Perspectives on Mobile Health Versus Clinic-Based Group Interventions for People With Serious Mental Illnesses: A Qualitative Study
Abstract
Objective:
Methods:
Results:
Conclusions:
Methods
Results
Participants
FOCUS (N=16) | WRAP (N=15) | |||
---|---|---|---|---|
Characteristic | N | % | N | % |
Gender | ||||
Male | 11 | 69 | 9 | 60 |
Female | 5 | 31 | 6 | 40 |
Race | ||||
White | 7 | 44 | 5 | 33 |
Black | 6 | 56 | 9 | 60 |
≥1 | 0 | — | 1 | 7 |
Latino ethnicity | 2 | 13 | 2 | 13 |
Education | ||||
8th grade | 1 | 6 | 0 | — |
Some high school | 4 | 25 | 2 | 13 |
High school diploma or GED | 7 | 44 | 4 | 27 |
Some college | 4 | 25 | 7 | 47 |
Bachelor’s degree | 0 | — | 1 | 7 |
Master’s degree | 0 | — | 1 | 7 |
Living status | ||||
Assisted | 5 | 31 | 4 | 27 |
With family | 0 | — | 4 | 27 |
Independent | 11 | 69 | 7 | 47 |
Had used a smartphone before | ||||
No | 5 | 31 | 6 | 40 |
Yes | 11 | 69 | 9 | 60 |
Diagnosis | ||||
Schizophrenia | 4 | 25 | 0 | — |
Schizoaffective disorder | 6 | 38 | 8 | 53 |
Bipolar disorder | 1 | 6 | 6 | 40 |
Major depression | 5 | 31 | 1 | 7 |
Satisfaction: Information, Accessibility, and Community
Theme and | |
---|---|
intervention | Quote |
New information | |
FOCUS | “With FOCUS there was some stuff that was new to me that I didn’t know about . . . and the doctor [in the FOCUS videos] would explain certain situations and I would remember it, and it would help me out with questions I had about what was going on with symptoms and stuff or medications or something. And the FOCUS program gave me enough information, like on different aspects of my own personal situations.” (Participant 41) |
WRAP | “[WRAP] taught me about myself, what it’s opened up to me and shown me some of the available resources that are out there . . . whereas the other groups that I had: ‘Okay, we’re just going to go talk about managing anxiety. You know, there’s five simple things to do to manage anxiety.’ They’re always the five same things. It’s like you never learn anything. . . . No light bulbs go off or anything like that, whereas in WRAP, some light bulbs went off and some new things.” (Participant 6) |
Accessibility | |
FOCUS | “[FOCUS] kept going with you everywhere you go. . . . No matter where you were at, what type of mood you come in, you can just type in something like that. I’m like, ‘Wow.’ And that’s what I liked about it—you could take it with you. . . . Help everywhere you go” (Participant 17); “I can go into FOCUS any time of day, I can’t, like, go to my case manager at midnight and check in with him, you know? But I can go into FOCUS any time of the night, and it’s like talking to someone.” (Participant 134) |
Community | |
WRAP | “What did I like most about [WRAP]? Being there with everyone, listening to everyone's story, and then getting the chance, you know, to share my story and my experience in life” (Participant 53); “[WRAP] made me realize I'm not in this alone. You know. There's a lot of people like me and that it made my awareness just come out.” (Participant 33) |
Treatment Commencement: Groups Versus Phones
Theme and | |
---|---|
intervention | Quote |
Phone | |
FOCUS | “I was [hoping for] the phone because for some reason it just sounded like a good experience . . . something new that I could possibly get involved in. . . . It went by a lot easier that way too. . . . The fact that I was at home and I could carry the phone with me.” (Participant 41) |
Group | |
WRAP | “I’m just not used to being in a group with a whole bunch of people telling their story.” (Participant 12) |
Impact of the Interventions: New Skills, Fresh Insights
Theme and | |
---|---|
intervention | Quote |
Fresh insights about mental illness | |
FOCUS | “[FOCUS] made me hope I can achieve more mentally and physically and what have you. It gave me insight into some successful endeavors and positive strength.” (Participant 140) |
WRAP | “[WRAP] inspired me to wanna find other things to do other than just sitting around the house and being a monotone person. I actually wanna meet [people]. . . . I'm more active. I'm more independent” (Participant 92); “I would say my recovery has been a struggle and it’s still a struggle. We’re still trying different medicines and stuff like that and that’s really challenging and frustrating to go through, taking this for 8 weeks to see if it works. . . . But the hope that things will get better and that there is a place of stability that can be achieved. Before the WRAP group, I didn’t really have any hope and encouragement in thinking that things will get better. . . . But learning there are things I can do daily to improve my mood and stuff like that . . . I think that’s what’s instilled the hope is realizing that there’s a lot more than I can control and have an impact on. You know, it’s not just I’m waiting for somebody else to do something. . . . So, it’s thinking about those things that you can do on a daily basis that make you feel better” (Participant 6); “With the WRAP, it's more you're enacting. You're more a participant, and you're more involved with your own recovery” (Participant 136); Interviewer: “What would you say is different today from what you were doing before you started WRAP 12 weeks ago?” Interviewee: “I’m more conscious in my daily interactions with people and how important they can be to me and me to them . . . realizing that that personal touch and that personal connection between people can be a vital tool for my mental health.” (Participant 6) |
New skills | |
FOCUS | “I liked what it would say about socialization, because being on the South Side, you have to know how to socialize and deal with people. Being on medication, they say we get the stigma. . . so we may get mistreated. . . . I’m high functioning, but I got to deal with the outside world. I have to know who to communicate to, who not to. . . . With FOCUS it says how to do it, how not to do it, give them a chance, don’t be scared of people, you know” (Participant 56); “I'm more open with people. . . . I'm not so quick to just like shut everybody out, which is sometimes what I still do” (Participant 108); “It helped me to learn a few things I didn’t even think about. . . . My sleep . . . can be like up and down, up and down. There was one patch where I only had like four hours of sleep. . . . Light in the room, I didn’t realize that could impact sleep. As far as caffeine that’s another thing that was brought up. . . . I learned not to drink caffeine so late at night” (Participant 108); “It motivated me in many ways. . . . It was drawing me in with the feedback. . . . It made me more motivated to go to other groups like [peer recovery center]. . . . It gave me a craving to expound cause I’m very much bashful, when I’m around individuals I know. . . . [FOCUS] freed me to go further” (Participant 67); “I would say this is the first time I’ve seen anybody take an interest in asking me what are, what is it like when you’re well? What are your goals of wellness? What does wellness look like to you? What are your triggers? . . . How can you help me get to some place [in recovery] if you don’t know where it is? You haven’t even bothered to ask, you know. Um, yeah, that’s a huge difference.” (Participant 6) |
Negative Experiences and Challenges With FOCUS and WRAP
Theme | |
---|---|
and intervention | Quote |
Repetition | |
FOCUS | “The options were few. Then, the same input. . . . You know I think it should be different when you call different times. It shouldn’t be the same thing they tell you to do. . . . I think there should be a little more variety and that was the only thing” (Participant 134); “At some point I just dropped off completely because it just . . . you can only do the same thing so many times . . . before it becomes so routine” (Participant 60); “Yes, I did already know those things. And it didn’t really help, you know. . . . It was feeling like it’s a waste, you know?” (Participant 10) |
Lack of personalization | |
FOCUS | “I am in sort of the advanced stage of recovery. The composite of choices was a bit dumbed down. . . . So [FOCUS] might have to target specific graduations of the program. . . . I would say at least three different levels. . . . Level one would be persons at the beginning of their recovery. Let’s say they’ve just been discharged from a facility or just was diagnosed . . . starting to learn about the illness. Level two is in the middle. They’ve reached a point where they’re getting more self-awareness or understanding of the illness and how to cope with certain symptomatic episodes. And then you have the advanced level, where that would be the one that would be the deepest.” (Participant 60) |
Lack of face-to-face connection and community | |
FOCUS | “It’s more real when you’re face to face with someone. That’s the only difference with this. If you have a face, then it can feel better than the phone can” (Participant 17); “Oh, I like to just, rather than the FOCUS, I just like rather talk to person, people in person.” (Participant 106) |
Group dynamics | |
WRAP | “I was like, ‘Wow. I really don't like group sessions.’ Yeah. I was like, ‘I hope, I hope.’ I was hoping I was getting the phone. It would have been easier” (Participant 12); “I was uncomfortable somewhat with the—sometimes during a few of the weeks different members of those other groups were going through some personal problems that they were sharing with the group. It was a little uncomfortable” (Participant 24); “A few parts I didn’t care for, someone said something like I had interrupted them or called them out, and he thought it was rude. . . . I was a little on edge, I felt a little hate from others. . . . I felt like I was targeted in some way along those lines. The staff made me feel more comfortable. I was relieved that they were there. It didn’t seem like there was much connection between me and the others in the group.” (Participant 94) |
Commitment | |
WRAP | “That was really the only time I had a problem was when people weren't showing up who were supposed to be. . . . If you say you're gonna do something, do it. . . . So, it seems like that some people were dropping in and out and . . . it made you question whether or not your business was being put out in the world, you know. . . . Like, how, how true is this person to this program?” (Participant 92) |
Privacy | |
WRAP | “Well, I feel more comfortable sharing with my case manager things about my relationship of my father with myself. . . . Very personal. . . . I'm more comfortable sharing with one person. Yeah, [with] my case manager, yeah.” (Participant 24) |
Discussion
Conclusions
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