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ISAD CANMAT Symposium, Dr. Erin Michalak, July 2016, Amsterdam
1. Fostering patient engagement with
online interventions:
A mixed methods exploration
Erin Michalak
Associate Professor
Department of Psychiatry
University of British Columbia
Network Lead, CREST.BD
erin.michalak@ubc.ca
@erin_michalak
@crest_bd
3. 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
4. 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
10. 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
11. 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
12. 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
13. 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
17. 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
18. 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)
22. 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)
23. 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
24. 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”
25. 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”
26. 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…
Editor's Notes
learned something new, applicable to me, met my expectations, would recommend to others with BD. Very high agreement with all four (all cells having Agree or Strongly Agree as the most common [modal] response). Conclusion: participants perceived the experience, in all cases, to be useful and engaging.