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

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 A qualitative investigation of LGBTQ+ young people’s experiences and perceptions of self-managing their mental health

2021 ◽  
Author(s):  
Rosa Town ◽  
Daniel Hayes ◽  
Peter Fonagy ◽  
Emily Stapley
Keyword(s):  
Mental Health ◽  
Young People ◽  
Management Strategies ◽  
Intervention Development ◽  
Community Support ◽  
Self Management ◽  
Future Research ◽  
Youth Groups ◽  
Coping Methods ◽  
Group A

AbstractThere is evidence that young people generally self-manage their mental health using self-care strategies, coping methods and other self-management techniques, which may better meet their needs or be preferable to attending specialist mental health services. LGBTQ+ young people are more likely than their peers to experience a mental health difficulty and may be less likely to draw on specialist support due to fears of discrimination. However, little is known about LGBTQ+ young people’s experiences and perceptions of self-managing their mental health. Using a multimodal qualitative design, 20 LGBTQ+ young people participated in a telephone interview or an online focus group. A semi-structured schedule was employed to address the research questions, which focussed on LGBTQ+ young people’s experiences and perceptions of self-managing their mental health, what they perceived to stop or help them to self-manage and any perceived challenges to self-management specifically relating to being LGBTQ+ . Reflexive thematic analysis yielded three key themes: (1) self-management strategies and process, (2) barriers to self-management and (3) facilitators to self-management. Participants’ most frequently mentioned self-management strategy was ‘speaking to or meeting up with friends or a partner’. Both barriers and facilitators to self-management were identified which participants perceived to relate to LGBTQ+ identity. Social support, LGBTQ+ youth groups and community support were identified as key facilitators to participants’ self-management of their mental health, which merits further investigation in future research. These findings also have important implications for policy and intervention development concerning LGBTQ+ young people’s mental health.

scholarly journals 83 A Medication Self-Management Intervention to Improve Medication Adherence For Older People with Multimorbidity: A Pilot Study

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C Yang ◽  
Z Hui ◽  
S Zhu ◽  
X Wang ◽  
G Tang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Older People ◽  
Intervention Group ◽  
Self Management ◽  
Control Group ◽  
Medication Knowledge ◽  
Management Intervention ◽  
Patient Reported

Abstract Introduction Medication self-management support has been recognised as an essential element in primary health care to promote medication adherence and health outcomes for older people with chronic conditions. A patient-centred intervention empowering patients and supporting medication self-management activities could benefit older people. This pilot study tested a newly developed medication self-management intervention for improving medication adherence among older people with multimorbidity. Method This was a two-arm randomised controlled trial. Older people with multimorbidity were recruited from a community healthcare centre in Changsha, China. Participants were randomly allocated to either a control group receiving usual care (n = 14), or to an intervention group receiving three face-to-face medication self-management sessions and two follow-up phone calls over six weeks, targeting behavioural determinants of adherence from the Information-Motivation-Behavioural skills model (n = 14). Feasibility was assessed through recruitment and retention rates, outcome measures collection, and intervention implementation. Follow-up data were measured at six weeks after baseline using patient-reported outcomes including medication adherence, medication self-management capabilities, treatment experiences, and quality of life. Preliminary effectiveness of the intervention was explored using generalised estimating equations. Results Of the 72 approached participants, 28 (38.89%) were eligible for study participation. In the intervention group, 13 participants (92.86%) completed follow-up and 10 (71.42%) completed all intervention sessions. Ten participants (71.42%) in the control group completed follow-up. The intervention was found to be acceptable by participants and the intervention nurse. Comparing with the control group, participants in the intervention group showed significant improvements in medication adherence (β = 0.26, 95%CI 0.12, 0.40, P < 0.001), medication knowledge (β = 4.43, 95%CI 1.11, 7.75, P = 0.009), and perceived necessity of medications (β = −2.84, 95%CI -5.67, −0.01, P = 0.049) at follow-up. Conclusions The nurse-led medication self-management intervention is feasible and acceptable among older people with multimorbidity. Preliminary results showed that the intervention may improve patients’ medication knowledge and beliefs and thus lead to improved adherence.

scholarly journals Older Adult Peer Specialists’ Role in Reducing Loneliness Among People With Mental Health Conditions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 662-662
Author(s):  
Karen Fortuna ◽  
George Mois ◽  
Jessica Brooks ◽  
Amanda Myers ◽  
Cynthia Bianco
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
Real World ◽  
Smartphone Application ◽  
Interactive Effects ◽  
Health Conditions ◽  
Self Management ◽  
Potential Effectiveness ◽  
Mental Health Conditions ◽  
Management Intervention

Abstract PeerTECH is a peer-delivered and technology-support integrated medical and psychiatric self-management intervention developed by peers. A pre/post trial by our group has shown PeerTECH is associated with statistically significant improvements in self-efficacy for managing chronic disease and psychiatric self-management skills. This presentation will discuss the feasibility and potential effectiveness of using ecological momentary assessments (EMA) with older adults with mental health conditions to allow us to recognize early signs of loneliness and intervene as early as possible in real-world settings. EMA involves repeated sampling of an individual’s behaviors and experiences in real time, real-world environments on the smartphone application. Then, we will discuss the main and interactive effects of loneliness and factors linked to mortality. In conclusion, we will discuss potential effectiveness of PeerTECH with older adults with SMI.

scholarly journals Mapping of modifiable barriers and facilitators of medication adherence in bipolar disorder to the Theoretical Domains Framework: a systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e026980 ◽  
Author(s):  
Asta Ratna Prajapati ◽  
Alexandra Lelia Dima ◽  
Allan B Clark ◽  
Claire Gant ◽  
Chris Gibbons ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Bipolar Disorder ◽  
Medication Adherence ◽  
Mental Health Treatment ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Primary Data ◽  
Cochrane Library ◽  
Long Term Treatment

IntroductionPeople with bipolar disorder require long-term treatment but it is estimated that 40% of these people do not adhere to prescribed medication regimens. Non-adherence increases the risk of relapse, hospitalisation and suicide. Some evidence syntheses report barriers to mental health treatment adherence but rarely delineate between modifiable and non-modifiable barriers. They also fail to distinguish between the patients’ perspective and that of other stakeholders such as clinicians despite of their different understanding and priorities about adherence. Facilitators of adherence, which are also important for informing adherence intervention design, are also lacking from syntheses and few syntheses focus on medications for bipolar disorder.This systematic review aims to identify modifiable barriers and facilitators (determinants) of medication adherence in bipolar disorder. We also plan to report determinants of medication adherence from perspectives of patients, carers, healthcare professionals and other third parties. A unique feature of this systematic review in the context of mental health is the use of the Theoretical Domains Framework (TDF) to organise the literature identified determinants of medication adherence.Methods and analysisThe protocol adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols and ENhancing Transparency in REporting the synthesis of Qualitative research (ENTREQ) guidelines. This review will include both qualitative and quantitative primary studies exploring determinants of medication adherence in bipolar disorder. We will search the following databases using a preplanned strategy: CINAHL, Cochrane Library (CENTRAL), Embase, LiLACS, Medline, PsychINFO, PubMed without date restrictions. We will report the quality of included studies. We will use framework synthesis using the TDF as an a priori ‘framework’. We will map the literature identified modifiable determinants to the domains of TDF.Ethics and disseminationEthical approval is not required as primary data will not be collected. The results will be disseminated through a peer-reviewed publication.PROSPERO registration numberCRD42018096306.

scholarly journals Collaborative care for patients with bipolar disorder: randomised controlled trial

2015 ◽  
Vol 206 (5) ◽  
pp. 393-400 ◽  
Author(s):  
Trijntje Y. G. van der Voort ◽  
Berno van Meijel ◽  
Peter J. J. Goossens ◽  
Adriaan W. Hoogendoorn ◽  
Stasja Draisma ◽  
...  
Keyword(s):  
Mental Health ◽  
Bipolar Disorder ◽  
Depressive Symptoms ◽  
Medication Adherence ◽  
The Netherlands ◽  
Collaborative Care ◽  
Controlled Trial ◽  
Response To Treatment ◽  
Care Programme ◽  
Relevant Effect

BackgroundA substantial number of people with bipolar disorder show a suboptimal response to treatment.AimsTo study the effectiveness of a collaborative care programme on symptoms and medication adherence in patients with bipolar disorder, compared with care as usual.MethodA two-armed, cluster randomised clinical trial was carried out in 16 out-patient mental health clinics in The Netherlands, in which 138 patients were randomised. Patient outcomes included duration and severity of symptoms and medication adherence, and were measured at baseline, 6 months and 12 months. Collaborative care comprised contracting, psychoeducation, problem-solving treatment, systematic relapse prevention and monitoring of outcomes. Mental health nurses functioned as care managers in this programme. The trial was registered with The Netherlands Trial Registry (NTR2600).ResultsCollaborative care had a significant and clinically relevant effect on number of months with depressive symptoms, both at 6 months (z =–2.6, P = 0.01, d = 0.5) and at 12 months (z =–3.1, P = 0.002, d = 0.7), as well as on severity of depressive symptoms at 12 months (z =–2.9, P = 0.004, d = 0.4). There was no effect on symptoms of mania or on treatment adherence.ConclusionsWhen compared with treatment as usual, collaborative care substantially reduced the time participants with bipolar disorder experienced depressive symptoms. Also, depressive symptom severity decreased significantly. As persistent depressive symptoms are difficult to treat and contribute to both disability and impaired quality of life in bipolar disorder, collaborative care may be an important form of treatment for people with this disorder.

Sign in / Sign up

Export Citation Format

Share Document