scholarly journals Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder (Preprint)

10.2196/25810 ◽  
2020 ◽  
Author(s):  
Cynthia A. Dopke ◽  
Alyssa McBride ◽  
Pamela Babington ◽  
Geneva K. Jonathan ◽  
Tania Michaels ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Self Management ◽  
Management Intervention

A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): User Experiences of the Intervention Change Process (Preprint)

2021 ◽  
Author(s):  
Geneva Kay Jonathan ◽  
Cynthia A Dopke ◽  
Tania Michaels ◽  
Clair R Martin ◽  
Chloe Ryan ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Medication Adherence ◽  
Behavior Change ◽  
Intervention Development ◽  
Signs And Symptoms ◽  
Self Management ◽  
Health Technologies ◽  
Management Intervention ◽  
Change Framework

BACKGROUND Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated and mixed mood states. Pharmacological management combined with adjunctive psychotherapy can decrease symptoms, lower relapse rates and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone applications are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. These studies have demonstrated that individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. OBJECTIVE The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. METHODS Individuals with bipolar disorder participated in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement and inductive coding was used to identify themes not captured by this framework. RESULTS In terms of behavioral targets, participants emphasized the importance of managing mood episode related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. In addition, participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends and providers was important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Participants indicated that monitoring facilitated self-awareness and reflection which they felt was valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. CONCLUSIONS In addition to addressing acceptability, satisfaction, and engagement, person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. In this study, participants discussed their perceptions that managing signs and symptoms and maintaining regular routines, sleep duration, and medication adherence were important for staying well and that monitoring played an important role in these efforts. These perceptions aligned with the intervention's primary behavioral targets and use of a monitoring tool as a core intervention feature. However, participants also highlighted how the intervention encouraged involving family and friends in their change efforts. While content addressing building and engaging supports was included in the intervention, this was not a primary intervention target. Participant feedback thus indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. Our findings suggest that using a comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development. CLINICALTRIAL NCT02405117

scholarly journals User Centered Design and Development of LiveWell: A Smartphone Based Self-Management Intervention for Bipolar Disorder (Preprint)

2020 ◽  
Author(s):  
Geneva K Jonathan ◽  
Cynthia A Dopke ◽  
Alyssa McBride ◽  
Pamela Babington ◽  
Tania Michaels ◽  
...  
Keyword(s):  
Social Support ◽  
Bipolar Disorder ◽  
Behavior Change ◽  
Field Trial ◽  
Rating Scale ◽  
Signs And Symptoms ◽  
Self Report ◽  
Self Management ◽  
Evidence Based ◽  
Management Intervention

BACKGROUND Bipolar disorder is a serious mental illness that results in significant morbidity and mortality. A combination of medications and psychotherapy improves outcomes, but accessibility of treatment is limited. Smartphones and other technologies have the potential to increase access to evidence-based strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. OBJECTIVE This study obtained user input to guide the development of LiveWell: a smartphone based self-management intervention for bipolar disorder. METHODS Individuals with bipolar disorder participated in an initial field trial focused on developing a self-report data collection platform followed by design sessions, usability testing, and a second field trial with the goal of developing a bipolar disorder smartphone self-management intervention. Participant feedback was obtained formally via structured interviews and questionnaires as well as informally during the second field trial coaching sessions. Iterative revisions to the application design were made based on participant feedback throughout all phases of development. A qualitative analysis of participants’ personalized anchors for mood, thought, and wellness ratings was utilized to better understand the signs and symptoms that participants identified as important for wellness self-monitoring. Thematic analysis of the second field trial’s exit interviews was used to better understand participants’ experience of the intervention and its delivery. RESULTS Our research team sought participant input to aid in the design and development of a smartphone-based self-management intervention for bipolar disorder. This process led to design revisions and provided insights into what participants valued. In discussing behavior change processes, participants emphasized the importance of managing early warning signs and symptoms and the central role of monitoring and social support in this management. Participants reported that personalizing their wellness rating scale descriptions and their plans for staying well was useful. Interestingly, when participants anchored a wellness rating scale rather than separate mood and thought scales, most anchors were categorized as behaviors. This suggests that a less directed approach may better capture participants’ experiences and needs. While participants found the current level of application personalization beneficial, they also requested more psychoeducational information and personalization. These requests lead to design tensions between individual participant preferences and the delivery of a generally useful evidence-based, self-management intervention for bipolar disorder. CONCLUSIONS This study emphasizes the importance of monitoring, evaluation and adjustment as well as the development of insight as key volitional and motivational factors that encourage behavior change. Participants also indicated that social support from the coach as well as involvement and engagement of family, friends and providers was important in terms of seeking and receiving assistance with behavior maintenance. Finally, personalization of digital mental health self-report tools such as scales, questionnaires and plans may enhance self-reflection practices as well as connection with core intervention content.

scholarly journals Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder (Preprint)

2020 ◽  
Author(s):  
Cynthia A. Dopke ◽  
Alyssa McBride ◽  
Pamela Babington ◽  
Geneva K. Jonathan ◽  
Tania Michaels ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Management Strategies ◽  
Self Management ◽  
Care Providers ◽  
Attrition Rates ◽  
Health Technologies ◽  
Management Intervention ◽  
Training And Supervision ◽  
Human Support

UNSTRUCTURED Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to the common recurrence of episodes, long episode durations, and persistence of inter-episode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, and timing of delivery, as well as the training and supervision for coaching support of the LiveWell technology. This support includes three clearly defined and structured roles that aim to encourage use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention.

scholarly journals User-Centered Development of LiveWell: A Smartphone Based Self-Management Intervention for Bipolar Disorder (Preprint)

10.2196/20424 ◽  
2020 ◽  
Author(s):  
Geneva K Jonathan ◽  
Cynthia A Dopke ◽  
Tania Michaels ◽  
Clair R Martin ◽  
Krina Adhikari ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Self Management ◽  
Management Intervention ◽  
User Centered Development ◽  
User Centered

A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Development of an Expert System to Provide Adaptive User Feedback (Preprint)

2021 ◽  
Author(s):  
Evan H Goulding ◽  
Cynthia A Dopke ◽  
Tania Michaels ◽  
Clair M Martin ◽  
Monika A Khiani ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Expert System ◽  
Clinical Care ◽  
Clinical Status ◽  
Decision Rules ◽  
Signs And Symptoms ◽  
Self Management ◽  
Health Technologies ◽  
Management Intervention

BACKGROUND Bipolar disorder is a severe mental illness that results in significant morbidity and mortality. While pharmacotherapy is the primary treatment, adjunctive psychotherapy can assist individuals with using self-management strategies to improve outcomes. However, access to therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously augmenting care by providing adaptive delivery of content to users as well as provider alerts to facilitate clinical care communication. Unfortunately, while adaptive interventions are being developed and tested to improve care, information describing the components of adaptive interventions is often not published in sufficient detail to facilitate replication and improvement of these interventions. OBJECTIVE To contribute to and support improvement and dissemination of technology-based mental health interventions, this paper provides a detailed description of the expert system for adaptively delivering content and facilitating clinical care communication for LiveWell, a smartphone based self-management intervention for individuals with bipolar disorder. METHODS Information from empirically supported psychotherapies for bipolar disorder, health psychology behavior change theories, and chronic disease self-management models was combined with user-centered design data and psychiatrist feedback to guide the development of the expert system. RESULTS Decision points determining the times at which intervention options are adapted were selected to occur daily and weekly based on daily and weekly self-report check-in data on medication adherence, sleep duration, routine, and wellness levels. This data was selected for use as the tailoring variables determining which intervention options to deliver when and to whom. Decision rules linking delivery of options and tailoring variable values were developed based on existing literature regarding bipolar disorder clinical status states and psychiatrist feedback. To address the need for adaptation of treatment with varying clinical states, decision rules for a clinical status state machine were developed for use with self-reported wellness rating data. Clinical status from this state machine is incorporated into hierarchal decision tables (if-then/elseif-then) that select content for delivery to users and alerts to providers. The majority of the adaptive content addresses sleep duration, medication adherence, managing signs and symptoms, building support, and keeping a regular routine as well as determinants underlying engagement in these target behaviors: attitudes and perceptions, knowledge, support, evaluation, planning. However, when problems with early warning signs, symptoms, and transitions to more acute clinical states are detected, the decision rules shift the adaptive content to focus on managing signs and symptoms and engaging with psychiatric providers. CONCLUSIONS Adaptive mental health technologies have the potential to enhance self-management of mental health disorders. However, the need for individuals with bipolar disorder to engage in the management of multiple target behaviors and to address changes in clinical status highlights the importance of detailed reporting of adaptive intervention components to allow replication and improvement of adaptive mental health technologies for complex mental health problems. CLINICALTRIAL NCT02405117, NCT03088462

Sign in / Sign up

Export Citation Format

Share Document