Abstract
BackgroundPeople with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies.MethodsBased on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed.ResultsSeventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient’s preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines.ConclusionWe have developed the first evidence-based health-optimization system enabling patients, clinicians, and caregivers to collaborate in optimizing the patient’s health on a shared platform. User tests indicate that the feasibility of the system is acceptable.
Highlights
People with bipolar disorder often experience ill health and have considerably reduced life expectancies
The second framework applied in this research was multi-criteria decision analysis (MCDA) [26], a subdiscipline of operations research
All the participants strongly agreed that the system helped them to find the best treatment option most accordant with their preferences
Summary
People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and nonadherence to medical interventions and lifestyle measures. Bipolar disorder is a leading cause of poor health worldwide, with a lifetime prevalence of 2.4% [1]. The results of treatment are often suboptimal: 60–85% of patients receiving treatment experience at least one manic or depressive relapse in 4–5 years, and residual symptoms, functional disability, and cognitive impairment between relapses are common [2]. Poor adherence to medication affects 20–60% of patients [4] and is associated with hospitalizations, recurrent mood episodes, and an increased risk of suicide attempts [5]. The symptoms of the disease and the effects of medicines can vary by patient and over time, and they are often unpredictable. Treatment based on trial and error is unavoidable
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