Background
Methods
Scoping review methodology
Stage 1: Identifying the review question
Stage 2: Identifying relevant studies
Key search terms | Inclusion criteria | Exclusion criteria | |
---|---|---|---|
Population | Severe mental illness Serious mental illness Schizophrenia Psychotic disorders Psychotic illness | Adults experiencing SMI including psychotic illness or mental illnesses with psychotic features | Solely high prevalence mental health conditions including anxiety, depression Solely bipolar disorder or major depression where presence of psychosis is unclear |
Intervention | Internet-based intervention Internet web-based eHealth, mHealth Online | Primary: Service user and mental health worker engaged in the intervention, whether synchronously or asynchronously Secondary: Service user and research personnel in mental health service engaged in the intervention | Intervention does not engage both service user and mental health worker or research personnel Stand-alone computer-mediated intervention (no web-based or mobile-device based component) |
Outcome | Recovery Self-management Illness management | Interventions that aim to support personal recovery and/or self-management | Interventions that focus solely on clinical recovery such as symptom reduction or treatment compliance |
Stage 3: Study selection
Stage 4: Charting the data
Stage 5: Collating, summarizing and reporting results
Results
Summary of included studies
Study characteristics
Study | Design/MMAT Rating | Setting/Country/Year | Intervention | Service users/ diagnosis | Workers/ profession |
---|---|---|---|---|---|
Anttila, Koivunen [42] | Qualitative description: worker questionnaires after 12 months using intervention 2/4 | Two inpatient psychiatric hospitals, Norway, 2005-2006 |
Mieli.Net
WB: patient education portal to support SM. Includes information, peer and staff support channels. Nurses used portal to deliver 6 education sessions over 1 month. SU continued access post discharge. | n = undisclosed Available to inpatients diagnosed with schizophrenia | n = 56 psychiatric nurses participating in study |
Koivunen, Huhtasalo [43] | Qualitative description: worker FGs and 1:1 IVs after providing systematic IT education 2/4 | n = 30 (subset of above). 14 nurses provided IT based education and 16 provided conventional education | |||
de Leeuw, van Splunteren [44] | Mixed methodsa Single group pilot study: qualitative results only. SU and worker open-ended questions at BL and after 9 months; and FGs at 15 months. 0/4 | Two MH organizations, Netherlands, 2009-2011 |
Personal Control in Rehabilitation (PCR)
WB: SM & communication portals including information, SM, communication tools. SU could authorize worker and carer access. | n = 19 (FG participants); 100% schizophrenia or first episode psychosis; 74% male; aged16-66 years | n = 36 15 nurses, 8 psychiatric nurses, 4 SW, 3 psychologists, 3 psychiatrists, 3 managers |
Forchuk, Rudnick [45] | Mixed methods, Initial analysis of data from two group, delayed intervention RCT. SU questionnaire at BL, 6, 12, 18 months and usage data. SU and worker FGs held over 18 months 0/4 | Four community MH agencies, Canada, 2012-2014 | Mental health engagement network (MHEN)WB and MDB: App with personal health record and SM tools. Smart phone provided to SU; tablet device provided to workers for both to access health record. | n = 400 59% Psychotic disorder; 60% male; mean age 37 years | n = 54 Nurses, SW, OT |
Forchuk, Donelle [46] | Mixed methods, SU questionnaires, and FG data as illustrative quotes 1/4 | n = 394 (same sample as above) | |||
Goscha and Rapp [47] | Qualitative description: 2 x 1:1 SU and worker IVs after 4 months intervention use 3/4 | One community MH centre, Kansas, USA 2006-2007 |
CommonGround
WB: SDM program with peer content and peer support, used to create health report. Report viewed by prescriber and used in appointments to make shared decisions, final plan shared with treating team. | n = 12 SMI: Unspecified % schizophrenia/psychotic disorders; 58% male; mean age 45 years | n = 15 5 CM, 3 prescribers, 3 nurses, 2 PW, 2 supervisors |
Bonfils, Dreison [48] | Mixed-methods: worker 1:1 IV at end of intervention use, SU usage data, fidelity reports 2/4 | One urban community MH centre, Indiana, USA 2013-2015 | n = 167 SMI: 67% schizophrenia diagnosis; 57% male; age not disclosed | n = 12 supervisors, PWs, psychiatrists, managers | |
Korsbek and Tonder [49] | Qualitative description, single group pilot study: worker FGs, SU 1:1 IVs held after using intervention 4 months 1/4 | Hospital, community MH, psychosis treatment centre, Denmark, Year not stated |
Momentum
MDB and WB: SDM app, with peer support. SU used to prepare for meeting and could authorize worker access. Workers logged in to treatment site to view shared preparations. | n = 7 of 78 participants with SMI, including schizophrenia, affective disorders; gender and age not disclosed | n = 19 12 workers: nurses, OT, psychologist, SW; 7 doctors |
Blankers, van Emmerik [50] | Quantitative non-randomized, two group pilot study: blended FACT (with SM focus) and conventional FACT Standardized SU questionnaires at baseline and 3 months 2/4 | SMI community treatment centre, Netherlands, 2012-2013 |
Blended flexible assertive community treatment (Blended FACT)
WB: Information and education portal, appointment scheduling and a peer forum. Skype contact with nurses. Computer, Internet and webcam provided to SU. | n = 47 SMI including 40% schizoaffective disorder or schizophrenia; 47% male; mean age 46 years | n = undisclosed psychiatric nurses |
Gammon, Strand [51] | Mixed-methods: single group (two sites) exploratory study. SU questionnaires BL; usage data; SU and worker FGs after using intervention 3 months; SU discussion groups and forum posts; documents 2/4 | Multiple health services, 1 urban, and 1 rural community, Norway, 2015-2016 |
ReConnect
WB: recovery-focused portal with resources and information, messaging with providers, peer support forum; workers had partial portal access. | n = 29 Receiving MH services at least 6 months; including 10% schizophrenia-related diagnosis; 14% male; mean age 44 years | n = 27 including 11 nurses, 5 SW, 3 physicians |
Strand, Gammon [52] | Qualitative description: SU and worker FGs early stage; 1:1 IVs and 1 dyad IV late stage 4/4 | n = 14 (subset of above) | n = 17 (subset of above) |
Study | Design/MMAT Rating | Setting/Country/Year | Intervention | Service users/ diagnosis | Workers/ profession |
---|---|---|---|---|---|
Baumel, Correll (53) | Quantitative, single group, descriptive study: contact logs and SU survey after 6 months of use 1/4 | Ten MH services, USA, 2013-2014 | Health Technology Program (HTP) WB and MDB: smartphone illness SM app, website with daily support and education resources. Smartphone and laptop provided to SU. Workers support use, view website data and respond to messages. | n = 200 schizophrenia, schizoaffective disorder, psychotic disorder currently or recently in hospital; 59% male; mean age 34 years | n = undisclosed Health technology coach (research role): trained CM |
Thomas, Farhall (54) | Quantitative, feasibility pilot, single group study after 3 months use: SU questionnaires, usage data, and post intervention 1:1 IV used as illustrative quotes 4/4 | Community MH service, Australia, 2015 |
Self-Management and Recovery Technology (SMART)
WB SM and recovery-focused website. Tablet device provided to worker to use website with SU in 8 sessions. | n = 10 psychotic disorder; 90% male; mean age 42 years | n = 2 MH worker (research role) |
Schlosser, Campellone (55) | Quantitative, single group feasibility study in intervention design phase and prior to RCT: SU satisfaction and usage data, after 3 months use. 1:1 IV used as illustrative quotes 4/4 | Early psychosis clinic and community treatment centres, USA, year not stated |
Personalized Real-Time Intervention for Motivation Enhancement (PRIME)
MDB and WB: smartphone app for SU to select and monitor goals, communicate with peers, and worker. Profile viewed by worker on website. Smart phone provided to SU. | n = 20 recent onset schizophrenia (10 used PRIME version 1, 10 used PRIME version 2); 85% male, mean age 23 years | n = 6 Motivation coaches (research role): Masters-level clinicians |
Fortuna, Dimilia (56) | Quantitative, pilot feasibility study, single group: SU questionnaires at BL, 1 and 3 months; fidelity assessment; usage data 3/4 | Community clinical teams, USA, year not stated |
PeerTECH
MDB and WB: smartphone SM app, WB eModules delivered in sessions with PW, text messaging with PW. Smartphone provided to SU. | n = 8 Older adults, SMI and co-morbid chronic medical conditions: 25% schizophrenia diagnosis; 12.5% male; mean age 68 years | n = 3 Certified peer specialists (research role) |
Study quality
Outline of Internet-based interventions
Internet-Based Intervention Feature | Usual MHW | MHW employed for research project | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
PCR, Netherlands [44] | Momentum, Denmark [49] | Blended FACT, Netherlands [50] | HTP, USA [53] | SMART, Australia [54] | PRIME, USA [55] | PeerTECH, USA [56] | ||||||
Purpose | Self-management | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||
Recovery | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||||
Enhance communication / SDM | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||||
Training and support | Training/support provided to SU | ✔b | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | |
Training provided to workers | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||
Technology components | Internet-based information portal | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | |||
Smartphone / tablet computer app | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||||
Tools to record own content | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | |||
Information/tools to support daily living | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | |||
Communication channel with worker | ✔c | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||
Peer communication – digital or F2F | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||
Peer narratives (e.g. photos, videos, audio) | ✔ | ✔ | ✔ | ✔ | ✔ | |||||||
Worker, SU interactions | Face-to-face using technology - prescribed | ✔ | ✔ | ✔d | ✔ | ✔d | ✔ | |||||
Face-to-face using technology – flexible | ✔ | ✔ | ✔ | ✔ | ||||||||
Internet-based – prescribed | ✔ | |||||||||||
Internet-based – flexible | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||
Reported Benefits | Increases SU autonomy – worker view | ✔ | ✔ | ✔ | ✔ | ✔ | ||||||
Expands conversations – worker view | ✔ | ✔ | ✔ | |||||||||
Facilitates goal-related communication – SU view | ✔ | ✔ | ✔ | ✔ | ||||||||
Reported Barriers | Difficulties logging in | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | |||||
Extra workload, not integrated in service system | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | ||||||
Unsuitable for SU – worker view | ✔ | ✔ | ✔ | ✔ |
Interventions used with usual mental health workers
Interventions used with research workers
Influences of jointly using an Internet-based intervention on practice
Influences on interactions between service users and workers
“There have been good conversations in education sessions, so I consider web pages to be quite helpful in nursing.” ([42], p.151).
“They wouldn’t get as much information out of me (prior to CommonGround)…once I tell the computer what my situation is, and they discuss it with me…that has helped” ([47], p.270).
“The goal module has really helped. When he/she says, “I wish I’d do more of this,” then I can put pressure on. When it’s written down in there as a concrete goal, then it kind of lights up a fire of sorts.” ([51], p.8).
“Since adopting this technology, many clients expressed feelings of greater control in their health management and in their life” ([45], p.4).
[Without the website] “we wouldn’t have had nearly as much to talk about. And then I would have been more stuck for words I think. I wouldn’t have been able to talk about all the issues that we had discussed about the website” ([54], p.8).
“Why did [provider] agree to work with me through this tool if she never expected to do it? She should have just said no. You get so disappointed” ([51], p.9).
“It’s hard work on busy days with an uninterested patient” ([42], p.151).
“I feel like they (workers) have so much they have to do already that trying to say, “hey, make sure you get people in for CommonGround” would just feel overwhelming to them” ([48], p.4).
“a consumer explained that she did not dare to share it (her treatment preparation), as some of her considerations might be irrelevant for the staff” ([49], p.171).