Power up: patient and public involvement in developing a shared decision-making app for mental health

Background The importance of patient and public involvement (PPI) in designing interventions to support young people’s mental health is becoming a central tenet of the research process. Existing research has indicated that co-design with service users may help to engender multiple improvements in research projects, from design through to applications of study findings. Aims The aim of this study is to examine our experience of making the involvement of young people an ongoing part of the research process. We report on PPI in relation to a feasibility trial of the development of an app called Power Up, which is designed to support shared decision-making in mental health. Method Young people, carers, and clinicians were involved in each aspect of the project from governance, needs and environment analysis, to development and revisions of the Power Up smartphone app intended for use within child and adolescent mental health services. Involvement was achieved through ongoing contributions to steering groups, co-design workshops, and interviews. The project model was approached as a cyclical multidirectional process of ideas, PPI input, reflection, and alterations. Conclusion PPI was embedded into the project model from the outset, to be iterative and cyclical informing the development and direction of the digital tool at each stage. Involving service users resulted in the identification and implementation of multiple changes to the app, both conceptual and tangible. Several challenges associated with PPI were also encountered, warranting future research and discussion

A Feasibility Trial of Power Up: Smartphone App to Support Patient Activation and Shared Decision Making for Mental Health in Young People

Background: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and therefore, develop evidence-based recommendations for practice.Objective: To determine the feasibility of undertaking a cluster randomized control trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health.Methods: Overall, 270 young people were screened for participation and 53% (N = 142) were recruited and completed baseline measures across eight specialist child mental health services (n = 62, mean (SD) age = 14.66 (1.99) years, 52% female) and two mainstream secondary schools (n = 80; mean (SD) age = 16.88 (0.68) years, 46% female). Young people received Power Up in addition to management as usual or received management as usual only. Post-trial interviews were conducted with 11 young people from the intervention arms (specialist services n = 6; schools n = 5).Results: Usage data showed that there were an estimated 50 (out of 64) users of Power Up in the intervention arms. Findings from the interviews indicated that young people found Power Up to be acceptable. Young people reported: 1) their motivation for use of Power Up, 2) the impact of use, and 3) barriers to use. Out of the 142 recruited participants, 45% (64/142) completed follow up measures, and the approaches to increase retention agreed by the steering group are discussed.Conclusions: The findings of the present research indicate that the app is acceptable and it is feasible to examine the effectiveness of Power Up in a prospective cluster randomized control trial