The Youth-Mental Health Engagement Network: An Exploratory Pilot Study of a Smartphone and Computer-Based Personal Health Record for Youth Experiencing Depressive Symptoms

摘要

Abstract: The Youth-Mental Health Engagement Network study explored the use of mobile technology to support youth in managing their mental health. The Lawson SMART record (LSR) is a web-based application that allows individuals to create and manage an electronic personal health record (ePHR). Through this record, individuals can store their personal health information (e.g., list of medications, family history, immunization records, allergies, care provider contact information, care plans, and crisis plans) and use interactive tools to manage their health care (e.g., mood monitor, reminder prompts, alerts, and mental health assessments). The purpose of this study was to evaluate the usability and acceptability of using an ePHR in providing mental health care to youth with mental illnesses who were experiencing depressive symptoms, from the perspectives of both the patients and their care providers. This 6-month study employed an exploratory descriptive design. Mixed methods research methodology was used to determine the uptake of the LSR as part of their mental health treatment by youth experiencing depressive symptoms. Participants included 41 patients, aged 16 to 21, receiving outpatient services from one of 9 care providers employed within a hospital-based youth mental health care program. Focus groups were held with participating care providers and patients throughout the study to explore youth and care provider perceptions of using the LSR for mental health care management. In addition, both patients and care providers completed surveys to elaborate on their use of and comfort with the technology. This study found that the majority of patients used a phone (90.6%) and computer (70.7%) daily and felt extremely comfortable using cell phones (71.9%) and computers (58.5%). Of the 41 patients, 9 (22%) had their smartphone lost, stolen, broken, or given away. Qualitative analysis of focus group discussions with patients and care providers revealed 6 themes: 1) extent of LSR use was related to the severity of illness and treatment intensity; 2) symptom tracking was the most common use of the LSR; 3) patients reported increased self-awareness and autonomy with LSR use; 4) use of the LSR changed and had the potential to enhance the therapeutic relationship; 5) use of the LSR was a good fit with Cognitive Behavioural Therapy and Dialectical Behaviour Therapy treatment requirements; and 6) the LSR should be personalized and simplified. In a population of youth with mental illnesses who were experiencing depressive symptoms, the LSR was found to be useful and to fit well with standard treatment practices. However, youth would prefer a simpler tool. Future research should evaluate the clinical- and cost-effectiveness of using an ePHR in a larger sample of youth with mixed clinical presentations and over a longer period of time. This additional research would be valuable in understanding the usability and acceptability of smart technologies as an integral part of usual mental health care for youth.