Top

Published in:

Open Access 01-12-2021 | Research

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

Authors: Thomas Steare, Maria Giorgalli, Katherine Free, Jasmine Harju-Seppänen, Syeda Akther, Michelle Eskinazi, Puffin O’Hanlon, Helen Rostill, Sarah Amani, Brynmor Lloyd-Evans, David Osborn, Sonia Johnson

Published in: BMC Psychiatry | Issue 1/2021

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.

Taskforce Mental Health. The Five Year Forward View For Mental Health. London: The Mental Health Taskforce; 2016.

Torous J, Woodyatt J, Keshavan M, Tully LM. A new hope for early psychosis care: the evolving landscape of digital care tools. Br J Psychiatry. 2019;214(5):269–72. https://doi.org/10.1192/bjp.2019.8.CrossRefPubMedPubMedCentral

Aref-Adib G, McCloud T, Ross J, O’Hanlon P, Appleton V, Rowe S, et al. Factors affecting implementation of digital health interventions for people with psychosis or bipolar disorder, and their family and friends: a systematic review. Lancet Psychiatry. 2019;6(3):257–66. https://doi.org/10.1016/S2215-0366(18)30302-X.CrossRefPubMed

Bucci S, Morris R, Berry K, Berry N, Haddock G, Barrowclough C, et al. Early psychosis service user views on digital technology: qualitative analysis. JMIR Ment Heal. 2018;5(4):e10091. https://doi.org/10.2196/10091.CrossRef

Gay K, Torous J, Joseph A, Pandya A, Duckworth K. Digital technology use among individuals with schizophrenia: results of an online survey. JMIR Ment Heal. 2016;3(2):e15. https://doi.org/10.2196/mental.5379.CrossRef

Van Der Krieke L, Wunderink L, Emerencia AC, De Jonge P, Sytema S. E-mental health self-management for psychotic disorders: state of the art and future perspectives. Psychiatr Serv. 2014;65(1):33–49. https://doi.org/10.1176/appi.ps.201300050.CrossRefPubMed

Bonet L, Izquierdo C, Escartí MJ, Sancho JV, Arce D, Blanquer I, et al. Use of mobile technologies in patients with psychosis: A systematic review. Rev Psiquiatr y Salud Ment (English Ed). 2017;10(3):168–78.

Mueser KT, Corrigan PW, Hilton DW, Tanzman B, Schaub A, Gingerich S, et al. Illness Management and Recovery: A Review of the Research. Focus. 2002;2:34–47.CrossRef

Lean M, Fornells-Ambrojo M, Milton A, Lloyd-Evans B, Harrison-Stewart B, Yesufu-Udechuku A, et al. Self-management interventions for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry. 2019;214(5):260–8. https://doi.org/10.1192/bjp.2019.54.CrossRefPubMedPubMedCentral

10.

Zou H, Li Z, Nolan MT, Arthur D, Wang H, Hu L. Self-management education interventions for persons with schizophrenia: a meta-analysis. Int J Ment Health Nurs. 2013;22(3):256–71. https://doi.org/10.1111/j.1447-0349.2012.00863.x.CrossRefPubMed

11.

Ben-Zeev D, Kaiser SM, Brenner CJ, Begale M, Duffecy J, Mohr DC. Development and usability testing of FOCUS: a smartphone system for self-management of schizophrenia. Psychiatr Rehabil J. 2013;36(4):289–96. https://doi.org/10.1037/prj0000019.CrossRefPubMedPubMedCentral

12.

Bucci S, Barrowclough C, Ainsworth J, Machin M, Morris R, Berry K, et al. Actissist: proof-of-concept trial of a theory-driven digital intervention for psychosis. Schizophr Bull. 2018;44(5):1070–80. https://doi.org/10.1093/schbul/sby032.CrossRefPubMedPubMedCentral

13.

O’Hanlon P, Aref-Adib G, Fonseca A, Lloyd-Evans B, Osborn D, Johnson S. Tomorrow’s world: current developments in the therapeutic use of technology for psychosis. BJPsych Adv. 2016;22(5):301–10. https://doi.org/10.1192/apt.bp.115.014654.CrossRef

14.

Chivilgina O, Wangmo T, Elger BS, Heinrich T, Jotterand F. mHealth for schizophrenia spectrum disorders management: a systematic review. Int J Soc Psychiat. 2020;66(7):642–65. https://doi.org/10.1177/0020764020933287.CrossRefPubMed

15.

Steare T, O’Hanlon P, Eskinazi M, Osborn D, Lloyd-Evans B, Jones R, et al. Smartphone-delivered self-management for first-episode psychosis: the ARIES feasibility randomised controlled trial. BMJ Open. 2020;10(8):e034927. https://doi.org/10.1136/bmjopen-2019-034927.CrossRefPubMedPubMedCentral

16.

Lewis S, Ainsworth J, Sanders C, Stockton-Powdrell C, Machin M, Whelan P, et al. Smartphone-enhanced symptom management in psychosis: open, Randomized Controlled Trial. JMIR. 2020;22(8):e17019. https://doi.org/10.2196/17019.CrossRefPubMedPubMedCentral

17.

Gumley A, Bradstreet S, Ainsworth J, Allan S, Alvarez-Jimenez M, Beattie L, et al. Early signs monitoring to prevent relapse in psychosis and promote well-being, engagement, and recovery: protocol for a feasibility cluster randomized controlled trial harnessing Mobile phone technology blended with peer support. JMIR Res Protoc. 2020;9(1):e15058. https://doi.org/10.2196/15058.CrossRefPubMedPubMedCentral

18.

Torous J, Michalak EE, O’Brien HL. Digital Health and Engagement—Looking Behind the Measures and Methods. JAMA Netw Open. 2020;3(7):e2010918.CrossRef

19.

Sekhon M, Cartwright M, Francis JJ. Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework. BMC Health Serv Res. 2017;17(1):1–13.CrossRef

20.

Berry N, Lobban F, Emsley DPR, Bucci S. Acceptability of interventions delivered online and through mobile phones for people who experience severe mental health problems: a systematic review. J Med Internet Res. 2016;18(5):e21.

21.

Killikelly C, He Z, Reeder C, Wykes T. Improving adherence to web-based and Mobile Technologies for People with Psychosis: systematic review of new potential predictors of adherence. JMIR mHealth uHealth. 2017;5(7):e94. https://doi.org/10.2196/mhealth.7088.CrossRefPubMedPubMedCentral

22.

Steare T, O’Hanlon P, Eskinazi M, Osborn D, Lloyd-Evans B, Jones R, et al. App to support Recovery in Early Intervention Services (ARIES) study: protocol of a feasibility randomised controlled trial of a self-management Smartphone application for psychosis. BMJ Open. 2019;9:e025823.

23.

Perkins R, Rinaldi M. Taking back control: a guide to planning your own recovery. South West London: St George’s Mental Health NHS Trust; 2007.

24.

Plaistow J, Birchwood M. Back in the saddle: a guide to relapse prevention. In: Birchwood M, Fowler D, Jackson C, editors. Early intervention in psychosis: a guide to concepts, Evidence and Interventions. Chichester: McGraw-Hill; 1996. p. 239–44.

25.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa.CrossRef

26.

Eisner E, Drake RJ, Berry N, Barrowclough C, Emsley R, Machin M, et al. Development and long-term acceptability of EXPRESS, a mobile phone app to monitor basic symptoms and early signs of psychosis relapse. JMIR mHealth uHealth. 2019;7(3):e11568.

27.

Berry N, Lobban F, Bucci S. A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems. BMC Psychiatry. 2019;19(1):1–3.CrossRef

28.

Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, et al. Barriers to and facilitators of user engagement with digital mental health interventions: systematic review. JMIR. 2021;23(3):e24387. https://doi.org/10.2196/24387.CrossRefPubMedPubMedCentral

29.

Palmier-Claus JE, Rogers A, Ainsworth J, Machin M, Barrowclough C, Laverty L, et al. Integrating mobile-phone based assessment for psychosis into people’s everyday lives and clinical care: a qualitative study. BMC Psychiatry. 2013;13(1):34. https://doi.org/10.1186/1471-244X-13-34.CrossRefPubMedPubMedCentral

30.

Hatch A, Hoffman JE, Ross R, Docherty JP. Expert consensus survey on digital health tools for patients with serious mental illness: optimizing for user characteristics and user support. J Med Internet Res. 2018;20(6):e46.

31.

Villagonzalo KA, Arnold C, Farhall J, Rossell SL, Foley F, Thomas N. Predictors of overall and mental health-related internet use in adults with psychosis. Psychiatry Res. 2019;278(May):12–8. https://doi.org/10.1016/j.psychres.2019.05.034.CrossRefPubMed

32.

Jonathan G, Carpenter-Song EA, Brian RM, Ben-Zeev D. Life with FOCUS: a qualitative evaluation of the impact of a smartphone intervention on people with serious mental illness. Psychiatr Rehabil J. 2019;42(2):182–9. https://doi.org/10.1037/prj0000337.CrossRefPubMed

33.

Robbins R, Krebs P, Jagannathan R, Jean-Louis G, Duncan DT. Health app use among US Mobile phone users: analysis of trends by chronic disease status. JMIR mHealth uHealth. 2017;5(12):e197. https://doi.org/10.2196/mhealth.7832.CrossRefPubMedPubMedCentral

34.

Mueser KT, Meyer PS, Penn DL, Clancy R, Clancy DM, Salyers MP. The illness management and recovery program: rationale, development, and preliminary findings. Schizophr Bull. 2006;32(SUPPL.1):32–43.CrossRef

35.

Leamy M, Clarke E, Le Boutillier C, Bird V, Janosik M, Sabas K, et al. Implementing a complex intervention to support personal recovery: a qualitative study nested within a cluster randomised controlled trial. PLoS One. 2014;9(5):1–10.CrossRef

36.

National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management. 2014. Avaliable from: https://www.nice.org.uk/guidance/cg178. Accessed 14 Jun 2021.

37.

Bucci S, Berry N, Morris R, Berry K, Haddock G, Lewis S, et al. “They are not hard-to-reach clients. We have just got hard-to-reach services.” Staff views of digital health tools in specialist mental health services. Front Psychiatry. 2019;10(MAY):1–14.

38.

Granja C, Janssen W, Johansen MA. Factors determining the success and failure of ehealth interventions: systematic review of the literature. J Med Internet Res. 2018;20(5):1–21.CrossRef

39.

Stevens WJM, van der Sande R, Beijer LJ, Gerritsen MGM, Assendelft WJJ. EHealth apps replacing or complementing health care contacts: scoping review on adverse effects. J Med Internet Res. 2019;21(3):e10736.

40.

Berry N, Bucci S, Lobban F. Use of the internet and mobile phones for self-management of severe mental health problems: qualitative study of staff views. JMIR Ment Heal. 2017;4(4):e52. https://doi.org/10.2196/mental.8311.CrossRef

41.

Allan S, Bradstreet S, Mcleod H, Farhall J, Lambrou M, Gleeson J, et al. EMPOWER Group. Developing a hypothetical implementation framework of expectations for monitoring early signs of psychosis relapse using a mobile app: qualitative study. JMIR. 2019;21(10):e14366.PubMedPubMedCentral

42.

Craig TK, Rus-Calafell M, Ward T, Leff JP, Huckvale M, Howarth E, et al. AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. Lancet Psychiat. 2018;5(1):31–40. https://doi.org/10.1016/S2215-0366(17)30427-3.CrossRef

43.

Schueller SM, Torous J. Scaling evidence-based treatments through digital mental health. Am Psychol. 2020;75(8):1093–104. https://doi.org/10.1037/amp0000654.CrossRefPubMed

44.

Weisel KK, Fuhrmann LM, Berking M, Baumeister H, Cuijpers P, Ebert DD. Standalone smartphone apps for mental health—a systematic review and meta-analysis. npj Digit Med. 2019;2(1):1–10. https://doi.org/10.1038/s41746-019-0188-8.CrossRef

45.

Williams A, Farhall J, Fossey E, Thomas N. Internet-based interventions to support recovery and self-management: a scoping review of their use by mental health service users and providers together. BMC Psychiatry. 2019;19(1):1–16.CrossRef

46.

Lee K, Bejerano IL, Han M, Choi HS. Willingness to use smartphone apps for lifestyle management among patients with schizophrenia. Arch Psychiatr Nurs. 2019;33(4):329–36. https://doi.org/10.1016/j.apnu.2019.01.002.CrossRefPubMed

Title: A qualitative study of stakeholder views on the use of a digital app for supported self-management in early intervention services for psychosis
Authors: Thomas Steare
Maria Giorgalli
Katherine Free
Jasmine Harju-Seppänen
Syeda Akther
Michelle Eskinazi
Puffin O’Hanlon
Helen Rostill
Sarah Amani
Brynmor Lloyd-Evans
David Osborn
Sonia Johnson
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03317-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Goal management training for adults with ADHD – clients’ experiences with a group-based intervention

Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

Association of treatment procedures and resilience to symptom load three-years later in a clinical sample of adolescent psychiatric patients

Association between depression and antibiotic use: analysis of population-based National Health Insurance claims data

Increased occurrence of PTSD symptoms in adolescents with major depressive disorder soon after the start of the COVID-19 outbreak in China: a cross-sectional survey

Psychometric properties of the dementia knowledge assessment scale-traditional Chinese among home care workers in Taiwan