A qualitative study of stakeholder views on the use of a digital app for supported self-management in early intervention services for psychosis

Abstract Background Digital tools such as Smartphones have the potential to increase access to mental health support including self-management interventions for individuals with psychosis, and ultimately to improve outcomes. Self-management strategies, including relapse prevention and crisis planning and setting personal recovery goals, are intended to assist people with long-term conditions to take an active role in their recovery, with evidence for a range of benefits. However, their implementation is inconsistent, and access and uptake need to be improved. The current study explores the acceptability of a Smartphone app (My Journey 3) that has been developed to facilitate supported self-management in Early Intervention in Psychosis (EIP) services. Methods Semi-structured one-to-one interviews were conducted with twenty-one EIP service users who had access to My Journey 3 as part of a feasibility trial, and with thirteen EIP service clinicians who were supporting service users with the app. Interviews focused on the acceptability and usability of My Journey 3. Data was coded to themes based on the Acceptability of Healthcare Interventions framework. Results Many service user participants found My Journey 3 to be acceptable. The symptom and medication trackers in particular were described as helpful. A smaller number of service users disliked the intervention. Individual-level factors that appeared to influence acceptability and engagement included recovery stage and symptom severity. Clinicians tended to report that My Journey 3 was a potentially positive addition to service users’ care, but they often felt unable to provide support due to competing demands in their work, which in turn may have impacted acceptability and usage of the app. Conclusions Our findings suggest that the app is perceived as having potential to improve users’ capacity to self-manage and work towards recovery goals, but barriers prevented many clinicians providing consistent and effective support as intended. Further evaluation of supported self-management apps in psychosis is warranted but needs to address implementation challenges from the start.

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Patients’, carers’ and providers’ experiences and requirements for support in self-management of multiple sclerosis: a qualitative study

European Journal for Person Centered Healthcare ◽

10.5750/ejpch.v1i2.687 ◽

2013 ◽

Vol 1 (2) ◽

pp. 457 ◽

Cited By ~ 11

Author(s):

Francesca Deibel ◽

Michelle Edwards ◽

Adrian Edwards

Keyword(s):

Multiple Sclerosis ◽

Qualitative Study ◽

Focus Groups ◽

Management Strategies ◽

Strong Relationship ◽

Information Provision ◽

Self Management ◽

Management Skills ◽

Long Term Conditions ◽

Management Interventions

Background: Self-management is a process increasingly promoted for the management of long term conditions, both for ethical reasons of enhancing autonomy and for likely cost-effectiveness, but the nature and scope of self-management strategies are currently highly variable.Objective: To identify patients’, carers’ and clinicians’ current experiences of self-management in multiple sclerosis (MS) and their recommendations for the development of a future MS-specific self-management interventionMethods: Qualitative study using focus groups and semi-structured one-to-one interviews with a purposive sample. Three focus groups were held with 25 patients with moderate to advanced multiple sclerosis and 4 carers. Ten clinicians were interviewed. Data underwent thematic analysis.Results: Participants perceived multiple aspects of MS to be amenable to self-management, but identified a current lack of service provision to support their abilities to self-manage. Participants felt that to address both the physical and psychosocial challenges posed by MS required better information provision, a strong relationship with healthcare professionals and a toolkit of self-management skills. Participants expressed concern at the lack of consideration currently given to carers, which should be addressed in future provision.Conclusion: The diverse experiences of patients living with MS warrant a multidisciplinary, flexible and proactive approach to improve their self-management capabilities, acknowledging both patients’ and carers’ unmet needs. The findings can be used to guide the development of future self-management interventions specific to individuals with multiple sclerosis.

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Effectiveness of self-management interventions in inflammatory arthritis: a systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

RMD Open ◽

10.1136/rmdopen-2021-001647 ◽

2021 ◽

Vol 7 (2) ◽

pp. e001647

Author(s):

Andréa Marques ◽

Eduardo Santos ◽

Elena Nikiphorou ◽

Ailsa Bosworth ◽

Loreto Carmona

Keyword(s):

Systematic Review ◽

Full Text ◽

Inflammatory Arthritis ◽

Data Extraction ◽

Management Strategies ◽

Psychosocial Interventions ◽

Behavioural Therapy ◽

Self Management ◽

Cochrane Library ◽

Management Interventions

ObjectiveTo perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA).MethodsThe SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation.ResultsFrom a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive–behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes.ConclusionsThe findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.

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Theoretical and contextual considerations for self-management strategies of children and adolescents with chronic diseases: An integrative review

Journal of Child Health Care ◽

10.1177/13674935211013697 ◽

2021 ◽

pp. 136749352110136

Author(s):

Logan J Camp-Spivey ◽

Ayaba Logan ◽

Michelle Nichols

Keyword(s):

Children And Adolescents ◽

Chronic Diseases ◽

Management Strategies ◽

Healthcare Providers ◽

Integrative Review ◽

Self Management ◽

Intervention Delivery ◽

Management Interventions ◽

Technological Platforms ◽

Management Behaviors

The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl’s methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.

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Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review

Arthritis ◽

10.1155/2018/2496190 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Shabana Amanda Ali ◽

Kristina M. Kokorelias ◽

Joy C. MacDermid ◽

Marita Kloseck

Keyword(s):

Social Support ◽

Health Care ◽

Scoping Review ◽

Health Care Professionals ◽

Management Strategies ◽

Self Management ◽

Cochrane Library ◽

Group Settings ◽

Management Interventions ◽

Positive Social Interaction

Systematic reviews of self-management programs for osteoarthritis suggest minimal evidence of benefit and indicate substantial heterogeneity in interventions. The purpose of this scoping review was to describe the nature of self-management interventions provided to patients with osteoarthritis focusing on the inclusion and type of education and social support components. We searched PsycINFO, EMBASE, MEDLINE, and Cochrane Library databases from 1990 to 2016 to identify studies addressing community-based management strategies for osteoarthritis that included aspects of disease-specific education and ongoing social support. Results are presented as a narrative synthesis to facilitate integration of diverse evidence. Data were extracted from 23 studies that met our inclusion and exclusion criteria, describing complex, multicomponent interventions for osteoarthritis. All studies included education components, and 18 of these were osteoarthritis-specific. Social support was most often offered through peers and health care professionals, but also through exercise trainers/instructors and researchers, and lasted between 5 and 52 weeks. We charted positive social interaction offered by peers in group settings and emotional/informational support offered by health care professionals. Overall, descriptions of self-management provided limited documentation of the rationale or content of the programs. This suggests that more precise definitions of the theoretical underpinnings, components, and mechanisms would be useful for greater insight into best practices for osteoarthritis self-management programs.

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Living Well With a Long-Term Condition

Qualitative Health Research ◽

10.1177/1049732316628834 ◽

2016 ◽

Vol 27 (4) ◽

pp. 547-558 ◽

Cited By ~ 7

Author(s):

Nicola Stenberg ◽

Penny J. Furness

Keyword(s):

Social Connectedness ◽

Holistic Approach ◽

Self Management ◽

Theoretical Understanding ◽

Long Term Conditions ◽

Term Condition ◽

Living Well ◽

The North ◽

Management Interventions

The outcomes of self-management interventions are commonly assessed using quantitative measurement tools, and few studies ask people with long-term conditions to explain, in their own words, what aspects of the intervention they valued. In this Grounded Theory study, a Health Trainers service in the north of England was evaluated based on interviews with eight service-users. Open, focused, and theoretical coding led to the development of a preliminary model explaining participants’ experiences and perceived impact of the service. The model reflects the findings that living well with a long-term condition encompassed social connectedness, changed identities, acceptance, and self-care. Health trainers performed four related roles that were perceived to contribute to these outcomes: conceptualizer, connector, coach, and champion. The evaluation contributes a grounded theoretical understanding of a personalized self-management intervention that emphasizes the benefits of a holistic approach to enable cognitive, behavioral, emotional, and social adjustments.

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Treating Illness Distress in Chronic Illness

European Psychologist ◽

10.1027/1016-9040/a000352 ◽

2019 ◽

Vol 24 (1) ◽

pp. 26-37 ◽

Cited By ~ 6

Author(s):

Joanna L. Hudson ◽

Rona Moss-Morris

Keyword(s):

Mental Health ◽

Mental Health Disorders ◽

Cognitive Behavioral ◽

Self Management ◽

Depression And Anxiety ◽

Long Term Conditions ◽

Management Interventions ◽

Health Disorders ◽

Behavioral Mechanisms ◽

The Impact

Abstract. Cognitive-behavioral therapy (CBT) is an evidence-based treatment for depression and anxiety recommended for those with and without physical long-term conditions (LTCs). However, the cognitive-behavioral mechanisms targeted in CBT protocols are based on empirical cognitive-behavioral models of depression and anxiety. In these models, emotions are conceptualized as primary mental health disorders rather than a reaction to the challenges of living with a LTC commonly referred to as illness distress. This raises important clinical questions with theoretical implications. These include: Is the experience of illness distress conceptually distinct from primary mental health diagnoses of anxiety and mood disorder? Are there unique cognitive-behavioral mechanisms related to illness self-management, which should be incorporated into CBT for illness distress? How can illness self-management interventions be embedded within existing CBT protocols for depression and anxiety? To address these questions, we distinguish between primary mental health disorders and illness distress conceptually and explore the impact of this on tailored treatment planning and engagement. Second, we review how health psychology theoretical models can help to inform modifications of existing cognitive-behavioral treatments for anxiety and depression to better support the needs of individuals experiencing illness distress. Third, we provide examples of how to embed processes important for illness self-management including, illness cognitions and adherence, alongside existing CBT techniques. The mechanisms and intervention techniques discussed may help to inform the development of integrated CBT treatments for illness distress for future hypothesis testing in comparative effectiveness trials.

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Implementation and Outcomes of Lay Health Worker–Led Self-Management Interventions for Long-Term Conditions and Prevention: A Systematic Review

Health Education & Behavior ◽

10.1177/1090198119863842 ◽

2019 ◽

Vol 46 (6) ◽

pp. 1045-1072 ◽

Cited By ~ 1

Author(s):

Mari Punna ◽

Tarja Kettunen ◽

Anne-Marie Bagnall ◽

Kirsti Kasila

Keyword(s):

Physical Activity ◽

Cardiovascular Diseases ◽

Behavior Change ◽

Health Worker ◽

Self Management ◽

Long Term Conditions ◽

Lay Health Worker ◽

Management Interventions ◽

Nutrition Behavior

The aim of this study was to systematically review lay health worker (LHW)–led self-management interventions for adults with long-term conditions to see how the interventions have been implemented and to compose a synthesis of research findings, taking into consideration the intervention components that have been applied. We conducted systematic searches for articles published between January 2010 and December 2015 in five databases: Cochrane, MEDLINE, CINAHL, PsycINFO, and Web of Science. Forty original studies were found that met the inclusion criteria: self-management with diabetes ( n = 29), cardiovascular diseases ( n = 8), and those at risk of cardiovascular diseases ( n = 3). These consisted of 22 randomized controlled trials and 18 other trials, with durations of 1 day to 24 months. The findings showed that the training of LHWs and the implementation of interventions varied widely. A synthesis of the implementation methods covers the background of the LHWs and the interventions as well as the components applied in each. Eight interventions had effects on physical activity and eight on nutrition behavior. The review also includes preliminary findings on intervention components effective in improving physical activity and nutrition behavior, including self-monitoring as a behavior change technique and group meetings as an intervention format. The same components and behavior change techniques were applied in effective and noneffective interventions. The review found that LHW-led interventions have potential in promoting self-management in long-term condition. In the future, a qualified and evidence-based structure for LHW-led interventions is suggested in order to improve the systematization of interventions and their effects.

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Carers' and service users' experiences of early intervention in psychosis services: implications for care partnerships

Early Intervention in Psychiatry ◽

10.1111/eip.12309 ◽

2016 ◽

Vol 12 (3) ◽

pp. 410-416 ◽

Cited By ~ 8

Author(s):

Jon Allard ◽

Susan Lancaster ◽

Sara Clayton ◽

Tim Amos ◽

Max Birchwood

Keyword(s):

Early Intervention ◽

Service Users ◽

Early Intervention In Psychosis

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Exploring the impact of peer support in early intervention in psychosis

Mental Health and Social Inclusion ◽

10.1108/mhsi-12-2016-0036 ◽

2017 ◽

Vol 21 (2) ◽

pp. 102-109

Author(s):

Hannah White ◽

Laura Price ◽

Tom Barker

Keyword(s):

Early Intervention ◽

Peer Support ◽

Qualitative Methodology ◽

Service Providers ◽

Service Users ◽

Content Type ◽

Service Engagement ◽

Mental Health Settings ◽

Early Intervention In Psychosis ◽

The Impact

Purpose Peer support (PS) has, over recent years, been implemented across a variety of NHS adult mental health settings. In November 2015, peer support workers (PSW) were introduced to an Early Intervention in Psychosis Service (EIS) in the Midlands. The purpose of this paper is to focus on organisational factors, asking how do PS impact on an early intervention in psychosis multi-disciplinary team (MDT). Design/methodology/approach Six EIS MDT members participated in an hour-long focus group. The data were analysed using thematic analysis, in line with a qualitative methodology (Braun and Clarke, 2006). Findings Two themes were generated, including “The values of PS” (consisting of three sub-themes: improving service engagement; personal qualities; and the peer relationship); and “The peer support role” (consisting of three sub-themes: living experience; boundaries; and alternative perspectives). Findings imply that PS in the current EIS related to: improved service engagement and greater understanding between service providers and users; which could be linked to better outcomes for service users (such as reduced duration of untreated psychosis (DUP)). Originality/value It has been suggested that PSWs facilitate an improved understanding between service providers and service users (Repper and Watson, 2012). However, research into organisational and team benefits of PS is lacking, with a need for more exploration (Repper, 2013). The current study begins to address the lack of literature regarding the organisational impact of PS, and even further regarding early intervention.

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