Michalak Erin E, Morton Emma, Barnes Steven J, Hole Rachelle, Murray Greg
Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.
JMIR Ment Health. 2019 Apr 15;6(4):e13493. doi: 10.2196/13493.
Self-management is increasingly recognized as an important method through which individuals with bipolar disorder (BD) may cope with symptoms and improve quality of life. Digital health technologies have strong potential as a method to support the application of evidence-informed self-management strategies in BD. Little is known, however, about how to most effectively maximize user engagement with digital platforms.
The aims of this study were (1) to create an innovative Web-based Bipolar Wellness Centre, (2) to conduct a mixed-methods (ie, quantitative and qualitative) evaluation to assess the impact of different sorts of engagement (ie, knowledge translation [KT]), and (3) to support engagement with the self-management information in the Bipolar Wellness Centre.
The project was implemented in 2 phases. In phase 1, community-based participatory research and user-centered design methods were used to develop a website (Bipolar Wellness Centre) housing evidence-informed tools and strategies for self-management of BD. In phase 2, a mixed-methods evaluation was conducted to explore the potential impact of 4 KT strategies (Web-based webinars, Web-based videos, Web-based one-to-one Living Library peer support, and in-person workshops). Quantitative assessments occurred at 2 time points-preintervention and 3 weeks postintervention. Purposive sampling was used to recruit a subsample of participants for the qualitative interviews, ensuring each KT modality was represented, and interviews occurred approximately 3 weeks postintervention.
A total of 94 participants were included in the quantitative analysis. Responses to evaluative questions about engagement were broadly positive. When averaged across the 4 KT strategies, significant improvements were observed on the Bipolar Recovery Questionnaire (F=5.887; P=.02) and Quality of Life in Bipolar Disorder (F=8.212; P=.005). Nonsignificant improvements in positive affect and negative affect were also observed. The sole difference that emerged between KT strategies related to the Chronic Disease Self-Efficacy measure, which decreased after participation in the webinar and video arms but increased after the Living Library and workshop arms. A subsample of 43 participants was included in the qualitative analyses, with the majority of participants describing positive experiences with the 4 KT strategies; peer contact was emphasized as a benefit across all strategies. Infrequent negative experiences were reported in relation to the webinar and video strategies, and included technical difficulties, the academic tone of webinars, and feeling unable to relate to the actor in the videos.
This study adds incremental evidence to a growing literature that suggests digital health technologies can provide effective support for self-management for people with BD. The finding that KT strategies could differentially impact chronic disease self-efficacy (hypothesized as being a product of differences in degree of peer contact) warrants further exploration. Implications of the findings for the development of evidence-informed apps for BD are discussed in this paper.
自我管理日益被视为双相情感障碍（BD）患者应对症状和改善生活质量的重要方法。数字健康技术作为一种支持BD患者应用循证自我管理策略的方法具有巨大潜力。然而，对于如何最有效地提高用户与数字平台的互动程度，我们知之甚少。
本研究的目的是：（1）创建一个创新的基于网络的双相情感健康中心；（2）进行混合方法（即定量和定性）评估，以评估不同类型互动（即知识转化[KT]）的影响；（3）支持用户参与双相情感健康中心的自我管理信息。
该项目分两个阶段实施。在第一阶段，采用基于社区的参与性研究和以用户为中心的设计方法开发一个网站（双相情感健康中心），该网站提供循证的BD自我管理工具和策略。在第二阶段，进行混合方法评估，以探索4种KT策略（基于网络的网络研讨会、基于网络的视频、基于网络的一对一生活图书馆同伴支持和面对面工作坊）的潜在影响。定量评估在两个时间点进行——干预前和干预后3周。采用目的抽样法招募部分参与者进行定性访谈，确保每种KT方式都有代表，访谈在干预后约3周进行。
共有94名参与者纳入定量分析。对关于参与度的评估问题的回答总体上是积极的。在4种KT策略中进行平均时，双相情感康复问卷（F=5.887；P=.02）和双相情感障碍生活质量量表（F=8.212；P=.005）有显著改善。积极情感和消极情感也有不显著的改善。KT策略之间唯一出现差异的是慢性病自我效能量表，在参加网络研讨会和视频组后该量表得分下降，而在生活图书馆和工作坊组后得分上升。43名参与者的子样本纳入定性分析，大多数参与者描述了对4种KT策略的积极体验；同伴联系被强调为所有策略的一个益处。关于网络研讨会和视频策略，报告了一些不常见的负面体验，包括技术困难、网络研讨会的学术语气以及感觉无法与视频中的演员产生共鸣。
本研究为越来越多的文献增添了证据，表明数字健康技术可为BD患者的自我管理提供有效支持。KT策略可能对慢性病自我效能有不同影响（假设这是同伴联系程度差异的结果）这一发现值得进一步探索。本文讨论了这些发现对开发BD循证应用程序的意义。
