Online collaboration tools for user involvement and continuity of care: Implementation research in community mental health

The project has adapted, implemented and pilot tested an online support tool for self-management and collaboration in mental health among people needing long-term treatment and support. The project has built on research from the fields of e-health, recovery and positive psychology. Service users have been extensively involved throughout the development process, along with a service user consultant who has participated as co-researcher from the start. The resulting tool is called ReConnect (earlier called PsyConnect) and can be portrayed as a 'dashboard for my life' that supports users in articulating life domains (e.g. employment/schooling, housing, mental/physical health) and goals. A toolbox of resources can be used to support progression from status to goals in ways that also help providers adapt their expertise in relevant and individualized ways. It is a supplementary support for ongoing treatment which service user and providers can use between consultations according to individual needs. Service users log-in via the secure Bank-ID and 'own' the tool in that they determine the content and which of their helpers (e.g. psychologist, mental health nurse, physician) has access to it. The toolbox of resources includes, for example; exercises (e.g. sleep hygiene, mindfulness, strength mapping), network map, diary, and daily registrations of relevant parameters (e.g. physical activity, anxiety episodes). In addition, service users can anonymously access peer-to-peer support in a discussion forum. 31 service users and their providers participated in the pilot study for a minimum of 6 months from Sept 2015 to completion of the pilot in May 2016. Data has been collected through questionnaires at baseline, 3 and 6 months, individual and group interviews, log-files (e.g. frequency and use of which modules), and approximately 1050 forum postings. We analyze data to assess the implications of ReConnect in terms of recovery processes, user activation, quality of life, therapeutic alliance, symptoms and satisfaction. Publications will continue through the fall of 2017, and to PhDs (one financed by the Northern Norway Regional Health Authority) will be completed in early 2018. ReConnect can be useful for many groups. In an innovation project, we plan to adapt ReConnect to a mentoring program for at-risk youth to assess the effects on school drop-out and employment.

Interactive Health Communication Applications (IHCA) have shown to improve users' self-care skills and patient-centered care, and could play a key role in transforming health care into user-centered collaborative practices across the continuum of care. Ho wever, the implementation of such applications into real-life practices has been slow, unpredictable, and is poorly understood. This study responds to calls for applying common conceptual frameworks and participatory approaches to gain the types of knowle dge needed to improve the success of IHCA in real-life contexts of care and across settings. A IHCA tool that has shown to effectively improve self-management and patient-centered cancer care will be adapted, implemented and evaluated in the context of co mmunity mental health care in the north and south of Norway. Guided by the Consolidated Framework for Advancing Implementation Research (CFIR) and the RE-AIM framework, a practice-research team including key stakeholders will: 1) identify local users' and providers' needs, priorities and requirements for an adapted tool called PsyConnect; 2) implement and evaluate PsyConnect in the two settings, 3) identify similarities/discrepancies between the two settings. Finally, we assess the suitably of applied fra meworks and propose guidelines for implementation of ICHA in community practices by combining research findings with available evidence. The project includes one PhD student and is a collaboration between the Norwegian Center for Integrated Care and Telem edicine, University Hospital in North-Norway (UNN); Center for Shared Decision-Making, Oslo University Hospital, Asker Municipality; Balsfjord Municipality; Department of Psychiatry/Blakstad, Vestre Viken HF; Psychiatric Center for Tromsø and surrounding districts (PSTO), UNN; Centers for Learning and Coping, Vestre Viken and UNN; Healthcare Innovation, Implementation and Evaluation at Health Medical Management Centre andThe Karolinska Institute, Stockholm.