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Users’ experiences of an online intervention for bipolar disorder: important lessons for design and evaluation
  1. Alyson L Dodd1,2,
  2. Sara Mallinson3,
  3. Martin Griffiths2,
  4. Richard Morriss4,
  5. Steven H Jones2,
  6. Fiona Lobban2
  1. 1 Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
  2. 2 Spectrum Centre for Mental Health Research, Division of Health Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK
  3. 3 Alberta Health Services/ Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Alyson L Dodd, Department of Psychology, Faculty of Health & Life Sciences, Northumbria University, Northumberland Building, Newcastle-upon-Tyne NE1 8ST, UK; alyson.dodd{at}


Background The evidence base for digital interventions for physical and mental health, including severe and enduring mental health difficulties, is increasing. In a feasibility trial, web-based Enhanced Relapse Prevention (ERPonline) for bipolar disorder demonstrated high recruitment and retention rates. Relative to participants in the waitlist control group, those who received ERPonline showed increased monitoring for early warning signs of relapse and had developed more positive illness models.

Objective To understand users’ motivations and barriers for taking part in an online/telephone-based trial, and for engagement with ERPonline.

Methods Participants from the trial who had been allocated to receive ERPonline were purposively sampled to participate in telephone-based, in-depth qualitative interviews about their experiences. Interviews (n=19) were analysed using framework analysis to identify themes relevant to study aims.

Findings Participants took part due to the convenient, flexible and rewarding aspects of the trial design, as well as a desire to improve the mental health of themselves and others. Barriers included extensive assessments, practical difficulties and mood. ERPonline was was generally considered to be accessible, relevant and straightforward, but there were individual preferences regarding design, content and who it was for. Several participants reported positive changes, but there was a sense that digital interventions should not replace routine care.

Conclusions There are a number of barriers and facilitators to consider when evaluating and implementing digital interventions. Individual preferences and human contact were key factors for both trial design and engagement with an online intervention.

Clinical implications Digital interventions should be co-produced, personalised, interactive and embedded as one component in a broader package of care.

Trial registration number ISRCTN56908625; Post-results.

  • Mental health
  • depression
  • mood disorders
  • qualitative research
  • clinical trials

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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  • Contributors AD was trial manager and prepared the current manuscript; SM was a co-investigator who supported the Principal Investigator (PI) in the design of this nested qualitative study, provided methodological supervision to MG, and contributed to analysis; MG collected and analysed the data; SHJ and RM were co-investigators and contributed to the design, analysis and interpretation of data; FL was the PI of the ERPonline feasibility trial and as such led the design, implementation, analysis and write-up of all aspects of the research. All authors have commented on and edited drafts of this manuscript.

  • Funding The ERPonline feasibility trial was funded by the National Institute for Health Research, Research for Patient Benefit scheme (PB-PG-0211-10001). This trial is registered with ISRCTN (56908625) since 26 March 2013.

  • Competing interests The authors developed the ERPonline intervention so this is not an independent evaluation.

  • Ethics approval Ethical approval was obtained from the UK National Research Ethics Service and Lancaster University Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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