Fostering patient engagement with online interventions:

A mixed methods exploration

Erin MichalakAssociate Professor

Department of Psychiatry University of British Columbia

Network Lead, CREST.BD

erin.michalak@ubc.ca@erin_michalak

@crest_bd

Faculty Disclosure

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Lundbeck X      

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No, nothing to disclose X Yes, please specify:

Objectives

1. Introduce CREST.BD’s Bipolar Wellness Centre and embedded engagement (knowledge translation - KT) strategies

2. Share initial results from a mixed methods analysis of impact of engagement strategies

R. Bauer et al. Psychiatry Research 242 (2016) 388–394

• International sample

• 81% of patients with BD using the Internet

• 78% of these seek BD information online

Bipolar Wellness Centre: Embedded Knowledge Translation Strategies

Bipolar Wellness CentreDesign:• 15-20 min • 1 QoL domain covered per webinar• CREST.BD expert covers science and strategies

Bipolar Wellness Centre

Design:

• 2-4 min • 1 QoL domain

covered per video• Feature Victoria

Maxwell (actress living well with BD)

• Show concrete self-management strategies in daily life

Bipolar Wellness Centre

Design: • 2.5 hrs in length, 2 QoL domains covered per workshop• Delivered by CREST.BD academic and peer-researchers• Combination of didactic, role-play, small group work• Delivered in Ottawa, Kingston, Toronto in June 2015

Bipolar Wellness Centre

Design: • 1x 45 min session • Delivered by CREST.BD peer living

well with BD • Content individually tailored

according to QoL Tool profile

Mixed methods evaluation framework

• Quantitative evaluation (immediately pre KT strategy intervention, 3 weeks post): – Satisfaction, implementation etc– Stanford Chronic Disease Self-Efficacy - Manage Disease in

General Scale (SEC-D General, Lorig, et al 1996)– Quality of Life in BD (QoL.BD, Michalak and Murray 2010)– Bipolar Recovery Questionnaire (BRQ, Jones et al., 2013)– Positive and negative affect scale (PANAS, Watson et al., 1988)

• Qualitative evaluation: (3-5 weeks)– Individual telephone interview, thematic analysis

Bipolar Recovery Questionnaire (BRQ), Jones S, Mulligan L, Higginson S, Dunn G, Morrison A., 2012.

Quantitative sample demographics

Strategy Mean (mode) satisfaction with session (post questions). Strongly Agree = 1, Strongly Disagree = 5

Something new

Applicable Expectations Recommend to others with BD

Workshop(n = 22)

1.78 (2) 1.34 (1) 1.81 (1) 1.55 (1)

Video(n = 26)

2.35 (2) 1.85 (2) 2.50 (2) 1.65 (2)

Webinar (n = 22)

2.41 (2) 1.77 (2) 2.55 (2) 1.77 (2)

Living library(n = 14)

1.93 (2) 1.86 (1) 2.21 (1) 1.43 (1)

Combined (n = 84)

2.14 (2) 1.63 (1) 2.24 (2) 1.65 (1)

Perceptions of participating in the four KT strategies

Quantitative results

• when averaged across the four KT modalities, participation led to significant improvements in BRQ (p = .018) and QoL.BD (p = .005)

• SECD an outlier, with a small (non-significant) decrease when averaged across the four modalities

• when examining differences between the four KT modalities, no significant differences between BRQ, QoL.BD, PA and NA according to KT strategy (i.e., no significant Time X Strategy effect)

• for SECD significant Time X Strategy effect (p = .016) • SECD improved in the two conditions that used in-person

engagement (workshop and living library), but declined in the two conditions that were more technology-dependent (webinar and videos)

Qualitative sample demographics (n = 43)

Qualitative analysis: emerging themes

• Implementation of self-management strategies

• Impact of actual KT strategy (+ and -)

– beyond impact of self-management strategies on recovery and QoL, KT strategies themselves described by some participants as impactful (e.g., normalisation of experiences, unhelpful comparisons with people apparently managing their BD more successfully)

Qualitative analysis: emerging themes

• No one size fits all

Diverse factors influenced KT strategy preference:

– Workshops - strong positive impact from interacting and sharing tips with others with BD, low computer literacy

– Videos - brevity, visually engaging, easily recalled, actress easily identified with

– Webinars - in depth content– Living Library - personalized and tailored

On Webinars:

“I follow a lot of their webinars online and stuff. Again I find them helpful, sometimes I find they go on in too much depth for where I

am. But I find them very informative, and I personally like

webinars”

On Workshops:

“I think… being with other people who are dealing with similar

health issues, similar problems, I think it’s always kind of reassuring to know that you know you’re not

the only one”

On Living Library:

“it was having the time and the space to discuss the issues. And out of that came the realization that I had

really given up on physio and that I shouldn’t. But also he was just very, very lovely, and I was speaking

to someone who cared and someone who was able to be or prepared to be flexible in terms of the

discussion”

Take home messages

Exploratory project indicates diverse KT strategies can:

• Impact outcomes such as QoL and recovery

• Increase engagement and uptake

• In themselves, be impactful (+ and -)

• Thoughtful attention to (and evaluation of) online engagement mechanisms time well spent

Special thanks…