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Real-world implementation of a smartphone-based psychoeducation program for bipolar disorder: observational ecological study

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dc.contributor.author García-Estela, Aitana
dc.contributor.author Cantillo, Jordi
dc.contributor.author Angarita-Osorio, Natalia
dc.contributor.author Mur-Mila, Estanislao
dc.contributor.author Anmella, Gerard
dc.contributor.author Pérez, Victor
dc.contributor.author Vieta, Eduard
dc.contributor.author Hidalgo Mazzei, Diego
dc.contributor.author Colom, Francesc
dc.date.accessioned 2022-10-06T05:44:13Z
dc.date.available 2022-10-06T05:44:13Z
dc.date.issued 2022
dc.identifier.citation García-Estela A, Cantillo J, Angarita-Osorio N, Mur-Milà E, Anmella G, Pérez V, Vieta E, Hidalgo-Mazzei D, Colom F. Real-world implementation of a smartphone-based psychoeducation program for bipolar disorder: observational ecological study. J Med Internet Res. 2022 Feb 2;24(2):e31565. DOI: 10.2196/31565
dc.identifier.issn 1439-4456
dc.identifier.uri http://hdl.handle.net/10230/54279
dc.description.abstract Background: SIMPLe is an internet-delivered self-management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment. Objective: The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use. Methods: This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users' data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use. Results: We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01). Conclusions: The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management.
dc.format.mimetype application/pdf
dc.language.iso eng
dc.publisher JMIR Publications
dc.relation.ispartof J Med Internet Res. 2022 Feb 2;24(2):e31565
dc.rights ©Aitana García-Estela, Jordi Cantillo, Natalia Angarita-Osorio, Estanislao Mur-Milà, Gerard Anmella, Víctor Pérez, Eduard Vieta, Diego Hidalgo-Mazzei, Francesc Colom. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 02.02.2022. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.
dc.rights.uri https://creativecommons.org/licenses/by/4.0/
dc.title Real-world implementation of a smartphone-based psychoeducation program for bipolar disorder: observational ecological study
dc.type info:eu-repo/semantics/article
dc.identifier.doi http://dx.doi.org/10.2196/31565
dc.subject.keyword Intervention
dc.subject.keyword SIMPLe
dc.subject.keyword App
dc.subject.keyword Bipolar disorder
dc.subject.keyword Mobile phone
dc.subject.keyword Psychoeducation
dc.subject.keyword Smartphone
dc.rights.accessRights info:eu-repo/semantics/openAccess
dc.type.version info:eu-repo/semantics/publishedVersion

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