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.

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

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

Social support and mental health status of internal migrants in Beijing

2020 ◽  
Vol 48 (4) ◽  
pp. 1-16
Author(s):  
Ying Zhou ◽  
Jianhua Wang
Keyword(s):  
Mental Health ◽  
Social Support ◽  
Health Status ◽  
Marital Status ◽  
Rating Scale ◽  
Mental Health Disorder ◽  
Mental Health Status ◽  
Self Report ◽  
Monthly Income ◽  
Internal Migrants

We investigated the mental health status of 320 internal migrants in Beijing according to gender, age, marital status, and monthly income, and examined the relationship between their mental health status and social support mechanisms. Participants completed the self-report Symptom Checklist-90-R and Social Support Rating Scale. Results showed that their mental health was significantly worse than the Chinese adult norm as assessed in 2017. Participants' social support varied according to age, marital status, and monthly income. Female participants younger than 30 years old with a monthly income lower than 3,000 yuan comprised the group with the most mental health disorder symptoms. They thus required greater personal attention to their health. The results suggested that social support can predict mental health among internal migrants. Directions for further research are discussed.

scholarly journals Feasibility of an mHealth self-management intervention for children and adolescents with sickle cell disease and their families

2021 ◽  
Author(s):  
Shannon Phillips ◽  
Julie Kanter ◽  
Martina Mueller ◽  
Amy Gulledge ◽  
Kenneth Ruggiero ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Rating Scale ◽  
Management Strategies ◽  
Self Management ◽  
Cell Disease ◽  
Vessel Occlusion ◽  
Feasibility Assessment ◽  
Management Intervention ◽  
Scale Scores

Abstract Sickle cell disease (SCD) is an inherited hemoglobinopathy that leads to blood vessel occlusion and multiorgan complications, including pain, that may be experienced daily. Symptom management often begins at home, and tools are needed to support self-management strategies that can be implemented by children with SCD and families. The purpose of this study was to assess the feasibility of the mHealth self-management intervention (application) Voice Crisis Alert V2 for children with SCD and families. Feasibility assessment was guided by the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. Data were collected with 60 dyads (children with SCD/caregivers) at four time points. Self-management data were collected via application use, and postintervention interviews were conducted. Analyses included descriptive statistics and constant comparison with directed content analysis. Recruitment was completed in 28 weeks, with 82% retention at end-of-intervention. Mobile Application Rating Scale scores and interview data indicated high satisfaction. From baseline to mid-intervention, 94% of dyads used the application (75% of total use); 45% used the application from mid-intervention to the end-of-intervention. Dyads made 2,384 actions in the application; the most commonly used features were recording health history and recording and tracking symptoms. Few reported issues with the application; most issues occurred early in the study and were corrected. After the intervention period was completed, 37% continued to use the application. Feasibility was confirmed by meeting recruitment and retention goals, high adoption of the application, and high reported satisfaction with the application. Challenges with sustained use were encountered, and areas for improvement were identified.

scholarly journals Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015452 ◽  
Author(s):  
Elaine Toomey ◽  
James Matthews ◽  
Deirdre A Hurley
Keyword(s):  
Low Back Pain ◽  
Mixed Methods ◽  
Qualitative Data ◽  
Self Report ◽  
Self Management ◽  
Low Back ◽  
Complex Behaviour ◽  
Management Intervention ◽  
Direct Observations ◽  
Audio Recordings

Objectives and designDespite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish the fidelity of delivery of a complex self-management intervention and explore the reasons for these findings using a convergent/triangulation design.SettingFeasibility trial of the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) intervention (ISRCTN49875385), delivered in primary care physiotherapy.Methods and outcomes60 SOLAS sessions were delivered across seven sites by nine physiotherapists. Fidelity of delivery of prespecified intervention components was evaluated using (1) audio-recordings (n=60), direct observations (n=24) and self-report checklists (n=60) and (2) individual interviews with physiotherapists (n=9). Quantitatively, fidelity scores were calculated using percentage means and SD of components delivered. Associations between fidelity scores and physiotherapist variables were analysed using Spearman's correlations. Interviews were analysed using thematic analysis to explore potential reasons for fidelity scores. Integration of quantitative and qualitative data occurred at an interpretation level using triangulation.ResultsQuantitatively, fidelity scores were high for all assessment methods; with self-report (92.7%) consistently higher than direct observations (82.7%) or audio-recordings (81.7%). There was significant variation between physiotherapists’ individual scores (69.8% - 100%). Both qualitative and quantitative data (from physiotherapist variables) found that physiotherapists’ knowledge (Spearman's association at p=0.003) and previous experience (p=0.008) were factors that influenced their fidelity. The qualitative data also postulated participant-level (eg, individual needs) and programme-level factors (eg, resources) as additional elements that influenced fidelity.ConclusionThe intervention was delivered with high fidelity. This study contributes to the limited evidence regarding fidelity assessment methods within complex behaviour change interventions. The findings suggest a combination of quantitative methods is suitable for the assessment of fidelity of delivery. A mixed methods approach provided a more insightful understanding of fidelity and its influencing factors.Trial registration numberISRCTN49875385; Pre-results.

scholarly journals The Effects of Gamification and Oral Self-Care on Oral Hygiene in Children: Systematic Search in App Stores and Evaluation of Apps (Preprint)

2019 ◽  
Author(s):  
Nino Fijačko ◽  
Lucija Gosak ◽  
Leona Cilar ◽  
Alenka Novšak ◽  
Ruth Masterson Creber ◽  
...  
Keyword(s):  
Public Health ◽  
Behavior Change ◽  
Oral Hygiene ◽  
Rating Scale ◽  
Self Care ◽  
Public Health Problem ◽  
Mobile App ◽  
Evidence Based ◽  
Behavior Change Techniques ◽  
Evidence Based Dentistry

BACKGROUND Poor oral hygiene is a great public health problem worldwide. Oral health care education is a public health priority as the maintenance of oral hygiene is integral to overall health. Maintaining optimal oral hygiene among children is challenging and can be supported by using relevant motivational approaches. OBJECTIVE The primary aim of this study was to identify mobile smartphone apps that include gamification features focused on motivating children to learn, perform, and maintain optimal oral hygiene. METHODS We searched six online app stores using four search terms (“oral hygiene game,” “oral hygiene gamification,” “oral hygiene brush game,” and “oral hygiene brush gamification”). We identified gamification features, identified whether apps were consistent with evidence-based dentistry, performed a quality appraisal with the Mobile App Rating Scale user version (uMARS), and quantified behavior scores (Behavior Change score, uMARS score, and Coventry, Aberdeen, and London-Refined [CALO-RE] score) using three different instruments that measure behavior change. RESULTS Of 612 potentially relevant apps included in the analysis, 17 met the inclusion criteria. On average, apps included 6.87 (SD 4.18) out of 31 possible gamification features. The most frequently used gamification features were time pressure (16/17, 94%), virtual characters (14/17, 82%), and fantasy (13/17, 76%). The most common oral hygiene evidence-based recommendation was brushing time (2-3 minutes), which was identified in 94% (16/17) of apps. The overall mean uMARS score for app quality was high (4.30, SD 0.36), with good mean subjective quality (3.79, SD 0.71) and perceived impact (3.58, SD 0.44). Sufficient behavior change techniques based on three taxonomies were detected in each app. CONCLUSIONS The majority of the analyzed oral hygiene apps included gamification features and behavior change techniques to perform and maintain oral hygiene in children. Overall, the apps contained some educational content consistent with evidence-based dentistry and high-quality background for oral self-care in children; however, there is scope for improvement.

Evidence-Based Implementation Process for the Development of an Assistive Technology Self-Management Intervention

2017 ◽  
Vol 71 (4_Supplement_1) ◽  
pp. 7111515258p1
Author(s):  
Elsa Orellano ◽  
Salim Pérez ◽  
Mailin Aquino ◽  
Andrea García ◽  
Jomaly Guilbe ◽  
...  
Keyword(s):  
Assistive Technology ◽  
Implementation Process ◽  
Self Management ◽  
Evidence Based ◽  
Management Intervention

scholarly journals Applying a Biopsychosocial Perspective to Investigate Factors Related to Emotional Adjustment and Quality of Life for Individuals With Brain Tumour

2010 ◽  
Vol 11 (3) ◽  
pp. 270-280 ◽  
Author(s):  
Tamara Ownsworth ◽  
Anna L. Hawkes ◽  
Suzanne Chambers ◽  
David G. Walker ◽  
David Shum
Keyword(s):  
Social Support ◽  
Brain Tumour ◽  
Rating Scale ◽  
Emotional Adjustment ◽  
Self Report ◽  
Depression Anxiety Stress Scale ◽  
Biopsychosocial Perspective ◽  
And Coping ◽  
Patient Competency

AbstractObjective:This exploratory study applied a biopsychosocial perspective to investigate cognitive and psychosocial factors related to emotional adjustment and QoL after brain tumour.Methods:Participants included 30 adults with a brain tumour (60% benign and 40% malignant) who were aged 28 to 71 years (M= 51.5,SD= 12.3) and on average 5.4 years post-diagnosis (SD= 5.6 years). Participants completed a brief battery of cognitive tests and self-report measures of emotional status (Depression, Anxiety Stress Scale), subjective impairment (Patient Competency Rating Scale), coping (COPE), social support (Brief Social Support Questionnaire), and QoL (Functional Assessment of Cancer Therapy — Brain Tumour [FACT-Br]).Results:QoL was significantly associated with global cognitive ability (r= .49,p< .01), subjective impairment (r= .66,p< .01), and satisfaction with support (r= .50,p< .05). Level of depressive symptoms was significantly correlated with premorbid IQ (r= -.49,p< .01), use of planning to cope (r= -.48,p< .01), and satisfaction with support (r= -.47,p< .01).Conclusions:Overall, these exploratory findings indicate that emotional adjustment and QoL after brain tumour is related to a slightly different pattern of neuropsychological, psychological (self-perceptions and coping) and social factors. The clinical implications for interventions with individuals with brain tumour are discussed.

Sign in / Sign up

Export Citation Format

Share Document