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High score on evaluation of a Mobile app for Shared Decision-Making in Treatment for Psychotic Disorders

Mari Skoge at SIRS

The evaluation shows that participants evaluated the iTandem intervention as both feasible and acceptable. The feedback from both patients and clinicians shows high mean scores on the System Usability Scale.

What was the aim of the study?

The aim of the study was to investigate how patients with psychotic disorders and their clinicians evaluate the feasibility and acceptability of integrating iTandem, a mobile application (app) for shared decision-making (SDM), in standard treatment.

iTandem is developed for flexible use, and it is possible to change the selected focus areas during the course of treatment (see Fig. 1). When the patient registers data in iTandem, a visual report is generated. The report can be reviewed and discussed in therapy sessions. The app consists of 8 modules (see Fig. 2). The content is based on positive psychology and a recovery perspective.

Why is this important?

  • In a changing digitalized world, service-users are expected to take a greater part in healthcare services
  • Personal involvement in setting goals for treatment has the potential to make it more focused and tailored to the service-users’ needs
  • Patients with psychotic disorders may have difficulties with identifying and expressing needs
  • Digital tools have potential to compensate for some barriers to SDM in therapy for psychotic disorders, but we know little about how

How did we do it?

  • We recruited 8 clinicians and 9 adult patients in treatment for psychotic disorders from both outpatient and inpatient units within Innlandet Hospital Trust, covering a mainly rural area of Norway
  • Patients and clinicians jointly decided on focus areas based on current preferences and needs. They used iTandem for 6 weeks as part of treatment
  • Quantitative data was collected pre- and post-intervention. Qualitative data was collected from individual in-depth semi-structured post-intervention interviews
  • A mixed methods approach was used for analysis. Qualitative data were analyzed using a critical realist oriented thematic analysis

What did we find?

We generated three themes from the thematic analysis related to the added value of the intervention. The first theme was a prerequisite for added value:

  1. Social scaffolding provided by clinicians, and often also close ones
  2. Treatment focus was tailored based on patient needs
  3. An aid for distributed cognition

The feedback on our study shows high mean scores on the System Usability Scale. Mean score from patients: 75, from clinicians: 82.

What impact will iTandem have for patients and for clinicians?

1) The project encourages further work to secure SDM through digital tools in services for persons with severe mental illness.
2) Other factors than symptom severity and level of functioning matter when evaluating aptness for digital interventions.
3) Training staff in digital therapeutical practices is needed to ensure successful and sustainable implementation.

I felt that I was very involved in deciding what we would focus on. Although it was difficult to express myself firmly, it helped me think “okay, this is what I want to focus on, this is what I want”

– patient

“[I used iTandem] as a reminder for myself, to maintain structure and keep track from one session to the next. I think it worked well for remembering to bring up topics.
– Clinician