A Blended Electronic Illness Management and Recovery Program for People With Severe Mental Illness: Qualitative Process Evaluation Alongside a Randomized Controlled Trial.

Titus A A Beentjes,Betsie G I Van Gaal,Peter J J Goossens,Hester Vermeulen,Maria W G Nijhuis-Van Der Sanden

doi:10.2196/20860

Abstract

BackgroundWe conducted a trial to test the electronic Illness Management and Recovery (e-IMR) intervention to provide conclusions on the potential efficacy of eHealth for people with severe mental illness (SMI). In the e-IMR intervention, we used the standard IMR program content and methodology and combined face-to-face sessions with internet-based strategies on the constructed e-IMR internet platform. During the trial, the e-IMR platform was sparsely used.ObjectiveThis study aimed to evaluate the added value of the e-IMR intervention and the barriers and facilitators that can explain the low use of the e-IMR platform.MethodsThis process evaluation was designed alongside a multicenter, cluster randomized controlled trial. In this study, we included all available participants and trainers from the intervention arm of the trial. Baseline characteristics were used to compare users with nonusers. Qualitative data were gathered at the end of the semistructured interviews. Using theoretical thematic analyses, the data were analyzed deductively using a pre-existing coding frame.ResultsOut of 41 eligible participants and 14 trainers, 27 participants and 11 trainers were interviewed. Of the 27 participants, 10 were identified as users. eHealth components that had added value were the persuasive nature of the goal-tracking sheets, monitoring, and the peer testimonials, which had the potential to enhance group discussions and disclosure by participants. The low use of the e-IMR platform was influenced by the inflexibility of the platform, the lack of information technology (IT) resources, the group context, participants’ low computer skills and disabilities, and the hesitant eHealth attitude of the trainers.ConclusionsThe extent of eHealth readiness and correlations with vulnerabilities in persons with SMI need further investigation. This study shows that flexible options were needed for the use of e-IMR components and that options should be provided only in response to a participant’s need. Use of the e-IMR intervention in the future is preconditioned by checking the available IT resources (such as tablets for participants) providing computer or internet guidance to participants outside the group sessions, evaluating the eHealth attitude and skills of trainers, and tailoring eHealth training to increase the skills of future e-IMR trainers.Trial RegistrationNetherlands Trial Register NTR4772; https://www.trialregister.nl/trial/4621International Registered Report Identifier (IRRID)RR2-10.1186/s12913-016-1267-z

Highlights

BackgroundIn mental health care, eHealth is expected to have great potential to increase access to care while being economically and socially efficient [1]. eHealth can be defined as making use of information technology (IT)
The low use of the electronic Illness Management and Recovery (e-Illness Management and Recovery (IMR)) platform was influenced by the inflexibility of the platform, the lack of information technology (IT) resources, the group context, participants’ low computer skills and disabilities, and the hesitant eHealth attitude of the trainers
This study shows that flexible options were needed for the use of e-IMR components and that options should be provided only in response to a participant’s need

Summary

Introduction

BackgroundIn mental health care, eHealth is expected to have great potential to increase access to care while being economically and socially efficient [1]. eHealth can be defined as making use of information technology (IT). EHealth is used for persons with severe mental illness (SMI). EHealth interventions for people with SMI are accepted and feasible [4], and they have potential to deliver effective education [5]. EHealth for persons with SMI is used in a wide range of interventions, such as self-management, relapse prevention, promoting adherence to medications and/or treatment, psychoeducation, supporting recovery, and promoting health and wellness and symptom monitoring [4]. Conclusions on their effectiveness cannot be drawn [4,6]. We conducted a trial to test the electronic Illness Management and Recovery (e-IMR) intervention to provide conclusions on the potential efficacy of eHealth for people with severe mental illness (SMI).

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