Introduction and background
Methods
Situational analysis tools
Quantitative methods
Qualitative methods
Quantitative analyses
Qualitative analyses
Results
SA tools
Coverage, uptake and service provision
Workflow
Readiness for MBC implementation
Mixed methods results: clinicians
Survey Question | Response | SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | Total: n (%) |
---|---|---|---|---|---|
Age Range | 18–29 | 0 | 0 | 4 (26.7) | 4 (3.4) |
30–39 | 34 (43.6) | 11 (47.8) | 9 (60.0) | 54 (46.6) | |
40–49 | 31 (39.7) | 12 (52.2) | 1 (6.7) | 44 (37.9) | |
50–59 | 13 (16.7) | 0 | 1 (6.7) | 14 (12.1) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Gender | Female | 51 (65.4) | 19 (82.6) | 10 (66.7) | 80 (69.0) |
Male | 27 (34.6) | 4 (17.4) | 5 (33.3) | 36 (31.0) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Highest degree | Junior college | 0 | 2 (8.7) | 1 (6.7) | 3 (2.6) |
Bachelor’s | 14 (17.9) | 11 (47.8) | 13 (86.7) | 38 (32.8) | |
Master’s | 36 (46.2) | 8 (34.8) | 1 (6.7) | 45 (38.8) | |
Doctorate | 28 (35.6) | 2 (8.7) | 0 | 30 (25.9) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Professional group | Psychiatrist | 78 (100) | 23 (100) | 15 (100) | 116 (100) |
General practitioner | 0 | 0 | 0 | 0 | |
Neurologist | 0 | 0 | 0 | 0 | |
Psychologist | 0 | 0 | 0 | 0 | |
Social worker | 0 | 0 | 0 | 0 | |
Nurse | 0 | 0 | 0 | 0 | |
Nurses assistant | 0 | 0 | 0 | 0 | |
Other | 0 | 0 | 0 | 0 | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Primary work | Hospital OPCa | 28 (35.9) | 4 (17.4) | 0 | 32 (27.6) |
Hospital IPUb | 9 (11.5) | 11 (47.8) | 15 (100) | 35 (30.2) | |
Hospital OPC and IPU | 35 (44.9) | 7 (30.4) | 0 | 42 (36.2) | |
Chronic disease centre | 1 (1.3) | 1 (4.3) | 0 | 2 (1.7) | |
Other | 5 (6.4) | 0 | 0 | 5 (4.3) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Years in job | < 1 year | 0 | 0 | 1 (6.7) | 1 (0.9) |
1–5 | 1 (1.3) | 3 (13.0) | 3 (20.0) | 7 (6.0) | |
6–10 | 15 (19.2) | 4 (17.4) | 6 (40.0) | 25 (21.6) | |
11–15 | 18 (23.1) | 6 (26.1) | 4 (26.7) | 28 (24.1) | |
16–20 | 22 (28.2) | 6 (26.1) | 0 | 28 (24.1) | |
> 20 | 22 (28.2) | 4 (17.4) | 1 (6.7) | 27 (23.3) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Hours/ week in patient care | < 8 | 5 (6.4) | 2 (8.7) | 3 (20.0) | 10 (8.6) |
8–20 | 18 (23.1) | 4 (17.4) | 5 (33.3) | 27 (23.3) | |
20–30 | 10 (12.8) | 4 (17.4) | 4 (26.7) | 18 (15.5) | |
30–40 | 24 (30.8) | 8 (34.8) | 3 (20.0) | 35 (30.2) | |
> 40 | 21 (26.9) | 5 (21.7) | 0 | 26 (22.4) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Average # of patients/ week | 20–50 | 14 (36.2) | 14 (60.9) | 14 (93.3) | 42 (36.2) |
50–80 | 17 (18.1) | 3 (13.0) | 1 (6.7) | 21 (18.1) | |
80–110 | 22 (20.7) | 2 (8.7) | 0 | 24 (20.7) | |
110–140 | 10 (10.3) | 2 (8.7) | 0 | 12 (10.3) | |
140–160 | 4 (3.4) | 0 | 0 | 4 (3.4) | |
160–200 | 5 (4.3) | 0 | 0 | 5 (4.3) | |
> 200 | 6 (6.9) | 2 (8.7) | 0 | 8 (6.9) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) | |
Primary specialization | Mood disorders | 15 (19.8) | 7 (30.4) | 1 (6.7) | 23 (19.8) |
Clinical psychology | 10 (10.3) | 1 (4.3) | 1 (6.7) | 12 (10.3) | |
Geriatric psychiatry | 4 (5.2) | 0 | 2 (13.3) | 6 (5.2) | |
Child and adolescent psychiatry | 7 (6.9) | 1 (4.3) | 0 | 8 (6.9) | |
General psychiatry | 40 (55.2) | 13 (56.5) | 11 (73.3) | 64 (55.2) | |
Substance use disorders | 2 (2.6) | 1 (4.3) | 0 | 3 (2.6) | |
Total | 78 (100) | 23 (100) | 15 (100) | 116 (100) |
Current practice related to MBC
Survey Question | Response | Location | Age | Gender | |||||
---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40–59 years | F | M | Total: n (%) | ||
MBC is important and useful to me in addition to my own clinical judgement | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 7 (9.0) | 1 (4.3) | 1 (6.7) | 5 (8.6) | 4 (6.9) | 7 (8.8) | 2 (5.6) | 9 (7.8) | |
Somewhat agree | 21 (26.9) | 8 (34.8) | 1 (6.7) | 13 (22.4) | 17 (29.3) | 16 (20.0) | 14 (38.9) | 30 (25.9) | |
Agree | 42 (53.8) | 11 (47.8) | 13 (86.7) | 33 (56.9) | 33 (56.9) | 49 (61.3) | 17 (47.2) | 66 (56.9) | |
Strongly agree | 8 (10.3) | 3 (13.0) | 0 | 7 (12.1) | 4 (6.9) | 8 (10.0) | 3 (8.3) | 11 (9.5) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I am trained in the use of MBC and how to use scores for clinical decisions. | Strongly disagree | 3 (3.8) | 0 | 0 | 1 (1.7) | 2 (3.4) | 1 (1.3) | 2 (5.6) | 3 (2.6) |
Disagree | 21 (26.9) | 5 (21.7) | 2 (13.3) | 18 (31.0) | 10 (17.2) | 21 (26.3) | 7 (19.4) | 28 (24.1) | |
Somewhat disagree | 11 (14.1) | 1 (4.3) | 0 | 5 (8.6) | 7 (12.1) | 8 (10.0) | 4 (11.1) | 12 (10.3) | |
Somewhat agree | 13 (16.7) | 4 (17.4) | 3 (20.0) | 9 (15.5) | 11 (19.0) | 16 (20.0) | 4 (11.1) | 20 (17.2) | |
Agree | 24 (30.8) | 9 (39.1) | 10 (66.7) | 22 (37.9) | 21 (36.2) | 29 (36.3) | 14 (38.9) | 43 (37.1) | |
Strongly agree | 6 (7.7) | 4 (17.4) | 0 | 3 (5.2) | 7 (12.1) | 5 (6.3) | 5 (13.9) | 10 (8.6) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I have sufficient knowledge to be able to interpret MBC scores. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 4 (5.1) | 2 (8.7) | 0 | 4 (6.9) | 2 (3.4) | 4 (5.0) | 2 (5.6) | 6 (5.2) | |
Somewhat disagree | 6 (7.7) | 1 (4.3) | 2 (13.3) | 4 (6.9) | 5 (8.6) | 5 (6.3) | 4 (11.1) | 9 (7.8) | |
Somewhat agree | 21 (26.9) | 5 (21.7) | 4 (26.7) | 16 (27.6) | 14 (24.1) | 24 (30.0) | 6 (16.7) | 30 (25.9) | |
Agree | 41 (52.6) | 14 (60.9) | 9 (60.0) | 32 (55.2) | 32 (55.2) | 45 (56.3) | 19 (52.8) | 64 (55.2) | |
Strongly agree | 6 (7.7) | 1 (4.3) | 0 | 2 (3.4) | 5 (8.6) | 2 (2.5) | 5 (13.9) | 7 (6.0) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I use MBC at each visit to monitor the course of treatment for patients. | Strongly disagree | 5 (6.4) | 1 (4.3) | 0 | 2 (3.4) | 4 (6.9) | 3 (3.8) | 3 (8.3) | 6 (5.2) |
Disagree | 18 (23.1) | 5 (21.7) | 0 | 14 (24.1) | 9 (15.5) | 18 (22.5) | 5 (13.9) | 23 (19.8) | |
Somewhat disagree | 21 (26.9) | 3 (13.0) | 0 | 9 (15.5) | 15 (25.9) | 15 (18.8) | 9 (25.0) | 24 (20.7) | |
Somewhat agree | 21 (26.9) | 10 (43.5) | 4 (26.7) | 18 (31.0) | 17 (29.3) | 26 (32.5) | 9 (25.0) | 35 (30.2) | |
Agree | 11 (14.1) | 4 (17.4) | 11 (73.3) | 14 (24.1) | 12 (20.7) | 17 (21.3) | 9 (25.0) | 26 (22.4) | |
Strongly agree | 2 (2.6) | 0 | 0 | 1 (1.7) | 11 (19.0) | 1 (1.2) | 1 (2.8) | 2 (1.7) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I discuss the MBC scores with my patients. | Strongly disagree | 1 (1.3) | 1 (4.3) | 0 | 1 (1.7) | 1 (1.7) | 2 (2.5) | 0 | 2 (1.7) |
Disagree | 6 (7.7) | 1 (4.3) | 0 | 6 (10.3) | 1 (1.7) | 6 (7.5) | 1 (2.8) | 7 (6.0) | |
Somewhat disagree | 10 (12.8) | 5 (21.7) | 0 | 10 (17.2) | 5 (8.6) | 11 (13.8) | 4 (11.1) | 15 (12.9) | |
Somewhat agree | 27 (34.6) | 12 (52.2) | 3 (20.0) | 15 (25.9) | 27 (46.6) | 29 (36.3) | 13 (36.1) | 42 (36.2) | |
Agree | 30 (38.5) | 4 (17.4) | 12 (80.0) | 24 (41.4) | 22 (37.9) | 30 (37.5) | 16 (44.4) | 46 (39.7) | |
Strongly agree | 4 (5.1) | 0 | 0 | 2 (3.4) | 2 (3.4) | 2 (2.5) | 2 (5.6) | 4 (3.4) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) |
“We also use the standardized outcome measures often. More frequently we use them in the initial assessments or when there are changes of medical conditions. Generally speaking, we do not use them for every regular visit. Especially when the medical condition is quite stable, measures are seldom used” (HK05)
“According to my clinical experience, then I will listen to his main complaints, includ(ing) observing some of his external performances, such as expression, tone of voice”. (SH03)
“When patients come to the visits, I’d ask about their status at home, including sleep, eating, work, and relationships with their family, as well as mood changes. After that, I’ll ask their family to add some medical conditions.” (FX06)
“Mainly based on the information provided by patients or their families after they take the medications, as well as patients’ own feelings/experience”. (SH02)
“First, we’ll focus on their main complaints. When they come, they’ll tell you some current symptoms. If they do not mention these actively, then we’ll ask them whether they have some physical discomforts or not, and ask them to think about whether these are related to the meds. If necessary, we’ll also do some measures.” (FX09)
“We usually ask about patients’ (abilities) such as work ability, as well as their general symptoms, but the most important thing is to ask their family, because some depression patients may have a different self-assessment of their abilities. Hence, we mainly ask their families, about their general daily performance at home, as well as work ability, etc.” (FX06)
“ [We can] identify the changes by measurement assessment. Such as the functional ability measure that we have now.” (HK03) and “Clinicians will assess the patient from some social function measures as well” (SH01)
Knowledge and beliefs about MBC
Survey Question | Response | Location | Age | Gender | Total: n (%) | ||||
---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40–59 years | F | M | |||
Standardized questionnaires and scales are valid (they measure what they are supposed to measure) and reliable (they give the same score with repeated use under the same conditions) assessments of symptom severity. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 3 (3.8) | 0 | 1 (6.7) | 3 (5.2) | 1 (1.7) | 2 (2.5) | 2 (5.6) | 4 (3.4) | |
Somewhat agree | 7 (9.0) | 2 (8.7) | 0 | 6 (10.3) | 3 (5.2) | 6 (7.5) | 3 (8.3) | 9 (7.8) | |
Agree | 56 (71.8) | 15 (65.2) | 12 (80.0) | 40 (69.0) | 43 (74.1) | 60 (75) | 23 (63.9 | 83 (71.6) | |
Strongly agree | 12 (15.4) | 6 (26.1) | 2 (13.3) | 9 (15.5) | 11 (19.0) | 12 (15) | 8 (22.2) | 20 (17.2) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC can improve patient outcomes. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 5 (6.4) | 1 (4.3) | 0 | 3 (5.2) | 3 (5.2) | 3 (3.8) | 3 (8.3) | 6 (5.2) | |
Somewhat disagree | 7 (9.0) | 1 (4.3) | 1 (6.7) | 6 (10.3) | 3 (5.2) | 6 (7.5) | 3 (8.3) | 9 (7.8) | |
Somewhat agree | 17 (21.8) | 5 (21.7) | 2 (13.3) | 9 (15.5) | 15 (25.9) | 18 (22.5) | 6 (16.7) | 24 (20.7) | |
Agree | 42 (53.8) | 15 (65.2) | 11 (73.3) | 36 (62.1) | 31 (53.4) | 46 (57.5) | 21 (58.3 | 67 (57.8) | |
Strongly agree | 7 (9.0) | 3 (13.0) | 1 (6.7) | 4 (6.9) | 6 (10.3) | 7 (8.8) | 3 (8.3) | 10 (8.6) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC is helpful for making treatment decisions. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 1 (1.3) | 0 | 0 | 0 | 1 (1.7) | 0 | 1 (2.8) | 1 (0.9) | |
Somewhat disagree | 2 (2.6) | 0 | 1 (6.7) | 2 (3.4) | 1 (1.7) | 2 (2.5) | 1 (2.8) | 3 (2.6) | |
Somewhat agree | 15 (19.2) | 5 (21.7) | 2 (13.3) | 10 (17.2) | 12 (20.7) | 13 (18.8) | 7 (19.4) | 22 (19.0) | |
Agree | 49 (62.8) | 15 (65.2) | 8 (53.3) | 37 (63.8) | 35 (60.3) | 50 (62.5) | 22 (61.1) | 72 (62.1) | |
Strongly agree | 11 (14.1) | 3 (13.0) | 4 (26.7) | 9 (15.5) | 9 (15.5) | 13 (16.3) | 5 (13.9) | 18 (15.5) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC at each visit is helpful for monitoring treatment response. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 2 (2.6) | 1 (4.3) | 2 (13.3) | 3 (5.2) | 2 (3.4) | 4 (5.0) | 1 (2.8) | 5 (4.3) | |
Somewhat agree | 14 (17.9) | 3 (13.0) | 0 | 9 (15.5) | 8 (13.8) | 11 (13.8) | 6 (16.7) | 17 (14.7) | |
Agree | 50 (64.1) | 16 (69.6) | 10 (66.7) | 36 (62.1) | 40 (69.0) | 51 (63.7) | 25 (69.4 | 76 (65.5) | |
Strongly agree | 12 (15.4) | 3 (13.0) | 3 (20.0) | 10 (17.2) | 8 (13.8) | 14 (17.5) | 4 (11.1) | 18 (15.5) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC enhances care provided to a given patient. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 2 (2.6) | 0 | 0 | 1 (1.7) | 2 (3.4) | 2 (2.5) | 1 (2.8) | 3 (2.6) | |
Somewhat disagree | 2 (2.6) | 1 (4.3) | 1 (6.7) | 3 (5.2) | 0 | 3 (3.8) | 0 | 3 (2.6) | |
Somewhat agree | 16 (20.5) | 7 (30.4) | 2 (13.3) | 8 (13.8) | 17 (29.3) | 13 (16.3) | 12 (33.3) | 25 (21.6) | |
Agree | 49 (62.8) | 11 (47.8) | 10 (66.7) | 38 (65.5) | 32 (55.2) | 52 (65.0) | 18 (50.0) | 70 (60.3) | |
Strongly agree | 9 (11.5) | 4 (17.4) | 2 (13.3) | 8 (13.8) | 7 (12.1) | 10 (12.5 | 5 (13.9) | 15 (12.9) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
Patients will find MBC helpful. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 1 (1.3) | 0 | 1 (6.7) | 1 (1.7) | 1 (1.7) | 2 (2.5) | 0 | 2 (1.7) | |
Somewhat disagree | 4 (5.1) | 4 (17.4) | 0 | 3 (5.2) | 5 (8.6) | 5 (6.3) | 3 (83) | 8 (6.9) | |
Somewhat agree | 22 (28.2) | 8 (34.8) | 3 (20.0) | 14 (24.1) | 19 (32.8) | 19 (23.8) | 14 (38.9) | 33 (28.4) | |
Agree | 48 (61.5) | 10 (43.5) | 11 (73.3) | 39 (67.2) | 30 (51.7) | 51 (63.7) | 18 (50.0) | 69 (59.5) | |
Strongly agree | 3 (3.8) | 1 (4.3) | 0 | 1 (1.7) | 3 (5.2) | 3 (3.8) | 1 (2.8) | 4 (3.4) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC can help educate patients about their mental health symptoms. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 2 (2.6) | 1 (4.3) | 0 | 1 (1.7) | 2 (3.4) | 3 (3.8) | 0 | 3 (2.6) | |
Somewhat agree | 13 (16.7) | 7 (30.4) | 2 (13.3) | 11 (19.0) | 11 (19.0) | 14 (17.5) | 8 (22.2) | 22 (19) | |
Agree | 50 (64.1) | 12 (52.2) | 12 (80.0) | 39 (67.2) | 35 (60.3) | 52 (65.0) | 22 (61.1) | 74 (63.8) | |
Strongly agree | 13 (16.7) | 3 (13.0) | 1 (6.7) | 7 (12.1) | 10 (17.2) | 11 (13.8) | 6 (16.7) | 17 (14.7) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC can help patients feel more engaged in shared decision making. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 4 (5.1) | 1 (4.3) | 1 (6.7) | 4 (6.9) | 2 (3.4) | 5 (6.3) | 1 (2.8) | 6 (5.2) | |
Somewhat agree | 10 (12.8) | 7 (30.4) | 0 | 5 (8.6) | 12 (20.7) | 10 (12.5) | 7 (19.4) | 17 (14.7) | |
Agree | 51 (65.4) | 12 (52.2) | 10 (66.7) | 38 (65.5) | 35 (60.3) | 50 (62.5) | 23 (63.9) | 73 (62.9) | |
Strongly agree | 13 (16.7) | 3 (13.0) | 4 (26.7) | 11 (19.0) | 9 (15.5) | 15 (18.8) | 5 (13.9) | 20 (17.2) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
MBC can help other providers care for mutual patients. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 1 (1.3) | 0 | 0 | 0 | 1 (1.7) | 0 | 1 (2.8) | 1 (0.9) | |
Somewhat disagree | 1 (1.3) | 2 (8.7) | 1 (6.7) | 2 (3.4) | 2 (3.4) | 3 (3.8) | 1 (2.8) | 4 (3.4) | |
Somewhat agree | 9 (11.5) | 5 (21.7) | 1 (6.7) | 9 (15.5) | 6 (10.3) | 7 (8.8) | 8 (22.2) | 15 (12.9) | |
Agree | 55 (70.5) | 10 (43.5) | 9 (60.0) | 34 (58.6) | 40 (69.0) | 53 (56.3) | 21 (58.3) | 74 (63.8) | |
Strongly agree | 12 (15.4) | 6 (26.1) | 4 (26.7) | 13 (22.4) | 9 (15.5) | 17 (21.7) | 17 (21.7) | 22 (19.0) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 80 (100) | 116 (100) |
“It may be relatively more standard or systematic, so it may be relatively comprehensive. It’s more standardized, not just the doctors’ feelings, right? If so (based on doctors’ feelings only), there might be some deviations. Through regular assessments, we can have a comprehensive evaluation, and it will also help us to have an overall idea of their medical conditions.” (HK01)
“MBC is not just about evaluating patient’s symptoms every time, but also identifying side effects, which is the most basic process…At first, we need to identify the efficacy and the side effects. Then measure the risk-benefit ratio between the two. So as to determine what kind of further treatment plan the clinician will use, like whether to increase or reduce medicine. Although MBC is somehow subjective, it is relatively more objective according to our clinical experience”. (SH03)
“Now, there should be measures, measures for depression, but in outpatient clinics, sometimes time is limited, so (we are) unable to do the measures.” (FX02)
“The more information you let patients know, the more questions they will have and the more time you need to spend for explanation. Hence the first thing is that we need time”. (SH08)
“If the questionnaire is too long, the patient seems to have no patience with it”. (HK07)
“...there's a huge difference between different individuals, and the scales are based on patients’ own feelings. They will fill out as what they believe their medical conditions are (which may not be the reality). Their feelings might not be very objective. Hence, the measures may not be very accurate.” (FX07)
“Different measurement tools can cause problems. If some of them are imported and translated into Chinese, they may not fit into [our] native culture”. (SH03)
“I think if it’s me, I’d be willing to use such an assessment, because in this way the doctors and patients will be in an equal status, and doctors will fully respect patients. Patients will have the right to know about their entire treatments. It’s about the informed consent. At least they know about their own disease better, which would benefit the following treatments.” (FX04)
“It will make it easier to identify the aspects of their improvements, and pay attention to those improvements as well instead of focusing on the unimproved ones. In this way, patients will become more faithful, which is helpful as well.” (HK01)
Feasibility and perceived barriers and facilitators of use of MBC
Survey Question | Response | Location | Age | Gender | |||||
---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40–59 years | F | M | Total: n (%) | ||
MBC would be easy to integrate into my daily workflow. | Strongly disagree | 1 (1.3) | 0 | 0 | 1 (1.7) | 0 | 0 | 1 (2.8) | 1 (0.9) |
Disagree | 6 (7.7) | 0 | 0 | 2 (3.4) | 4 (6.9) | 3 (3.8) | 3 (8.3) | 6 (5.2) | |
Somewhat disagree | 10 (12.8) | 2 (8.7) | 1 (6.7) | 8 (13.8) | 5 (8.6) | 9 (11.3) | 4 (11.1) | 13 (11.2) | |
Somewhat agree | 24 (30.8) | 15 (65.2) | 2 (13.3) | 20 (34.5) | 21 (36.2) | 29 (36.3) | 12 (33.3) | 41 (35.3) | |
Agree | 36 (46.2) | 6 (26.1) | 11 (73.3) | 26 (44.8) | 27 (46.6) | 39 (48.8) | 14 (38.9) | 53 (45.7) | |
Strongly agree | 1 (1.3) | 0 | 1 (6.7) | 1 (1.7) | 1 (1.7) | 0 | 2 (5.6) | 2 (1.7) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I would use MBC if my hospital provided training and resources. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 1 (1.3) | 0 | 0 | 0 | 1 (1.7) | 1 (1.3) | 0 | 1 (0.9) | |
Somewhat disagree | 2 (2.6) | 1 (4.3) | 0 | 2 (3.4) | 1 (1.7) | 2 (2.5) | 1 (2.8) | 3 (2.6) | |
Somewhat agree | 17 (21.8) | 5 (21.7) | 1 (6.7) | 9 (15.5) | 14 (24.1) | 15 (18.8) | 8 (22.2) | 23 (19.8) | |
Agree | 45 (57.7) | 12 (52.2) | 9 (60.0) | 37 (63.8) | 29 (50.0) | 46 (57.5) | 20 (55.6) | 66 (56.9) | |
Strongly agree | 13 (16.7) | 5 (21.7) | 5 (33.3) | 10 (17.2) | 13 (22.4) | 16 (20.0) | 7 (19.4) | 23 (19.8) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I would use data collected from MBC to evaluate my own practices. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 4 (5.1) | 0 | 0 | 2 (3.4) | 2 (3.4) | 3 (3.8) | 1 (2.8) | 4 (3.4) | |
Somewhat agree | 21 (26.9) | 6 (26.1) | 2 (13.3) | 11 (19.0) | 18 (31.0) | 18 (22.5) | 11 (30.6) | 29 (25.0) | |
Agree | 44 (56.4) | 14 (60.9) | 11 (73.3) | 40 (69.0) | 29 (50.0) | 50 (62.5) | 19 (52.8) | 69 (59.5) | |
Strongly agree | 9 (11.5) | 3 (13.0) | 2 (13.3) | 5 (8.6) | 9 (15.5) | 9 (11.3) | 5 (13.9) | 14 (12.1) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
My patients would be willing to complete MBC at each visit. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 4 (5.1) | 1 (4.3) | 0 | 1 (1.7) | 4 (6.9) | 4 (5.0) | 1 (2.8) | 5 (4.3) | |
Somewhat disagree | 13 (16.7) | 5 (21.7) | 1 (6.7) | 10 (17.2) | 9 (15.5) | 19 (16.4) | 5 (13.9) | 19 (16.4) | |
Somewhat agree | 35 (44.9) | 15 (65.2) | 4 (26.7) | 28 (48.3) | 26 (44.8) | 54 (46.6) | 17 (47.2) | 54 (46.6) | |
Agree | 25 (32.1) | 2 (8.7) | 10 (66.7) | 19 (32.8) | 18 (31.0) | 37 (31.9) | 12 (33.3) | 37 (31.9) | |
Strongly agree | 1 (1.3) | 0 | 0 | 0 | 1 (1.7) | 1 (0.9) | 1 (2.8) | 1 (0.9) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 116 (100 | 36 (100) | 116 (100) | |
If MBC was automated and available electronically with easy to interpret results, I would be more likely to use MBC. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Somewhat disagree | 4 (5.1) | 0 | 0 | 1 (1.7) | 3 (5.2) | 3 (3.8) | 1 (2.8) | 4 (3.4) | |
Somewhat agree | 9 (11.5) | 3 (13.0) | 1 (6.7) | 5 (8.6) | 8 (13.8) | 6 (7.5) | 7 (19.4) | 13 (11.2) | |
Agree | 39 (50.0) | 11 (47.8) | 9 (60.0) | 32 (55.2) | 27 (46.6) | 40 (50.0) | 19 (52.8) | 59 (50.9) | |
Strongly agree | 26 (33.3) | 9 (39.1) | 5 (33.3) | 20 (34.5) | 20 (34.5) | 31 (38.8) | 9 (25.0) | 40 (34.5) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I don’t know how to fit MBC into my current workflow because I am too busy. | Strongly disagree | 2 (2.6) | 1 (4.3) | 1 (6.7) | 2 (3.4) | 2 (3.4) | 4 (5.0) | 0 | 4 (3.4) |
Disagree | 11 (11.4) | 5 (21.7) | 2 (13.3) | 9 (15.5) | 9 (15.5) | 9 (11.3) | 9 (25.0) | 18 (15.5) | |
Somewhat disagree | 18 (23.1) | 2 (8.7) | 3 (20.0) | 7 (12.1) | 16 (27.6) | 18 (22.5) | 5 (13.9) | 23 (19.8) | |
Somewhat agree | 23 (29.5) | 9 (39.1) | 4 (26.7) | 21 (36.2) | 15 (25.9) | 25 (31.3) | 11 (30.6) | 36 (31.0) | |
Agree | 14 (17.9) | 4 (17.4) | 5 (33.3) | 13 (22.4) | 10 (17.2) | 17 (21.3) | 6 (16.7) | 23 (19.8) | |
Strongly agree | 10 (12.8) | 2 (8.7) | 0 | 6 (10.3) | 6 (10.3) | 7 (8.8) | 5 (13.9) | 12 (10.3) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) |
“...it’s like more electronic and more easy, convenient. Better to have records saved, that can be accessed at any time, which may be more convenient to both doctors and patients. Also the records need to be improved, better to have some curve figure to show the results to make it more straightforward.” (FX07)
“I don't necessarily have time to do the measures. If I have to do a self-rating scale, it is not convenient as well. Because I need to give the measures in paper to the patient and he might have to record the result in the computer at the end, and the workload would be a little bit heavy” (HK09).
“...the biggest challenge is that patients may not be willing to collaborate, not willing to do it” (FX05).
“I think that patients should be able to accept it first. For example, it would be easily accepted in the inpatient ward. However in the outpatient clinics, there are many patients, they will not have enough patience for everyone doing the MBC” (HK08)
“Literacy level, age, and other factors need to be suitable for completing the measures” (FX01)
“Then there are some patients who may be resistant to the measure because of their illness. Since the patient is depressed, he is not interested in anything, he is not willing to touch anything, so that maybe creates a little problem when using the measures”. (HK07)
“...if [we] compare the MBC with our usual outpatient clinic, the clinician may not have enough time to meet with all the patients if they all used MBC, since we have roughly 40 to 50 patients in one single morning. MBC requires evaluating the patient and discussing with the patient his condition change, which is time consuming.” (HK02)
“At present, we mainly use some measures that needed to be charged. During the follow-up appointment, most of the patients will consider the measures useless. “I don’t have to spend this money, I am already recovered” (SH01).
“One [thing that is needed] is policy support. Personnel needs to be arranged. When patients come here, before seeing patients, someone needs to take them to do the measures, right? Communicate with doctors. Or the nurses or social workers can see the patients first, and send the completed measures to doctors. That’s good, I think. It needs a specific person to get it done, before the medical appointment.” (HK04)
“…It is better to have a private, independent and quiet environment, so that the clinician can have a more detailed communication with the patient. This enables patients to make an objective assessment without reservation,” (HK03)
“We can do this here, but I don't know if we can still do it elsewhere, because there is no psychological measurement room or assessors in the minor cities” (SH05)
Acceptability and perceived barriers and facilitators to use of enhanced MBC (eMBC)
Survey Question | Response | Location | Age | Gender | |||||
---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40–59 years | F | M | Total: n (%) | ||
A mobile phone app, as described above, will make it easier to use MBC. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 1 (4.3) | 0 | 0 | 1 (1.7) | 1 (1.3) | 0 | 1 (0.9) | |
Somewhat disagree | 2 (2.6) | 2 (8.7) | 0 | 2 (3.4) | 2 (3.4) | 2 (2.5) | 2 (5.6) | 4 (3.4) | |
Somewhat agree | 14 (17.9) | 2 (8.7) | 3 (20.0) | 11 (19.0) | 8 (13.8) | 12 (15.0) | 7 ()19.4) | 19 (16.4) | |
Agree | 46 (59.0 | 15 (65.2) | 7 (46.7) | 32 (55.2) | 36 (62.1) | 46 (57.5) | 22 (61.1) | 68 (58.6) | |
Strongly agree | 16 (20.5) | 3 (13.) | 5 (33.3) | 13 (22.4) | 11 (19.0) | 19 (23.8) | 5 (13.9) | 24 (20.7) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
I am willing to use a mobile phone app with my patients for MBC. | Strongly disagree | 1 (1.3) | 0 | 0 | 0 | 1 (1.7) | 0 | 1 (2.8) | 1 (0.9) |
Disagree | 1 (1.3) | 0 | 0 | 1 (1.7) | 0 | 0 | 1 (2.8) | 1 (0.9) | |
Somewhat disagree | 7 (9.0) | 2 (8.7) | 0 | 3 (5.2) | 6 (10.3) | 6 (7.5) | 3 (8.3) | 9 (7.8) | |
Somewhat agree | 15 (19.2) | 5 (21.7) | 3 (20.0) | 11 (19.0) | 12 (20.7) | 16 (20.0) | 7 (19.4) | 23 (19.8) | |
Agree | 41 (52.6) | 10 (43.5) | 10 (66.7) | 34 (58.6) | 27 (46.6) | 41 (51.2) | 20 (55.6) | 61 (52.6) | |
Strongly agree | 13 (16.7) | 5 (21.7) | 2 (13.3) | 9 (15.5) | 11 (19.0) | 16 (20.0 | 4 (11.1) | 20 (17.2) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 57 (98.3) | 79 (98.0) | 36 (100) | 116 (100) | |
My patients will find it easy to use a mobile phone app, as described above. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 0 | 2 (8.7) | 2 (13.3) | 3 (5.2) | 1 (1.7) | 3 (3.8) | 1 (2.8) | 4 (3.4) | |
Somewhat disagree | 9 (11.5) | 4 (17.4) | 0 | 4 (6.9) | 9 (15.5) | 10 (12.5) | 3 (8.3) | 13 (11.2) | |
Somewhat agree | 24 (30.8) | 10 (43.5) | 5 (33.3) | 22 (37.9) | 17 (29.3) | 26 (32.5) | 13 (36.1) | 39 (33.6) | |
Agree | 38 (48.7) | 7 (30.4) | 8 (53.3) | 27 (46.6) | 26 (44.8) | 38 (47.5) | 15 (41.7) | 53 (45.7) | |
Strongly agree | 7 (9.0) | 0 | 0 | 2 (3.4) | 5 (8.6) | 3 (3.8) | 4 (11.1) | 7 (6.0) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) | |
My patients would be willing to use a mobile phone app to track their outcomes. | Strongly disagree | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disagree | 2 (2.6) | 2 (8.7) | 1 (6.7) | 2 (3.4) | 3 (5.2) | 5 (6.3) | 0 | 5 (4.3) | |
Somewhat disagree | 7 (9.0) | 4 (17.4) | 1 (6.7) | 8 (13.8) | 4 (6.9) | 11 (13.8) | 1 (2.8) | 12 (10.3) | |
Somewhat agree | 28 (35.9) | 11 (47.8) | 3 (20.0) | 20 (34.5) | 22 (37.9) | 26 (32.5) | 16 (44.4) | 42 (36.2) | |
Agree | 33 (42.3) | 6 (26.1) | 10 (66.7) | 26 (44.8) | 23 (39.7) | 34 (42.5) | 15 (41.7) | 49 (42.2) | |
Strongly agree | 8 (10.3) | 0 | 0 | 2 (3.4) | 6 (10.3) | 4 (5.0) | 4 (11.1) | 8 (6.9) | |
Total | 78 (100) | 23 (100) | 15 (100) | 58 (100) | 58 (100) | 80 (100) | 36 (100) | 116 (100) |
“In this way, it’ll save doctors some time. Doctors can have deeper communication with patients on some highlights of their issues. Based on the assessments results, we may skip some unimportant things, and avoid some ineffective consultation.” (HK01)
“It’s also mobile and portable, and hence the tool itself is very convenient to patients. Patients may complete when they have time, and they do not have to do it during their wait for the appointments. Hence its usability and accessibility is very good”. (SH09)
“I think it’d be that patients’ feelings would be better respected in this way, so that there’d be a better relationship with patients and doctors. Their adherence to medications and treatments may be improved” (FX09)
“I think it’s more targeted. And it’ll be easier for us to understand patients, such as what treatments they prefer, or which issues they are more concerned with and want to solve first. When we make decisions, we’ll pay more attention to these things” (HK05).
“There is definitely benefits. ...Lot of studies had confirmed that the treatment of depression will be better if the doctor's treatment plan is in line with the patient's own wishes”. (SH 03)
“In the process, there is not only an assessment, but also health education and the understanding of disease knowledge, which can help patients to eliminate fear and shame of depression. Then they can find out from the assessment which aspects have a more positive change, thus accumulating confidence in the treatment” (SH10)
“The measurement in MBC should be comprehensive, including the psychiatric exams, i.e. doctor’s assessment, feedback from families, etc. All these together are called measurement-based. If it’s only based on self-report, I don’t think it’s measurement-based. It’s just one-sided. Hence, measurement-based care is good, but if you only use this one tool, there must be bias”. (SH08)
“Of course, no assessments/measures can replace the actual communication between doctors and patients, including collecting information such as their body language, tone, or even their smell, etc., which cannot be assessed by the paper or mobile measures/scales. Hence, (the measures/scales) as a supplement” (SH09)
“However in fact, we still hope to provide formal diagnosis, formal treatments and formal suggestions in the medical authorities, which have better qualifications for medical practice, instead of providing some suggestions in the chats. The patients may consider those chats as doctors’ instructions, which may be not formal.” (FX09)
“What he considers the treatments may sometimes contradict to our medical knowledge. He will apply those treatment strategies, and thinks that this is what he needs most. In fact, this is not the best strategy. This is a challenge”. (HK09)
“I don’t like it. I feel that if you let patients to use the mobile phone by themselves, then their trust for doctors will go down. They’ll feel you are not useful, and they are completing all things by themselves”. (HK06)
“There is no big challenge for clinicians, I can use cell phone apps, and be able to see the patients’ scores. I don't think there is any big challenge for me. But for the patient, the challenge is that once his condition worsens and there is severe depression, it may not be possible to complete the eMBC”. (HK02)
“For example, some anti-depressants may have some side effects. If you tell them about these side effects, patients may have some concerns. Another thing is that if patients know too much about their medical conditions, it will affect their moods?” (FX06)
“They may randomly choose an answer, which is meaningless. That’s why self-report should be used together with administered report. Self-report is not always totally reliable, and it can just be used as a reference. At the beginning, they may take it serious, and do it carefully, but after a while, they become unwilling to do it”. (SH08)
“I think it’s time consuming to let patients scan the QR code, and the process… to download this thing using the QR code to explain it.. I mean, the work of explaining it to clinical patients, and to promote/implement it, would be a challenge”. (SH02)
“... if it’s like Wechat and when the patients add you on it, they might occupy your personal time (for consultation). I think the word “occupy” in this situation is appropriate.” (FX03)
“Some seniors may not know how to use a mobile phone, and another [challenge] is that if their literacy level is not high enough, they may not understand it, or may not understand some questions, right?” (FX02)
“For some older clinicians, the challenges might be such as the application of the mobile phone is not familiar which makes them unable to use it” (HK09)
“I think the issue for this kind of tool is data confidentiality. For patients’ privacy, they may have concerns about who has the access to data and who will know their information, what this information will be used for”. (SH09)
“There must be publicity for the two treatments since not everyone can accept these care right away. The treatments are very good but not every good thing can be accepted by everyone. Therefore, publicity is important so as to let the patients and the clinicians better understand the treatment methods. What do MBC/eMBC mean to the treatment? What outcomes will they bring to the clinical practice? What are the difference between the two? The clinician and the patient need to accept MBC and eMBC from the bottom of their heart so that it is easier to implement and market in the clinical practice”. (HK08)
“For initial visits, we can arrange specific staff to provide health education (for clinicians) including training on measures. Professional assistance is needed to do it” and “I think for the first time using the measures, there should be some health education to make sure patients can understand the terms correctly”. (HK06)
Mixed methods results: patients
Patient demographics
Survey Question | Response | SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | Total: n (%) |
---|---|---|---|---|---|
Age | 18–29 | 99 (65.6) | 2 (2.3) | 8 (11.4) | 109 (35.3) |
30–39 | 30 (19.9) | 8 (9.1) | 13 (18.6) | 51 (16.5) | |
40–49 | 10 (6.6) | 12 (13.6) | 11 (15.7) | 33 (10.7) | |
50–59 | 6 (4.0) | 16 (18.2) | 21 (30) | 43 (13.9) | |
60–69 | 5 (3.3) | 40 (45.5) | 15 (21.4) | 60 (19.4) | |
70+ | 1 (0.7) | 10 (11.4) | 2 (2.9) | 13 (4.2) | |
Total | 151 (100) | 88 (100) | 70 (100) | 309 (100) | |
Gender | Female | 109 (72.2) | 64 (72.7) | 45 (64.3) | 218 (70.6) |
Male | 40 (26.5) | 23 (26.1) | 25 (35.7) | 88 (28.5) | |
Prefer not to answer | 2 (1.3) | 1 (1.1) | 0 (0.0) | 3 (1.0) | |
Total | 151 (100) | 88 (100) | 70 (100) | 309 (100) | |
Are you currently a resident of Shanghai | Yes | 98 (64.9) | 86 (97.7) | 59 (84.3) | 243 (78.6) |
No | 53 (35.1) | 2 (2.3) | 11 (15.7) | 66 (21.4) | |
Total | 151 (100) | 88 (100) | 70 (100) | 309 (100) | |
Please select the type of area you live in | Urban area | 110 (72.8) | 82 (93.2) | 6 (8.6) | 198 (64.1) |
Suburban area | 39 (25.8) | 5 (5.7) | 51 (72.9) | 95 (30.7) | |
Rural area | 2 (1.3) | 1 (1.1) | 13 (18.6) | 16 (5.2) | |
Total | 151 (100) | 88 (100) | 70 (100) | 309 (100) | |
Please select the highest level of education you have obtained | Primary school | 0 | 1 (1.1) | 5 (7.1) | 6 (1.9) |
Middle school | 8 (5.3) | 27 (30.7) | 20 (28.6) | 55 (17.8) | |
High school | 25 (16.6) | 35 (39.8) | 26 (37.1) | 86 (27.8) | |
Undergraduate degree | 78 (51.7) | 14 (15.9) | 12 (17.1) | 104 (33.7) | |
Vocational school | 13 (8.6) | 2 (2.3) | 5 (7.1) | 20 (6.5) | |
Post-graduate or professional degree | 24 (15.9) | 4 (4.5) | 0 (0.0) | 28 (9.1) | |
3 (2.0) | 5 (5.7) | 2 (2.9) | 10 (3.2) | ||
Total | 151 (100) | 88 (100) | 70 (100) | 309 (100) | |
Please select your current employment status | Employed full-time | 59 (39.1) | 22 (25.0) | 22 (31.4) | 103 (33.3) |
Employed part-time | 3 (2.0) | 0 | 2 (2.9) | 5 (1.6) | |
Self employed | 9 (6.0) | 3 (3.4) | 6 (8.6) | 18 (5.8) | |
At-home parent | 4 (2.6) | 0 | 1 (1.4) | 5 (1.6) | |
Not employed | 14 (9.3) | 2 (2.3) | 6 (8.6) | 22 (7.1) | |
Retired | 9 (6.0) | 60 (68.2) | 26 (37.1) | 95 (30.7) | |
Student | 49 (32.5) | 1 (1.1) | 5 (7.1) | 55 (17.8) | |
Other (fill in) | 4 (2.6) | 0 | 2 (2.9) | 6 (1.9) | |
Total | 151 (100) | 88 (100) | 70 (100) | 309 (100) |
Patient use of internet and Mobile technology
Survey | Response | Location | Age | Gender | Total: n (%) | |||||
---|---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40+ years | F | M | Unknown | |||
How frequently do you use the Internet? | Many times a day | 137 (90.7) | 68 (77.3) | 49 (70.0) | 146 (91.3) | 108 (72.5) | 182 (83.5) | 70 (79.5) | 2 (66.7) | 254 (82.2) |
Once a day | 8 (5.3) | 7 (8.0) | 5 (7.1) | 5 (3.1) | 15 (10.1) | 11 (5.0) | 9 (10.2) | 0 (0.0) | 20 (6.5) | |
Once every few days | 1 (0.7) | 4 (4.5) | 1 (1.4) | 2 (1.3) | 4 (2.7) | 2 (0.9) | 4 (4.5) | 0 (0.0) | 6 (1.9) | |
Once a week | 3 (2.0) | 0 | 1 (1.4) | 2 (1.3) | 2 (1.3) | 2 (0.9) | 2 (2.3) | 0 (0.0) | 4 (1.3) | |
A few times a month | 1 (0.7) | 2 (2.3) | 1 (1.4) | 2 (1.3) | 2 (1.3) | 3 (1.4) | 0 (0.0) | 1 (33.3) | 4 (1.3) | |
Rarely or not at all | 1 (0.7) | 7 (8.0) | 13 (18.6) | 3 (1.9) | 18 (12.1) | 18 (8.3) | 3 (3.4) | 0 (0.0) | 21 (6.8) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
Which statement most accurately describes your access to a Smartphone? | I own my own Smartphone | 149 (98.7) | 81 (92.0) | 62 (88.6) | 158 (98.8) | 134 (89.9) | 204 (93.6) | 85 (96.6) | 3 (100) | 292 (94.5) |
I share a Smartphone with family members or friends | 1 (0.7) | 2 (2.3) | 1 (1.4) | 1 (0.6) | 3 (2.0) | 2 (0.9) | 2 (2.3) | 0 (0.0) | 4 (1.3) | |
I do not own or have access to a Smartphone | 1 (0.7) | 2 (2.3) | 6 (8.6) | 1 (0.6) | 8 (5.4) | 8 (3.7) | 1 (1.1) | 0 (0.0) | 9 (2.9) | |
Other | 0 | 3 (3.4) | 1 (1.4) | 0 (0.0) | 4 (2.7) | 4 (1.8) | 0 (0.0) | 0 (0.0) | 4 (1.3) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 8 (100) | 3 (100) | 309 (100) | |
If you selected i or ii in the previous question, how long have you been using a Smartphone? | Less than 1 year | 3 (2.0) | 4 (4.5) | 5 (7.9) | 5 (3.1) | 7 (5.1) | 6 (2.9) | 6 (6.9) | 0 (0.0) | 12 (4.1) |
2–3 years | 13 (8.6) | 11 (12.5) | 10 (15.9) | 8 (5.0) | 26 (19.0) | 26 (12.6) | 8 (9.2) | 0 (0.0) | 34 (11.5) | |
3–5 years | 20 (13.2) | 29 (33.0) | 14 (22.2) | 22 (13.8) | 41 (29.9) | 43 (20.9) | 20 (23.0) | 0 (0.0) | 63 (21.3) | |
More than 5 years | 107 (70.8) | 38 (43.2) | 32 (50.8) | 118 (74.2) | 59 (43.1) | 124 (60.2) | 50 (57.5) | 3 (100) | 177 (59.8) | |
Missing | 8 (5.3) | 6 (6.8) | 2 (3.2) | 6 (3.8) | 4 (2.9) | 7 (3.4) | 3 (3.4) | 0 (0.0) | 10 (3.4) | |
Total | 151 (100) | 88 (100) | 63 (100) | 159 (100) | 137 (100) | 206 (100) | 87 (100) | 3 (100) | 296 (100) | |
How do you usually access the Internet? | I only access the Internet on my Smartphone | 31 (20.5) | 39 (44.3) | 29 (41.4) | 26 (16.3) | 73 (49.0) | 70 (32.1) | 29 (33.0) | 0 (0.0) | 99 (32.0) |
I use both my Smartphone and a computer to access the Internet | 117 (77.5) | 34 (38.6) | 26 (37.1) | 133 (83.1) | 44 (29.5) | 122 (56.0) | 52 (59.1) | 0 (0.0) | 177 (57.3) | |
I only access the Internet on a computer | 2 (1.3) | 2 (2.3) | 0 (0.0) | 0 (0.0) | 4 (2.7) | 3 (1.4) | 1 (1.1) | 0 (0.0) | 4 (1.3) | |
I rarely access the Internet | 1 (0.7) | 11 (12.5) | 3 (4.3) | 1 (0.6) | 14 (9.4) | 12 (5.5) | 3 (3.4) | 0 (0.0) | 15 (4.9) | |
I never access the Internet | 0 | 2 (2.3) | 12 (17.1) | 0 (0.0) | 14 (9.4) | 11 (5.0) | 3 (3.4) | 0 (0.0) | 14 (4.5) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
How familiar are you with using mobile apps on your Smartphone? | Very familiar | 110 (72.8) | 29 (33.0) | 22 (31.4) | 124 (77.5) | 37 (24.8) | 111 (50.9) | 49 (55.7) | 1 (33.3) | 161 (52.1) |
Somewhat familiar | 39 (25.8) | 49 (55.7) | 34 (48.6) | 35 (21.9) | 87 (58.4) | 89 (40.8) | 32 (36.4) | 1 (33.3) | 122 (39.5) | |
Not at all familiar | 1 (0.7) | 6 (6.8) | 9 (12.9) | 0 (0.0) | 16 (10.7) | 11 (5.0) | 5 (5.7) | 0 (0.0) | 16 (5.2) | |
Not applicable | 1 (0.7) | 4 (4.5) | 5 (7.1) | 1 (0.6) | 9 (6.0) | 7 (3.2) | 2 (2.3) | 1 (33.3) | 10 (3.2) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
How familiar are you with the WeChat app? | Very familiar | 125 (82.8) | 45 (51.1) | 34 (48.6) | 131 (81.9) | 73 (49.0) | 142 (65.1) | 61 (69.3) | 1 (33.3) | 204 (66.0) |
Somewhat familiar | 24 (15.9) | 36 (40.9) | 27 (38.6) | 27 (16.9) | 60 (40.3) | 63 (28.9) | 23 (26.1) | 1 (33.3) | 87 (28.2) | |
Not at all familiar | 0 | 5 (5.7) | 3 (4.3) | 0 (0.0) | 8 (5.4) | 6 (2.8) | 2 (2.3) | 0 (0.0) | 8 (2.6) | |
Not applicable | 2 (1.3) | 2 (2.3) | 6 (8.6) | 2 (1.3) | 8 (5.4) | 7 (3.2) | 2 (2.3) | 1 (33.3) | 10 (3.2) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
If you selected i or ii for question 2.6, how often do you use WeChat? | Many times a day | 140 (92.7) | 68 (77.3) | 50 (71.4) | 150 (94.9) | 108 (81.2) | 185 (90.2) | 71 (84.5) | 2 (100) | 258 (88.7) |
Once a day | 4 (2.6) | 8 (9.1) | 7 (10) | 3 (1.9) | 16 (12.0) | 11 (5.4) | 8 (9.5) | 0 (0.0) | 19 (6.5) | |
Once every few days | 2 (1.3) | 2 (2.3) | 3 (4.3) | 4 (2.5) | 3 (2.3) | 4 (2.0) | 3 (3.6) | 0 (0.0) | 7 (2.4) | |
Once a week | 1 (0.7) | 0 | 0 (0.0) | 0 (0.0) | 1 (0.8) | 1 (0.5) | 0 (0.0) | 0 (0.0) | 1 (0.3) | |
A few times a month | 1 (0.7) | 1 (1.1) | 0 (0.0) | 1 (0.6) | 1 (0.8) | 1 (0.5) | 1 (1.2) | 0 (0.0) | 2 (0.7) | |
Rarely or not at all | 1 (0.7) | 2 (2.3) | 1 (1.4) | 0 (0.0) | 4 (3.0) | 3 (1.5) | 1 (1.2) | 0 (0.0) | 4 (1.4) | |
Missing | ||||||||||
Total | 151 (100) | 88 (100) | 61 (100) | 158 (100) | 133 (100) | 205 (100) | 84 (100) | 2 (100) | 291 (100) |
Patient use of the internet for health information and support
Survey | Response | Location | Age | Gender | Total: n (%) | |||||
---|---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40+ years | F | M | Unknown | |||
I access information about general health issues on the Internet | Often | 64 (42.4) | 33 (37.5) | 26 (37.1) | 70 (43.8) | 53 (35.6) | 83 (38.1) | 39 (44.3) | 1 (33.3) | 123 (39.8) |
Sometimes | 80 (53.0) | 45 (51.1) | 22 (31.4) | 81 (50.6) | 66 (44.3) | 107 (49.1) | 38 (43.2) | 2 (66.7) | 147 (47.6) | |
Never | 7 (4.6) | 10 (11.4) | 22 (31.4) | 9 (5.6) | 30 (20.1) | 28 (12.8) | 11 (12.5) | 0 (0.0) | 39 (12.6) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I access information about mental health issues on the Internet | Often | 47 (31.1) | 30 (34.1) | 22 (31.4) | 54 (33.8) | 45 (30.2) | 68 (31.2) | 30 (34.1) | 1 (33.3) | 99 (32.0) |
Sometimes | 92 (60.9) | 45 (51.1) | 27 (38.6) | 92 (57.5) | 72 (48.3) | 117 (53.7) | 45 (51.1) | 2 (66.7) | 164 (53.1) | |
Never | 12 (7.9) | 13 (14.8) | 21 (30) | 14 (8.8) | 32 (21.5) | 33 (15.1) | 13 (14.8) | 0 (0.0) | 46 (14.9) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
If you selected i or ii to questions 3.1 and/ or 3.2,what types of Internet sources have you used to access health information (please select all that apply). | Official websites | 56 (38.4) | 34 (42.5) | 17 (33.3) | 57 (37.7) | 50 (40.7) | 73 (37.2) | 32 (41.0) | 2 (66.7) | 107 (38.6) |
Online discussion forums | 45 (30.8) | 14 (17.5) | 8 (15.7) | 48 (31.2) | 19 (15.4) | 46 (23.5) | 20 (25.6) | 1 (33.3) | 67 (24.2) | |
Online or mobile apps | 63 (43.2) | 24 (30.0) | 25 (49.0) | 73 (47.4) | 39 (31.7) | 72 (36.7) | 38 (48.7) | 2 (66.7) | 112 (40.4) | |
Social media | 67 (35.9) | 41 (51.3) | 23 (45.1) | 72 (46.8) | 59 (48.0) | 93 (47.4) | 38 (48.7) | 0 (0.0) | 131 (47.3) | |
Other (fill in) | 11 (7.5) | 8 (10.0) | 4 (7.8) | 11 (7.1) | 12 (9.8) | 19 (9.7) | 3 (3.8) | 1 (33.3) | 23 (8.3) | |
Missing | 2 (1.4) | 0 (0.0) | 0 (0.0) | 2 (1.3) | 0 (0.0) | 2 (1.0) | 0 (0.0) | 0 (0.0) | 2 (0.7) | |
Total | 146 (100) | 80 (100) | 51 (100) | 154 (100) | 123 (100) | 196 (100) | 78 (100) | 3 (100) | 277 (100) | |
If you selected i or ii to questions 3.1 and/ or 3.2,what types of information do you generally search for? (Choose all that apply) | Information about medications | 58 (39.8) | 42 (52.5) | 18 (35.3) | 62 (40.2) | 56 (45.5) | 85 (43.4) | 30 (38.5) | 3 (100) | 118 (52.3) |
Information on how to cope with or manage symptoms | 82 (56.2) | 36 (45.0) | 15 (29.4) | 84 (54.5) | 49 (39.8) | 94 (48.0) | 36 (46.2) | 3 (100) | 133 (48.0) | |
General information about health and/ or mental health problems | 119 (81.5) | 45 (56.3) | 34 (66.7) | 121 (78.6) | 77 (62.6) | 141 (71.9) | 54 (69.2) | 3 (100) | 198 (71.5) | |
Information about general health and/ or mental health services | 62 (42.5) | 36 (45.0) | 19 (37.3) | 63 (40.3) | 54 (43.9) | 88 (44.9) | 27 (34.6) | 2 (66.7) | 117 (42.2) | |
Other (fill) | 4 (2.7) | 7 (8.8) | 3 (5.9) | 6 (39.0) | 8 (6.5) | 12 (6.1) | 2 (2.6) | 0 (0.0) | 14 (5.1) | |
Total | 146 (100) | 80 (100) | 51 (100) | 154 (100) | 123 (100) | 196 (100) | 78 (100) | 3 (100) | 277 (100) | |
I feel confident in my ability to use the Internet to find health and mental health information | Strongly Disagree | 1 (0.7) | 1 (1.1) | 0 (0.0) | 1 (0.6) | 1 (0.7) | 2 (0.9) | 0 (0.0) | 0 (0.0) | 2 (0.6) |
Disagree | 8 (5.3) | 4 (4.5) | 6 (8.6) | 6 (3.8) | 12 (8.1) | 10 (4.6) | 8 (9.1) | 0 (0.0) | 18 (5.8) | |
Undecided | 56 (37.1) | 20 (22.7) | 31 (44.3) | 63 (39.4) | 44 (29.5) | 74 (33.9) | 32 (36.4) | 1 (33.3) | 107 (34.6) | |
Agree | 77 (51.0) | 61 (69.3) | 30 (42.9) | 79 (49.4) | 89 (59.7) | 122 (56.0) | 44 (50.0) | 2 (66.7) | 168 (54.4) | |
Strongly Agree | 9 (6.0) | 2 (2.3) | 3 (4.3) | 11 (6.9) | 3 (2.0) | 10 (4.6) | 4 (4.5) | 0 (0.0) | 14 (4.5) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I feel confident in my ability to tell the difference between high quality and low quality sources of health information on the Internet | Strongly Disagree | 0 (0.0) | 1 (1.1) | 0 (0.0) | 0 (0.0) | 1 (0.7) | 1 (0.5) | 0 (0.0) | 0 (0.0) | 1 (0.3) |
Disagree | 9 (6.0) | 4 (4.5) | 7 (10) | 9 (5.6) | 11 (7.4) | 13 (6.0) | 7 (8.0) | 0 (0.0) | 20 (6.5) | |
Undecided | 57 (37.7) | 33 (37.5) | 31 (44.3) | 64 (40.0) | 57 (38.3) | 93 (42.7) | 26 (29.6) | 2 (66.7) | 121 (39.2) | |
Agree | 74 (49.0) | 48 (54.5) | 31 (44.3) | 76 (47.5) | 77 (51.7) | 103 (47.2) | 49 (55.7) | 1 (33.3) | 153 (49.5) | |
Strongly Agree | 11 (7.3) | 2 (2.3) | 1 (1.4) | 11 (6.9) | 3 (2.0) | 8 (3.7) | 6 (6.8) | 0 (0.0) | 14 (4.5) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I feel confident in my ability to use health information from the Internet to make health decisions | Strongly Disagree | 0 (0.0) | 1 (1.1) | 0 (0.0) | 0 (0.0) | 1 (0.7) | 1 (0.5) | 0 (0.0) | 0 (0.0) | 1 (0.3) |
Disagree | 26 (17.2) | 4 (4.5) | 8 (11.4) | 27 (16.9) | 11 (7.4) | 22 (10.1) | 16 (18.2) | 0 (0.0) | 38 (12.3) | |
Undecided | 62 (41.1) | 35 (39.8) | 35 (50) | 67 (41.9) | 65 (43.6) | 100 (45.9) | 30 (34.1) | 2 (66.7) | 132 (42.7) | |
Agree | 58 (38.4) | 47 (53.4) | 26 (37.1) | 61 (38.1) | 70 (47.0) | 91 (41.7) | 39 (44.3) | 1 (33.3) | 131 (42.4) | |
Strongly Agree | 5 (3.3) | 1 (1.1) | 1 (1.4) | 5 (3.1) | 2 (1.3) | 4 (1.8) | 3 (3.4) | 0 (0.0) | 7 (2.3) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I have previously used resources available on the Internet (e.g. web-based or mobile apps) to support me with managing health conditions | Yes | 58 (38.4) | 38 (43.2) | 29 (41.4) | 61 (38.1) | 64 (43.0) | 96 (41.7) | 34 (38.6) | 0 (0.0) | 125 (40.5) |
No | 74 (49.0) | 31 (35.2) | 23 (32.9) | 79 (49.4) | 49 (32.9) | 81 (39.4) | 40 (45.5) | 2 (66.7) | 128 (41.4) | |
Not sure | 19 (12.6) | 19 (21.6) | 18 (25.7) | 20 (12.5) | 36 (24.2) | 41 (18.8) | 14 (15.9) | 1 (33.3) | 56 (18.1) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) |
“When I was just diagnosed with depression… I did research about depression. I searched on Sohu.com , with information about the symptoms of depression, how bad it will be with no treatments, and why.” (HKMC Older)
When I first identified depression, I stayed into the patient group chat for quite a long time. Then I gradually followed some official accounts on Wechat. There were so many official accounts with inspiring articles which related to psychology. They benefit me very much, I got a lot of help from them. (SMHC Younger)
Patient acceptability of MBC and eMBC
Survey | Response | Location | Age | Gender | Total: n (%) | |||||
---|---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40+ years | F | M | Unknown | |||
I would be willing to spend 5 min completing a questionnaire as described in the scenario above before each appointment with my doctor | Strongly disagree | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Disagree | 2 (1.3) | 3 (3.4) | 1 (1.4) | 1 (0.6) | 5 (3.4) | 4 (1.8) | 2 (2.3) | 0 (0.0) | 6 (1.9) | |
Somewhat disagree | 5 (3.3) | 14 (15.9) | 6 (8.6) | 8 (5.0) | 17 (11.4) | 19 (8.7) | 5 (5.7) | 1 (33.3) | 25 (8.1) | |
Somewhat agree | 23 (15.2) | 12 (13.6) | 12 (17.1) | 25 (15.6) | 22 (14.8) | 30 (13.8) | 16 (18.2) | 1 (33.3) | 47 (15.2) | |
Agree | 98 (64.9) | 56 (63.6) | 48 (68.6) | 101 (63.1) | 101 (67.8) | 142 (65.1) | 60 (68.2) | 0 (0.0) | 202 (65.4) | |
Strongly agree | 23 (15.2) | 3 (3.4) | 3 (4.3) | 25 (15.6) | 4 (2.7) | 23 (10.6) | 5 (5.7) | 1 (33.3) | 29 (9.4) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I would like to play a more active role in making decisions about my treatment for depression. | Strongly disagree | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Disagree | 2 (1.3) | 3 (3.4) | 0 (0.0) | 1 (0.6) | 4 (2.7) | 4 (1.8) | 1 (1.1) | 0 (0.0) | 5 (1.6) | |
Somewhat disagree | 1 (0.7) | 9 (10.2) | 1 (1.4) | 1 (0.6) | 10 (6.7) | 9 (4.1) | 2 (2.3) | 0 (0.0) | 11 (3.6) | |
Somewhat agree | 13 (8.6) | 12 (13.6) | 15 (21.4) | 18 (11.3) | 22 (14.8) | 27 (142.) | 13 (14.8) | 0 (0.0) | 40 (12.9) | |
Agree | 90 (59.6) | 55 (62.5) | 46 (65.7) | 92 (57.5) | 99 (66.4) | 131 (60.1) | 57 (64.8) | 3 (100) | 191 (61.8) | |
Strongly agree | 45 (29.8) | 9 (10.2) | 8 (11.4) | 48 (30.0) | 14 (9.4) | 47 (21.6) | 15 (17.0) | 0 (0.0) | 62 (20.1) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I believe that using a short questionnaire to keep track of changes in my depression symptoms would help with my depression treatment | Strongly disagree | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Disagree | 5 (3.3) | 5 (5.7) | 2 (2.9) | 6 (3.8) | 6 (4.0) | 9 (4.1) | 3 (3.4) | 0 (0.0) | 12 (3.9) | |
Somewhat disagree | 5 (3.3) | 10 (11.4) | 6 (8.6) | 9 (5.6) | 12 (8.1) | 17 (7.8) | 3 (3.4) | 1 (33.3) | 21 (6.8) | |
Somewhat agree | 29 (19.2) | 23 (26.1) | 18 (25.7) | 32 (20.0) | 38 (26.5) | 47 (21.6) | 22 (25.0) | 1 (33.3) | 70 (22.7) | |
Agree | 95 (62.9) | 45 (51.1) | 39 (55.7) | 92 (57.5) | 87 (58.4) | 125 (57.3) | 53 (60.2) | 1 (33.3) | 179 (57.9) | |
Strongly agree | 17 (11.3) | 5 (5.7) | 5 (7.1) | 21 (13.1) | 6 (4.0) | 20 (9.2) | 7 (8.0) | 0 (0.0) | 27 (8.7) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I believe that using a short questionnaire to keep track of changes in my depression symptoms would help me to talk to my doctor about my depression treatment | Strongly disagree | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Disagree | 1 (0.7) | 4 (4.5) | 0 (0.0) | 1 (0.6) | 4 (2.7) | 4 (1.8) | 1 (1.1) | 0 (0.0) | 5 (1.6) | |
Somewhat disagree | 4 (2.6) | 11 (12.5) | 3 (4.3) | 4 (2.5) | 14 (9.4) | 13 (6.0) | 5 (5.7) | 0 (0.0) | 18 (5.8) | |
Somewhat agree | 28 (18.5) | 22 (25.0) | 23 (32.9) | 37 (23.1) | 36 (24.2) | 54 (24.8) | 18 (20.5) | 0 (0.0) | 73 (23.6) | |
Agree | 99 (65..5) | 48 (54.5) | 41 (58.6) | 96 (60.0) | 92 (61.7) | 127 (58.3) | 59 (67.0) | 1 (33.3) | 188 (60.8) | |
Strongly agree | 19 (12.6) | 3 (3.4) | 3 (4.3) | 22 (13.8) | 3 (2.0) | 20 (9.2) | 5 (5.7) | 2 (66.7) | 25 (8.1) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I believe that using a questionnaire as described in the scenario would help to understand my depression | Strongly disagree | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) |
Disagree | 3 (2.0) | 6 (6.8) | 3 (4.3) | 4 (2.5) | 8 (5.4) | 9 (4.1) | 3 (3.4) | 0 (0.0) | 12 (3.9) | |
Somewhat disagree | 13 (8.6) | 13 (14.8) | 2 (2.9) | 14 (8.8) | 14 (9.4) | 20 (9.2) | 7 (8.0) | 1 (33.3) | 28 (9.1) | |
Somewhat agree | 23 (15.2) | 18 (20.5) | 22 (31.4) | 28 (17.5) | 35 (23.5) | 43 (19.7) | 19 (21.6) | 1 (33.3) | 63 (20.4) | |
Agree | 96 (63.6) | 48 (54.5) | 41 (58.6) | 95 (59.4) | 90 (60.4) | 129 (59.2) | 55 (62.5) | 1 (33.3) | 185 (59.9) | |
Strongly agree | 16 (10.6) | 3 (3.4) | 2 (2.9) | 19 (11.9) | 2 (1.3) | 17 (7.8) | 4 (4.5) | 0 (0.0) | 21 (6.8) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) |
Survey | Response | Location | Age | Gender | Total: n (%) | |||||
---|---|---|---|---|---|---|---|---|---|---|
SMHC: n (%) | HKMC: n (%) | FXMC: n (%) | 18–39 years | 40+ years | F | M | Unknown | |||
I would be willing to use Internet-based resources as described in the scenario to support me with managing depression | Strongly disagree | 0 (0.0) | 1 (1.1) | 0 (0.0) | 0 (0.0) | 1 (0.7) | 0 (0.0) | 1 (1.1) | 0 (0.0) | 1 (0.3) |
Disagree | 4 (2.6) | 10 (11.4) | 7 (10) | 3 (1.9) | 18 (12.1) | 14 (6.4) | 6 (6.8) | 1 (33.3) | 21 (6.8) | |
Somewhat disagree | 13 (8.6) | 15 (17.0) | 9 (12.9) | 12 (7.5) | 25 (16.8) | 26 (11.9) | 11 (12.5) | 0 (0.0) | 37 (12.0) | |
Somewhat agree | 36 (23.8) | 18 (20.5) | 16 (22.9) | 43 (26.9) | 27 (18.1) | 48 (22.0) | 20 (22.7) | 2 (66.7) | 70 (22.7) | |
Agree | 82 (54.3) | 40 (45.5) | 36 (51.4) | 85 (53.1) | 73 (49.0) | 115 (52.8) | 43 (48.9) | 0 (0.0) | 158 (51.1) | |
Strongly agree | 16 (10.6) | 4 (4.5) | 2 (2.9) | 17 (10.6) | 5 (3.4) | 15 (6.9) | 7 (8.0) | 0 (0.0) | 22 (7.1) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I would be willing to use a mobile app to track my symptoms if my doctor recommended it | Strongly disagree | 1 (0.7) | 1 (1.1) | 0 (0.0) | 1 (0.6) | 1 (0.7) | 1 (0.5) | 1 (1.1) | 0 (0.0) | 2 (0.6) |
Disagree | 1 (0.7) | 12 (13.6) | 10 (14.3) | 3 (1.9) | 20 (13.4) | 16 (7.3) | 6 (6.8) | 1 (33.3) | 23 (7.4) | |
Somewhat disagree | 12 (7.9) | 15 (17.0) | 11 (15.7) | 11 (6.9) | 27 (18.1) | 26 (11.9) | 12 (13.6) | 0 (0.0) | 38 (12.3) | |
Somewhat agree | 27 (17.9) | 16 (18.2) | 12 (17.1) | 29 (18.1) | 26 (17.4) | 35 (16.1) | 19 (21.6) | 1 (33.3) | 55 (17.8) | |
Agree | 85 (56.3) | 41 (46.6) | 35 (50) | 91 (56.9) | 70 (47.0) | 119 (54.6) | 41 (46.6) | 1 (33.3) | 161 (52.1) | |
Strongly agree | 25 (16.6) | 3 (3.4) | 2 (2.9) | 25 (15.6) | 5 (3.4) | 21 (9.6) | 9 (10.2) | 0 (0.0) | 30 (9.7) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) | |
I believe that I would be able to use an app to respond to a short questionnaire about my depression symptoms on a regular basis | Strongly disagree | 0 (0.0) | 1 (1.1) | 0 (0.0) | 0 (0.0) | 1 (0.7) | 0 (0.0) | 1 (1.1) | 0 (0.0) | 1 (0.3) |
Disagree | 4 (2.6) | 11 (12.5) | 13 (18.6) | 4 (2.5) | 24 (16.1) | 19 (8.7) | 8 (9.1) | 1 (33.3) | 28 (9.1) | |
Somewhat disagree | 10 (6.6) | 16 (18.2) | 6 (8.6) | 8 (5.0) | 24 (16.1) | 25 (11.5) | 7 (8.0) | 0 (0.0) | 32 (10.4) | |
Somewhat agree | 22 (14.6) | 16 (18.2) | 14 (20.0) | 29 (18.1) | 23 (15.4) | 33 (15.1) | 18 (20.5) | 1 (33.3) | 52 (16.8) | |
Agree | 97 (64.2) | 42 (47.7) | 36 (51.4) | 101 (63.1) | 74 (49.7) | 126 (57.8) | 48 (54.4) | 1 (33.3) | 175 (56.6) | |
Strongly agree | 18 (11.9) | 2 (2.3) | 1 (1.4) | 18 (11.3) | 3 (2.0) | 15 (6.9) | 6 (6.8) | 0 (0.0) | 21 (6.8) | |
Total | 151 (100) | 88 (100) | 70 (100) | 160 (100) | 149 (100) | 218 (100) | 88 (100) | 3 (100) | 309 (100) |
“The patient can understand and record himself by using the app, and the clinician can better understand the changes of the patient’s emotion. I think this win-win situation is pretty good.” (SMHC FG1)
Especially during initial assessment, let’s say the app is universal[ly] used in any clinics, then it doesn’t matter where the patient will have the initial assessment, since the initial assessment is just some form tests. Patients can save the consultation fee and the time. That is the truth, I think using the app does good to me. (SMHC FG1)
“it’s very convenient, in terms of the time. For example, if you can do it on your mobile phone, then you probably can finish it on the public transit (bus, subway), or do it on their way (to the hospital). Without the app, you need to do it in the hospital.”. (FXMC Young)
“The app does not just present the result by adding scores, but let’s say, it can reduce the time that clinician has to inquire patients, and also can direct the patients to adjust themselves, then it is beneficial. I think this is what the app should be like.” (SMHC FG1)
Focus group participants also acknowledged that eMBC can help with understanding depression and self-management:“I think that the Mental Health Center in Hongkou will soon be famous and customers will have a degree of adhesion, they will come by themselves and the center’s reputation will increase”. (HK young group)
The collaborative nature of eMBC also appealed to patients:“With this app, for example, you can have an assessment and test for yourself, then you can have some prevention, that is, you can mediate yourself, or go to the hospital for medical treatment, let’s say, an early planning” (HKMC young group).
Regarding whether they would adhere to eMBC instruction from their clinician, participant responses suggest that they value clinical advice:“The patient can learn more about himself and these quantitative indicators can show him what is happening now, or what the whole course of the depression will be. If combined (with) the clinician’s expertise to develop a treatment plan, will increase the patient’s confidence. I feel that the patient can know himself better in this way, since people may get nervous when they don’t know what is happening”. (HKMC Young group)
Focus group participants also made suggestions about ways to improve the uptake and use of eMBC, including through promotion and awareness, as stated by a participants from FXMC: “maybe there should be some promotion” (FX Young)“Absolutely. Whatever the doctor said, I will adhere to. Listening to the clinician is very important, whatever the clinician said is right”. (SMHC FG2)
“There are so many apps in the market, how can I assess if an app is good or not?” (HK Young group)
“...that the app can shorten the time of consultation, is actually also a shortcoming. Each patient with depression is very distressed. He is not understood at home nor in the society. Hey, I am seeing the clinician because I want to talk more with the clinician from whom I can get support and understanding. Why do I have to shorten the interview time? I think this is very difficult to understand…To my opinion, I am seeing the clinician to discuss with him my symptoms, I can do the measure later if I need to.” (SMHC 01)
Consonant with some concerns voiced by clinicians, one patient from HKMC also spoke to concerns about eMBC eroding clinician expertise or authority:“I think this should be discussed with the doctors. After all if you use the app and learn by yourself based on your medical conditions, it’s not professional. In addition, the medications usually have side effects, and if there are changes caused by the side effects, I feel it’s better to discuss with the doctors face to face”. (FXMC Young)
Similarly, there is a perception that eMBC might lead to a loss of nuance in understanding or the human, interpretive element of a traditional clinical consultation. One SMHC participant said of using an app: “Then there is no need for Dr. [Name] showing up. A robot can do that too.”“If the clinician relies solely on the result of the app then give the patient a corresponding diagnosis, everyone can be a clinician, right?...I am worried that the app will cause the deterioration of the clinician’s professional medical level… (and they risk becoming) over-reliant on the app”. (HK Young group)
Lack of conviction was also apparent in some focus group participants about clinical impact or accuracy of eMBC:“The subjective things cannot be quantified. Not every patient with depression has the same symptom nor will they have the same emotion feelings.” (SMHC 01)
“I may not be able to fully express the changes I had in the past period. Because the feeling of depression is comparatively subtle, it is not easy to describe”. (SMHC FG2)
From a more technical standpoint, concerns were also voiced about potential lack of long-term engagement with eMBC and about having to use or download a specific app:“...since the questions in the measure are fixed, patient might change his answer next time just because he wants to have a better score instead of indicating his real feelings.” (SMHC 01)
“I guess when the app comes out, at the beginning people would be like, I’ll download it to measure my moods, but you need to consider the follow-ups. Some people may just download it, use it for measurement, and then they’d be like oh there’s nothing wrong, so they may uninstall. This could happen” (FX Young group)