Yildirim, Mehmet
(2024)
Supporting mental wellbeing of UK health and care workers using a mobile application: a mixed-methods feasibility study.
PhD thesis, University of Nottingham.
Abstract
Background
Poor mental wellbeing is highly prevalent among health and care workers, causing decreased individual health and patients’ safety as well as leading to organisational problems. Prioritising mental wellbeing support for this population is crucial for promoting a healthy work environment. Mobile application-based self-care interventions have emerged as promising tools in recent decades due to their ease of implementation, cost-effectiveness, and user-friendliness. While numerous studies have demonstrated their effectiveness in promoting mental wellbeing, the scoping review revealed limited research focused specifically on health and care workers. Furthermore, existing interventions often target specific aspects of mental wellbeing, such as stress, burnout, anxiety, and depression, neglecting the broader mental wellbeing concept. Additionally, the literature identified a lack of qualitative studies exploring the experiences of health and care workers using these interventions. To address these gaps, this study employed a mobile application-based self-monitoring tool encompassing various aspects of mental wellbeing, from physical components to mental health conditions. The study also incorporated qualitative individual interviews to gain deeper insights into the participants' experiences with mental wellbeing monitoring via a mobile application.
Aims
The main aim of this mixed-method study was to assess the feasibility of a self-monitoring-based mobile application designed to improve mental well-being among health and care workers/students in the UK. The qualitative part also aimed to explore the mobile application's acceptability and usability through users' daily experiences, identifying barriers and facilitators to engagement with the monitoring.
Methods
This feasibility study employed a concurrent mixed method design, incorporating a feasibility randomised control trial (RCT) and subsequent qualitative study. The feasibility criteria included recruitment and enrolment, retention and adherence to the intervention, data collection methods, and daily user engagement rate for mobile applications. The feasibility RCT comprised two arms: the intervention and control group. In the intervention group, participants used the mobile application to monitor mood, behaviours, and mental health-related symptoms based on their preferences. After six weeks, they were invited to conduct a semi-structured individual interview to share their experiences with mental wellbeing monitoring. Participants in the control group were signposted to an NHS website that provided information about how to promote mental wellbeing. Baseline data was collected through a survey using instruments including demographics, the Warwick-Edinburg Mental Wellbeing Scale (WEMWBS), and the Depression Anxiety and Stress Scale (DASS-21). After six weeks, the mHealth Application Usability Questionnaire (MAUQ) was additionally applied in the intervention group. Descriptive statistical analysis was used for quantitative data.
The qualitative study incorporated semi-structured individual interviews to explore user engagement with the mobile application. Qualitative findings were analysed using Braun and Clark’s thematic analysis approach.
Findings
In total, 49 participants (32 health and care workers and 17 health and care students aged between 18 and 60+) were included. Ten dropouts were recorded, accounting for a 20.5% dropout rate. The daily application usage rate was 64.5%. According to the WEMWBS, the control group showed a higher improvement in well-being than the intervention group; however, this improvement did not exceed the cutoff point of 3. Mobile application-based mental wellbeing monitoring showed minimal impact on help-seeking behaviours for seeking mental wellbeing help. The most chosen items to monitor were daily mood, food, sleep, and exercise. Working hours, caffeine intake, work challenges, and low energy were also frequently chosen.
Four main themes were identified from the interviews: “Usefulness”, “Enablers of engagement”, “Barriers to engagement”, and “Suggested improvements”. Mental wellbeing monitoring was found acceptable, but there were various views on its usefulness. The factors facilitating engagement included ease of use and accessibility, increased awareness, reminder e-mails, and unique individual strategies. The barriers to the engagement included personal challenges, technical difficulties, and motivational issues. Participants suggested including more work-related questions, push notifications, advice on improving mental well-being, goal settings and interface improvements to increase user engagement.
Conclusion
The research indicates that an RCT testing a mobile application for monitoring mental wellbeing, including physical and mental health aspects, is feasible regarding recruitment, dropout rate, and intervention engagement. The findings from the Mobile App Usability Questionnaire (MAUQ), qualitative interviews, and user engagement show that health and care workers/students find using mobile applications acceptable for promoting their mental wellbeing. Additionally, the study suggests that mobile application-based monitoring has the potential to positively impact daily habit changes, which may contribute to long-term improvements in mental well-being. However, the study's generalisability was limited to young adults aged 20-41 due to recruitment through social media. There are various views on the impact of the intervention on perceived mental well-being improvement. The qualitative data suggest that the application content, interface, and design should be improved by adding work-oriented questions, which finally will help increase user engagement.
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