A web-based, peer-supported self-management intervention to reduce distress in relatives of people with psychosis or bipolar disorder: the REACT RCT


Lobban, Fiona, Akers, Nadia, Appelbe, Duncan, Capuccinello, Rossella Iraci, Chapman, Lesley, Collinge, Lizzi, Dodd, Susanna ORCID: 0000-0003-2851-3337, Flowers, Sue, Hollingsworth, Bruce, Honary, Mahsa et al (show 12 more authors) (2020) A web-based, peer-supported self-management intervention to reduce distress in relatives of people with psychosis or bipolar disorder: the REACT RCT. HEALTH TECHNOLOGY ASSESSMENT, 24 (32). pp. 1-142.

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Abstract

<h4>Background</h4>Relatives caring for people with severe mental health problems find information and emotional support hard to access. Online support for self-management offers a potential solution.<h4>Objective</h4>The objective was to determine the clinical effectiveness and cost-effectiveness of an online supported self-management tool for relatives: the Relatives' Education And Coping Toolkit (REACT).<h4>Design and setting</h4>This was a primarily online (UK), single-blind, randomised controlled trial, comparing REACT plus a resource directory and treatment as usual with the resource directory and treatment as usual only, by measuring user distress and other well-being measures at baseline and at 12 and 24 weeks.<h4>Participants</h4>A total of 800 relatives of people with severe mental health problems across the UK took part; relatives who were aged ≥ 16 years, were experiencing high levels of distress, had access to the internet and were actively seeking help were recruited.<h4>Intervention</h4>REACT comprised 12 psychoeducation modules, peer support through a group forum, confidential messaging and a comprehensive resource directory of national support. Trained relatives moderated the forum and responded to messages.<h4>Main outcome measure</h4>The main outcome was the level of participants' distress, as measured by the General Health Questionnaire-28 items.<h4>Results</h4>Various online and offline strategies, including social media, directed potential participants to the website. Participants were randomised to one of two arms: REACT plus the resource directory (<i>n</i> = 399) or the resource directory only (<i>n</i> = 401). Retention at 24 weeks was 75% (REACT arm, <i>n</i> = 292; resource directory-only arm, <i>n</i> = 307). The mean scores for the General Health Questionnaire-28 items reduced substantially across both arms over 24 weeks, from 40.2 (standard deviation 14.3) to 30.5 (standard deviation 15.6), with no significant difference between arms (mean difference -1.39, 95% confidence interval -3.60 to 0.83; <i>p</i> = 0.22). At 12 weeks, the General Health Questionnaire-28 items scores were lower in the REACT arm than in the resource directory-only arm (-2.08, 95% confidence interval -4.14 to -0.03; <i>p</i> = 0.027), but this finding is likely to be of limited clinical significance. Accounting for missing data, which were associated with higher distress in the REACT arm (0.33, 95% confidence interval -0.27 to 0.93; <i>p</i> = 0.279), in a longitudinal model, there was no significant difference between arms over 24 weeks (-0.56, 95% confidence interval -2.34 to 1.22; <i>p</i> = 0.51). REACT cost £142.95 per participant to design and deliver (£62.27 for delivery only), compared with £0.84 for the resource directory only. A health economic analysis of NHS, health and Personal Social Services outcomes found that REACT has higher costs (£286.77), slightly better General Health Questionnaire-28 items scores (incremental General Health Questionnaire-28 items score adjusted for baseline, age and gender: -1.152, 95% confidence interval -3.370 to 1.065) and slightly lower quality-adjusted life-year gains than the resource directory only; none of these differences was statistically significant. The median time spent online was 50.8 minutes (interquartile range 12.4-172.1 minutes) for REACT, with no significant association with outcome. Participants reported finding REACT a safe, confidential environment (96%) and reported feeling supported by the forum (89%) and the REACT supporters (86%). No serious adverse events were reported.<h4>Limitations</h4>The sample comprised predominantly white British females, 25% of participants were lost to follow-up and dropout in the REACT arm was not random.<h4>Conclusions</h4>An online self-management support toolkit with a moderated group forum is acceptable to relatives and, compared with face-to-face programmes, offers inexpensive, safe delivery of National Institute for Health and Care Excellence-recommended support to engage relatives as peers in care delivery. However, currently, REACT plus the resource directory is no more effective at reducing relatives' distress than the resource directory only.<h4>Future work</h4>Further research in improving the effectiveness of online carer support interventions is required.<h4>Trial registration</h4>Current Controlled Trials ISRCTN72019945.<h4>Funding</h4>This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in <i>Health Technology Assessment</i>; Vol. 24, No. 32. See the NIHR Journals Library website for further project information.

Item Type: Article
Uncontrolled Keywords: Humans, Single-Blind Method, Family, Bipolar Disorder, Psychotic Disorders, Quality-Adjusted Life Years, Internet, Adult, Middle Aged, Cost-Benefit Analysis, Female, Male, Surveys and Questionnaires, United Kingdom, Self-Management, Psychological Distress
Depositing User: Symplectic Admin
Date Deposited: 27 Jan 2021 09:20
Last Modified: 21 Aug 2023 19:04
DOI: 10.3310/hta24320
Related URLs:
URI: https://livrepository.liverpool.ac.uk/id/eprint/3114842
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