2014 Network Meeting

Delphi Project

Main cast: Erin Michalak, Sara Lapsley, Jehannine Austin, Michael Scott, Lesley Berk,

Steven Barnes, Melinda SutoSupporting cast: Sally McBride, Sharon Hou,

Nusha Balram Elliott, Chandra Jade

Study Objective

To generate knowledge on what self-management strategies work best for:- Keeping balance in mood

- Stopping progression in hypomania and mania

Self-Management Strategies (SMS)- Sleep, diet, rest and exercise

- Regular monitoring and adjustment

- Reflective, meditative, spiritual practices

- Understanding BD, educating others

- Connecting with others

- Enacting a plan

CREST.BD definition of ‘self-management’

• Wide ranges of plans and/or routines and activities that a person with BD uses to promote health and QoL

• Healthcare providers, friends, family or caregivers can be involved in developing strategies and supporting their use

• Outside of hospital settings, it’s typically the person with BD who chooses, enacts their self-management approach and tailors their self-management strategies

RecruitmentTechniques

Round 1 Sample (Round 2 Sample)Gender & Age

Female70%

Male30%

Female78%

Male22%

Healthcare Providers: Community Members:

• 79 female (68 female)• 22 male, mean age 43 (range 19-68)

(15 male)

• 101 total (83)

91% response rate

• 35 female (29 female)• 15 male, mean age 47 (range 24-81)

(14 male)

• 51 total (43)

81% response rate

Choosing which SMSs to include in Round 2

• Round 1: 436 strategies

• Round 2: 154 strategies

• 70 strategies for both Maintaining Balance and Stopping Progression

• 42 each for only MB or SP

• Approximately 20 minutes to complete

Top Self-Management Strategies

Maintaining Balance: CM

• Learn to manage stress

• Prioritize rest and sleep

• Never run out of meds

• Cultivate loving, healthy relationships

• End unhealthy relationships

Maintaining Balance: HCP

• Learn to manage stress

• Commit to getting to sleep

• Exercise regularly

Top Self-Management Strategies

Stopping Progression to Hypomania & Mania: CM

• Be aware of early warning signs (EWS)

• Use past experience to identify EWS

• Prioritize rest and sleep

• Never run out of medication

Stopping Progression to Hypomania & Mania: HCP

• Be aware of early warning signs (EWS)

• Use past experience to identify EWS

• Commit to getting to sleep

• Take medications as prescribed; don’t adjust without consulting doctor

• Find the right medication regime

Research - Most important findings from the Delphi survey:

• Maintaining Balance SMS more highly endorsed than Stopping Progression SMS

• SMS to address EWS highly endorsed by both panels

• For Maintaining Balance, CM highly endorsed relationship-related SMS

• For Stopping Progression, HCP highly endorsed medication-related SMS

Knowledge Exchange -Key learning to share with network members:

• Communicate robust SMS to HCP and CM living with BD

• Address different learning styles and needs of diverse communities

• Determine ways to include under-accessed communities in a broader survey

• Develop methods for evaluating uptake of SMS

With thanks to…

Our 152 Delphi participants –you rock!

Round 1 Results SMS ratings

There was a very high level of consensusbetween both panels on the ratings

Strategies about early warning signs were prominent for Stopping Progression

Strategies about relationships and emotions were prominent for Maintaining Balance

Strategies for Maintaining Balance were rated higher than those for Stopping Progression

Round 1 ResultsAnd while there was consensus…

…there were also interesting, though slight, differences between the opinions of the panels.

HCPs had more strategies for Stopping Progression in their top quartile than CMs did

CMs rated strategies about social supports lower than HCPs for both MB and SP

Round 1 ResultsWhat about low-rated strategies?

The lowest-rated strategy for both panels was “Take St. John’s Wort”

Strategies that referenced spiritualityreceived low ratings from panels

Strategies about regulating diet generally did not rate highly in either panel

No strategies on parenting and only one on sex in the highest quartile for either panel

Choosing which SMSs to include in Round 2

• We chose an equal number (X) of both types of strategies: Maintaining Balance & Stopping Progression.

• We chose the strategies in the top quartile (highest 25%) for both Maintaining Balance and Stopping Progression

This gave us an equal number of both types of strategy

Peer-reviewed literature

Re-analysis of Wellness

Study

Phase 1

Last slide: should address 2 Qs:

Phase 1

Grey Literature

Search

Materials NOT published in academic journals

VideosConference Proceedings

BlogsWebsites

Government DocumentsBooks

Organisation

Phase 2

PanelRecruitment

Phase 3

SharingResearchFindings

Phase 4

Round 1 Results Healthcare providers, discipline

22%

2%

26%

0%

50%

Psychiatrist (11)

Nurse Practitioner (1)

Psychologist (13)

Family physician (0)

Other (25)

“Other” included: Occupational Therapist (5), Social Worker (4), Psychotherapist (2), Mental Health Worker (2), Did not specify (2), Researcher (2), Peer Support Worker, Nurse, Genetic Counsellor, Nurse Educator, Family Counsellor, CBT & EMDR Therapist.