staff Perceptions. J Behav Health Serv Res 44, 89–101 (2017). https://doi.org/10.1007/s11414-016-9512-0

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  • Staff Member
  • Service User
  • Normalisation Process
  • Substance Misuse
  • Normalisation Process Theory