Supporting Self-management and Quality of Life in Bipolar Disorder With the PolarUs App (Alpha): Protocol for a Mixed Methods Study

Abstract

Background Quality of life (QoL) is increasingly being recognized as a key outcome of interventions for bipolar disorder (BD). Mobile phone apps can increase access to evidence-based self-management strategies and provide real-time support. However, although individuals with lived experiences desire support with monitoring and improving broader health domains, existing BD apps largely target mood symptoms only. Further, evidence from the broader mobile health (mHealth) literature has shown that the desires and goals of end users are not adequately considered during app development, and as a result, engagement with mental health apps is suboptimal. To capitalize on the potential of apps to optimize wellness in BD, there is a need for interventions developed in consultation with real-world users designed to support QoL self-monitoring and self-management. Objective This mixed methods pilot study was designed to evaluate the alpha version of the newly developed PolarUs app, developed to support QoL self-monitoring and self-management in people with BD. Co-designed using a community-based participatory research framework, the PolarUs app builds on the web-based adaptation of a BD-specific QoL self-assessment measure and integrates material from a web-based portal providing information on evidence-informed self-management strategies in BD. The primary objectives of this project were to evaluate PolarUs app feasibility (via behavioral use metrics), the impact of PolarUs (via the Brief Quality of Life in Bipolar Disorder scale, our primary outcome measure), and explore engagement with the PolarUs app (via quantitative and qualitative methods). Methods Participants will be residents of North America (N=150), aged >18 years, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of BD type 1, BD type 2, or BD not otherwise specified as assessed by structured diagnostic interview. An embedded mixed methods research design will be adopted; qualitative interviews with a purposefully selected subsample (approximately, n=30) of participants will be conducted to explore in more depth feasibility, impact, and engagement with the PolarUs app over the 12-week study period. Results At the time of publication of this protocol, the development of the alpha version of the PolarUs app was complete. Participant enrollment has begun in June 2022. Data collection is expected to be completed by December 2022. Conclusions Beyond contributing knowledge on the feasibility and impact of a novel app to support QoL and self-management in BD, this study will also provide new insights related to engagement with mHealth apps. Furthermore, it will function as a case study of successful co-design between people with BD, health care providers, and BD researchers, providing a template for the future use of community-based participatory research frameworks in mHealth intervention development. The results will be used to further refine the PolarUs app and inform the design of a larger clinical trial. International Registered Report Identifier (IRRID) PRR1-10.2196/36213

Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions

“…Finally, it is recommended that users are involved early in the design process, and their involvement should not be limited solely to the design but also to all aspects of the research, ensuring end-to-end involvement. Case studies of apps using a co-design framework include the quality of life–focused LiveWell and PolarUs apps, both of which consulted people with BD throughout development [ 36 , 37 ]. Figure 2 depicts 2 screens from the PolarUs app: on the home screen (left image), users are prompted to engage in quality of life, sleep, and mood self-monitoring, and are provided with relevant resources [ 37 ].…”

“…Case studies of apps using a co-design framework include the quality of life–focused LiveWell and PolarUs apps, both of which consulted people with BD throughout development [ 36 , 37 ]. Figure 2 depicts 2 screens from the PolarUs app: on the home screen (left image), users are prompted to engage in quality of life, sleep, and mood self-monitoring, and are provided with relevant resources [ 37 ]. Users can review their self-monitoring data over time (right image).…”

“… Interface of the PolarUs app (reproduced from Michalak et al [ 37 ], which is published under Creative Commons Attribution 4.0 International License [ 43 ]). …”