Feasibility, Acceptability, and Preliminary Effectiveness of a Peer-Delivered and Technology Supported Self-Management Intervention for Older Adults with Serious Mental Illness

To assess the feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported integrated medical and psychiatric self-management intervention for older adults with serious mental illness. Ten older adults with serious mental illness (i.e., schizophrenia, schizoaffective disorder, bipolar disorder, or major depressive disorder) and medical comorbidity (i.e., cardiovascular disease, obesity, diabetes, chronic obstructive pulmonary disease, hypertension, and/or high cholesterol) aged 60 years and older received the PeerTECH intervention in their homes. Three certified peer specialists were trained to deliver PeerTECH. Data were collected at baseline, one-month, and three-month. The pilot study demonstrated that a three-month, peer-delivered and technology-supported integrated medical and psychiatric self-management intervention (“PeerTECH”) was experienced by peer specialists and participants as feasible and acceptable. PeerTECH was associated with statistically significant improvements in psychiatric self-management. In addition, pre/post, non-statistically significant improvements were observed in self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment. This pre/post pilot study demonstrated it is possible to train peers to use technology to deliver an integrated psychiatric and medical self-management intervention in a home-based setting to older adults with serious mental illness with fidelity. These findings provide preliminary evidence that a peer-delivered and technology-supported intervention designed to improve medical and psychiatric self-management is feasible, acceptable, and is potentially associated with improvements in psychiatric self-management, self-efficacy for managing chronic health conditions, hope, quality of life, medical self-management skills, and empowerment with older adults with serious mental illness and chronic health conditions.

[1]  Nora Jacobson,et al.  What is recovery? A conceptual model and explication. , 2001, Psychiatric services.

[2]  J. Naslund,et al.  Integrated IMR for psychiatric and general medical illness for adults aged 50 or older with serious mental illness. , 2014, Psychiatric services.

[3]  D. Penn,et al.  The Illness Management and Recovery program: rationale, development, and preliminary findings. , 2006, Schizophrenia bulletin.

[4]  B. Druss,et al.  Mental disorders and use of cardiovascular procedures after myocardial infarction. , 2000, JAMA.

[5]  M. Salzer,et al.  Examining the factor structure of the recovery assessment scale. , 2004, Schizophrenia bulletin.

[6]  J. Lingler,et al.  Measuring hope among families impacted by cognitive impairment , 2016, Dementia.

[7]  P. Solomon.  Peer support/peer provided services underlying processes, benefits, and critical ingredients. , 2004, Psychiatric rehabilitation journal.

[8]  Sarah Pratt,et al.  Long-term outcomes of a randomized trial of integrated skills training and preventive healthcare for older adults with serious mental illness. , 2014, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[9]  D. Ward,et al.  Design and Implementation of a Nutrition and Physical Activity Curriculum for Child Care Settings , 2006, Preventing chronic disease.

[10]  P. Mortensen,et al.  Mortality and Causes of Death in First Admitted Schizophrenic Patients , 1993, British Journal of Psychiatry.

[11]  G. Haugan,et al.  The Herth Hope Index—A Psychometric Study Among Cognitively Intact Nursing Home Patients , 2013, Journal of Nursing Measurement.

[12]  B. Druss,et al.  Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. , 2015, JAMA psychiatry.

[13]  H. Möller,et al.  Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care , 2011, World psychiatry : official journal of the World Psychiatric Association.

[14]  J. Talbott.  Understanding Excess Mortality in Persons With Mental Illness: 17-Year Follow Up of a Nationally Representative US Survey , 2012 .

[15]  Karen L. Fortuna,et al.  Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness. , 2017, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[16]  M. Salzer,et al.  Validating the empowerment scale with a multisite sample of consumers of mental health services. , 2010, Psychiatric services.

[17]  J. Naslund,et al.  Feasibility and effectiveness of an automated telehealth intervention to improve illness self-management in people with serious psychiatric and medical disorders. , 2013, Psychiatric rehabilitation journal.

[18]  Preethy E. George,et al.  Peer support services for individuals with serious mental illnesses: assessing the evidence. , 2014, Psychiatric services.

[19]  K. Lorig,et al.  Effect of a self-management program on patients with chronic disease. , 2001, Effective clinical practice : ECP.

[20]  Heather Becker,et al.  Self-Rated Abilities for Health Practices: A Health Self-Efficacy Measure. , 1993 .

[21]  S. Morris,et al.  Measurement equivalence of the Empowerment Scale for White and Black persons with severe mental illness. , 2014, Psychiatric rehabilitation journal.

[22]  M. Suarez‐Almazor,et al.  Validation of the Self‐Efficacy for Managing Chronic Disease Scale: A Scleroderma Patient‐Centered Intervention Network Cohort Study , 2016, Arthritis care & research.

[23]  M. Salzer,et al.  Certified peer specialist roles and activities: results from a national survey. , 2010, Psychiatric services.

[24]  Michael B. Spring,et al.  Designing websites for persons with cognitive deficits: Design and usability of a psychoeducational intervention for persons with severe mental illness. , 2007, Psychological services.

[25]  R. Rosenheck,et al.  An empirical conceptualization of the recovery orientation , 2005, Schizophrenia Research.

[26]  D. Stevanović.  Quality of Life Enjoyment and Satisfaction Questionnaire-short form for quality of life assessments in clinical practice: a psychometric study. , 2011, Journal of psychiatric and mental health nursing.

[27]  A. Sarkin,et al.  The psychometric properties of the Illness Management and Recovery scale in a large American public mental health system , 2012, Psychiatry Research.

[28]  Craig W. Colton,et al.  Congruencies in Increased Mortality Rates, Years of Potential Life Lost, and Causes of Death Among Public Mental Health Clients in Eight States , 2006, Preventing chronic disease.

[29]  S. A. Wowra,et al.  Validation of the empowerment scale with an outpatient mental health population. , 1999, Psychiatric services.

[30]  S. Bartels,et al.  Helping Older People Experience Success: An Integrated Model of Psychosocial Rehabilitation and Health Care Management for Older Adults with Serious Mental Illness , 2008 .

[31]  Karen L. Whiteman,et al.  Systematic Review of Integrated General Medical and Psychiatric Self-Management Interventions for Adults With Serious Mental Illness. , 2016, Psychiatric services.

[32]  Stephen J Bartels,et al.  A Peer- and Technology-Supported Self-Management Intervention. , 2017, Psychiatric services.

[33]  D. Roe,et al.  The psychometric properties of the illness management and recovery scale: Client and clinician versions , 2008, Psychiatry Research.

[34]  Michelle P. Salyers,et al.  Measuring Illness Management Outcomes: A Psychometric Study of Clinician and Consumer Rating Scales for Illness Self Management and Recovery , 2007, Community Mental Health Journal.

[35]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[36]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[37]  K. Herth.  Abbreviated instrument to measure hope: development and psychometric evaluation. , 1992, Journal of Advanced Nursing.

[38]  P. Cuijpers,et al.  Supportive Accountability: A Model for Providing Human Support to Enhance Adherence to eHealth Interventions , 2011, Journal of medical Internet research.