isad canmat symposium, dr. erin michalak, july 2016, amsterdam
TRANSCRIPT
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Fostering patient engagement with online interventions:
A mixed methods exploration
Erin MichalakAssociate Professor
Department of Psychiatry University of British Columbia
Network Lead, CREST.BD
[email protected]@erin_michalak
@crest_bd
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Faculty Disclosure
Company Name Honoraria/Expenses
Consulting/ Advisory Board
Funded Research
Royalties/ Patent
Stock Options
Ownership/ Equity
PositionEmployee Other
(please specify)
Lundbeck X
CANMAT X
No, nothing to disclose X Yes, please specify:
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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
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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
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Bipolar Wellness Centre: Embedded Knowledge Translation Strategies
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Bipolar Wellness CentreDesign:• 15-20 min • 1 QoL domain covered per webinar• CREST.BD expert covers science and strategies
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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
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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
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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
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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
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Bipolar Recovery Questionnaire (BRQ), Jones S, Mulligan L, Higginson S, Dunn G, Morrison A., 2012.
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Quantitative sample demographics
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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
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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)
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Qualitative sample demographics (n = 43)
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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)
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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
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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”
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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”
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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…
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