Self-management education for patients with bipolar disorder
Introduction and background
Bipolar disorder (BD) is a severe chronic mental illness characterised by fluctuating mood and activity patterns, alternating between euthymic, hypo-manic or manic, major depressive, and mixed-mood episodes. The diagnosis can be classified according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as a bipolar I disorder when a service user endures at least one manic episode. When suffering one or more depressive episodes accompanied by at least one episode of hypomania (milder features of mania, not severe enough for a necessary acute hospitalisation), the disorder is classified as bipolar II. The lifetime prevalence of BD is approximately 1%, with a cumulative incidence of 1.5 to 2% in the European Union population between 18 and 65 years.
General hypothesis and specific aims of the project
This project has a hypothesis generating purpose rather than hypothesis testing. The overall objective of this dissertation is to identify and describe determinants for successful self-management in bipolar disorder, in order to guide future educational interventions in nursing care for this patient category.
(a) This project will be done with existing techniques.
(b) No collaboration with third party labs, expect study 5 with a different research group then the above mentioned.
(c) Data is already collected; ethical permission was granted by central committees.
(d) All data is gathered during the time of the project. Data collection was done by me except in study 1 and the study 5. Data-analysis was partly done in the first study. All other studies are analyzed be me. Writing of all papers was/will be done by me.
Study 1. Attitudes of Patients With Bipolar Disorder Toward the Life Chart Methodology: A Phenomenological Study.
Aim: To describe attitudes and motivations of patients with BD for (not) using the LCM.
Method: A phenomenological design with unstructured in-depth interviews of patients (N=14) with BD. Patient narratives were audiotaped, transcribed verbatim, analyzed, and coded inductively.
Study 2. Identifying and describing service users’ learning experiences towards self-management of bipolar disorders: A phenomenological study.
Aim: This study describes learning experiences of service users in self-managing BD which could provide a possible explanation for varying effectiveness.
Method: A phenomenological design. Face-to-face, open, in-depth interviews, guided by a topic list, along service users (N=16) with BD I or II. Interviews were digitally recorded and transcribed verbatim prior to analysis in Atlas.ti 7.
Study 3. Self-management education in bipolar disorder: a phenomenological study on the supporting strategies of caregivers.
Aim: To describe the perspectives of caregivers (CPN’s) on self-management support of patients with BD.
Method: A phenomenological design. Face-to-face, open, in-depth interviews, guided by a topic list, along family caregivers (N=10) related to patients with BD. Interviews were digitally recorded and transcribed verbatim prior to analysis in Atlas.ti 7.
Study 4. Self-management education in bipolar disorder: a phenomenological study on the supporting strategies of community psychiatric nurses.
Aim: To describe the perspectives of community psychiatric nurses (CPN’s) on self-management support of patients with BD.
Method: A phenomenological design. Face-to-face, open, in-depth interviews, guided by a topic list, along CPNs (N=9) appointed to patients with BD. Interviews were digitally recorded and transcribed verbatim prior to analysis in Atlas.ti 7.
Study 5. Outcomes in randomised controlled trials of self-management educational programmes for severe chronic illnesses: a systematic review.
Aim: to identify possible determinants of self-management in BD through a critical appraisal of intervention outcomes and measurements used in randomised controlled trials of severe chronic illnesses 2003-2015.
Method: A systematic review of randomised controlled trials of self-management education programmes in people with a chronic (mental) illness. Identification of available literature on the topics ‘self-management’, ‘illness management’, ‘disease management’, ‘chronic illness’ and ‘chronic disease’ is done through a systematic search in CINAHL, EMBASE, Medline, PsycINFO without language restriction.
Study 6. Self-management utility and user experiences of an online personal health record for bipolar disorders (PHR-BD): A pilot study
Aim: To evaluate the utility, and the user-experiences of patients, relatives and healthcare professionals, of a tailored PHR-BD.
Method: A pre-post design to evaluate the utility and user-experiences of patients with BD, their relatives and caregivers with a PHR-BD over three specialized outpatient treatment facilities. At baseline (T0) and at 12-months follow-up (T1) the effects of the PHR-BD are measured on quality of life, empowerment, symptom reduction, changes in mood and activity and, illness burden and severity, with the MANSA, NEL, IDS-SR, ASRM, OQ-45, GAF, and CGI-BP. Qualitative face-to-face semi-structured interviews were conducted to collect in-depth information on user-experiences at T1.