Background
There is considerable potential for information technology within healthcare (such as e-Health interventions) to improve the capacity of patients to self-manage long-term conditions [
1]. Over 30 million people in the UK now access the internet every day [
2] and policy-makers are eager to harness the power of the internet to allow individuals to take a more active role in their own care [
3,
4]. One potential disadvantage of face-to-face group psychoeducation is the cost of therapist time, training and travel. In collaboration with patients with bipolar disorder, their families and health professionals we have developed an internet-based psychoeducational intervention called “Beating Bipolar” [
5]. This work has built on the success of group psychoeducation interventions for bipolar disorder (focusing on illness awareness, adherence to treatment, early detection of recurrence and lifestyle regularity), which have emerged as an effective treatment option for long-term management [
6‐
9].
There have been recent studies which have evaluated group-based psychoeducation for bipolar disorder, such as the randomised controlled trial by Castle et al., 2010 [
10], which found that the treatment group had a significantly reduced rate of relapse, and the randomised controlled trial by Eker and Harkin [
11] which found that patients’ adherence to medication had significantly increased after group psychoeducation. Larger randomised controlled trials of group psychoeducation for bipolar disorder found that manic symptoms may be reduced for up to 2 years following the intervention [
12], and a study by Bauer et al., 2006 [
13,
14], found that at 3 years follow-up the treatment group had significantly fewer weeks in a bipolar episode, significantly improved social functioning and significantly improved mental quality of life.
Beating Bipolar involves a blending of different delivery mechanisms, with initial face-to-face delivery, followed by internet-based interactive delivery of factual content and ongoing support via a web forum [
15]. The key areas covered are: i) the accurate diagnosis of bipolar disorder; ii) the causes of bipolar disorder; iii) the role of medication; iv) the role of lifestyle changes; v) relapse prevention and early intervention; vi) psychological approaches; vii) gender-specific considerations; and, viii) advice for family and carers. In the clinical trial [
16] participants were given access to each of the modules in turn every 2 weeks and were encouraged to discuss the content of each module within the discussion forum. The programme content is similar in focus to Bauer and McBride’s Life Goals Program [
17] and Colom and Vieta’s group psychoeducation intervention for bipolar disorder [
18]. In a recent exploratory randomised trial we found that
Beating Bipolar was relatively easy to deliver, engaging and had a modest effect on psychological quality of life [
16]. Here we report a qualitative study which aims to explore more fully issues relating to the feasibility, acceptability and impact of the intervention.
Appendix 1
Semi-structured interview schedule
INITIAL QUESTIONS:
How are you doing at the moment?
Have you felt better or worse since April, or do you feel the same as you felt then?
If participant feels better or worse: To what extent?
Could you access the programme?
To what extent do you feel competent in using a computer?
Did you access the programme at home or in a public venue (such as a library or internet café)?
If participant accessed programme in public venue: Did you feel that your privacy was compromised as a result of accessing the programme a public venue?
How much of the programme did you do?
(Can you tell me which modules you did?)
(Did you finish the modules?)
(Did you skip any modules?)
If participant did not continue with programme: Why did you decide not to continue with the programme?
Did you need assistance from anyone with any aspect(s) of the programme?
If so: who; with what; why?
Did you use the forum?
(Did you contribute to the forum or just read it?)
What are your impressions of the forum?
How could the forum be improved?
Do you, or would you, still log in to the website? (
If so: Why?)
Did you experience a significant high or low before, during, or after the programme (such as depression or mania)?
If so: Do you feel that this may have impacted on your ability to benefit from the programme?
Why did you want to undertake the programme?
What did you like about the programme?
What didn’t you like about the programme?
Were there aspects you found to be particularly helpful?
Were there aspects you found to be frustrating?
Overall, would you say you have benefitted from undertaking the programme?
Could you understand the content of the modules? (Ask for elaboration if necessary)
Were some modules easier to grasp than others? (If so: which were easier and why; which more difficult and why)
Did you have any difficulty paying attention to the modules? (If so: why?)
Were any modules more interesting than other modules? (If so: why?)
Were any modules more relevant to you than other modules? (If so: why; and why were other modules less relevant?)
Have you any other comments or suggestions for improvement regarding the content of the modules?
Did you share the content of any of the modules with anyone? (If so: which [aspects of] modules, why, and how?)
Did the programme impact on your relationship with your family?
Since using the programme have you made any lifestyle changes? (
If so: what are they?
And: what triggered this?)
What are your impressions of the visual appearance of the programme? (Probe: videos; tasks to do)
Was the pace of each module okay, or too fast or too slow?
Did the programme run smoothly on your computer?
Did you find any aspect of the design of the programme particularly engaging? (If so: which?)
Did you find any aspect of the design of the programme particularly frustrating? (If so: which?)
Have you any other comments or suggestions about the presentation of the modules?
Was the gap between modules about right?
Has the programme as a whole, or any module or modules in particular, impacted upon your understanding of bipolar disorder? (Can you tell me more?)
As a result of the programme are you more aware of how to manage your condition? (Can you tell me more?)
As a result of the programme have you modified aspects of your behaviour or your routine? (Can you tell me more?)
Has your attitude towards medication changed as a result of the programme? (Can you tell me more?)
G)
SUGGESTIONS FOR IMPROVEMENT
Have you any other comments or suggestions for improvements?
Do you think the programme may help others with bipolar disorder?
Would you recommend the programme to others with bipolar disorder? (If so: why?)
In the future should the programme be accessible to people with bipolar disorder via the NHS?
Can you think of characteristics of some participants which may prevent them from fully benefiting from this programme?
(Prompt for elaboration if necessary)
Aside from the programme, since July 2009 has anything or anyone else provided you with additional support to manage your bipolar disorder?
(If asked, give examples)
If so: How did this help?
If you had been given the choice of either Beating Bipolar the online programme or a group-based programme (where you may have up to 15 people with bipolar disorder learning together under the direction of a clinician) which format would you have preferred?
Why?
Competing interests
All authors report that they have no competing interests.
Authors’ contributions
RP recruited participants, conducted the interviews, and coded and analysed the data. RP, DS and SS sought agreement on the design and methods used for the study. RP drafted the manuscript. DS and SS contributed to the final manuscript. All authors read and approved the final manuscript.