Pre-Post, Mixed Methods Feasibility Study of the WorkingWell Mobile Support Tool for Individuals with Serious Mental Illness in the United States

Successful competitive employment has been found to be related to enhanced self-esteem, higher quality of life and reduced mental health service use for individuals living with serious mental illnesses (SMIs) including schizophrenia, bipolar disorder and major depression. The effectiveness of the individual placement and support model has been demonstrated in multiple randomised controlled trials in many countries. The management of stress, depression and anxiety in the workplace may be effectively enhanced through digital mental health interventions. The WorkingWell mobile support tool (‘app’) is specifically designed to meet the need for illness management support for individuals with SMI in the workplace, as an adjunct to professional treatment

The WorkingWell Smartphone App for Individuals with Serious Mental Illnesses: A Proof-of-Concept, Mixed Methods Feasibility Study (Preprint)

Background: The disparities in employment for individuals with serious mental illnesses (SMI) have been well documented, as have the benefits of work. The benefits of mobile technology in providing accessible, in-the-moment support for these individuals has been demonstrated. The WorkingWell mobile app was developed to meet the need for accessible follow-along supports for individuals with SMI in the workplace. Objective: We explore the usability, usage, usefulness and overall feasibility of the WorkingWell mobile app with individuals with SMI receiving community-based services and actively employed. Methods: In this proof-of-concept, mixed methods, two-month feasibility study (N=40), employed individuals with SMI were recruited in mental health agencies. Participants completed surveys regarding background characteristics and cellphone use at enrollment; and responded to interview items regarding app usability, usage and usefulness in technical assistance calls at one, two, four and six weeks of study participation and in the exit interview at 8 weeks. Data on the frequency of app usage were downloaded and monitored on a daily basis. A version of the System Usability Scale (SUS) was administered in the exit interview. Feasibility was determined by the percent of users completing the study. General impressions were obtained from users regarding user support materials, technical assistance, and study procedures. Results: Over half of the participants were male (60%, 24/40). The majority were age 55 or under (70%, 28/40), Caucasian (80%, 32/40), had less than a 4-year college education (78%, 31/40), were employed part-time (98%, 39/40), had been working more than six months (60%, 24/40), and indicated a diagnosis of bipolar, schizoaffective or depressive disorder (84%, 16/25). The vast majority of participants owned cellphones (95%, 38/40), using them multiple times per day (83%, 33/40). Their average rating on SUS usability items was 3.93 (SD = 0.77; range = 1.57 to 5.00), reflecting positive responses. Participants, in general, indicated WorkingWell was “very easy”, “straightforward”, “simple”, and “user-friendly”. Usability challenges were related to personal issues (e.g., memory) or to difficulties with the phone or app. Data on app usage varied considerably. The most frequent navigations were to the home screen, followed by Rate My Day and My Progress, and then by Manage the Moment and Remind Me. The app was described as useful by most study participants; 86% (30/35) agreed the app would help them manage better on the job. Thirty-five of the 40 original participants (87%) completed the study. Conclusions: The WorkingWell app is a feasible approach to providing accessible, as-needed employment support for individuals with SMI. The app would benefit from additional modifications to address recommendations from feasibility testing. Controlled research with larger samples, more diverse in individual characteristics and workplace settings, is essential to demonstrating the effectiveness of the app