JMIR Publications

ABSTRACT

Background:

Web-based interventions are promising tools for increasing the understanding of illness and treatment among patients with serious mental disorders.

Objective:

We aim to test the feasibility and acceptability of a web-based patient education intervention using a quasi-experimental cluster design and to report feedback on patient education sessions and the website used, and preliminary evidence of the intervention’s impact on patients with schizophrenia spectrum disorder.

Methods:

We conducted a single-blind, parallel, quasi-experimental study (n=57) over a 6-month period comparing web-based education (n=33) with a nonequivalent control group (‘treatment as usual’, n=24) for people with schizophrenia spectrum disorder. The participants were recruited from one psychiatric hospital (6 wards). Feasibility was assessed by participants’ commitment (refusal rate, drop-out rate) to the study. Acceptability was assessed as participants’ commitment to the intervention. Feedback regarding the patient education sessions and the website were assessed by the patients and health care professionals (HCRs). The preliminary impact of the sessions on patients’ self-efficacy, self-esteem, illness cognition and knowledge level were measured at baseline and follow-ups (after 8 weeks and 6 months) with self-rated questionnaires.

Results:

Feasibility, assessed by refusal rate (67% in the intervention group, 75% in the control group, P=.21) and drop-out rate (48% in the intervention group, 58% in the control group, P=.46), was low with no statistical difference between the study groups. Acceptability of the intervention was good as 31 participants out of 33 (94%) completed all five sessions. Feedback was mainly positive, while patients and HCRs evaluated three out of four subscales of session evaluations above the midpoint of 4.0. Patients’ and HCRs’ feedback of the website was mainly positive with a grade of ‘good’ for content (patients n=20, 69%; HCRs n=21, 75%), layout (patients n=18, 62%; HCRs n=17, 61%) and usability (patient n=18, 62%; HCRs n=19, 68%). The patients using the intervention had significantly higher scores 6 months after the sessions in self-efficacy (at baseline Mean 26.12, SD 5.64; after 6 months Mean 29.24, SD 6.05, P=.003) and regarding their knowledge level about schizophrenia (at baseline Mean 11.39, SD 4.65; after 6 months Mean 15.06, SD 5.26, P=.002), and lower scores in the subscale of ‘helplessness’ in illness cognition (at baseline Mean 2.26, SD 0.96; after 6 months Mean 1.85, SD 0.59, P=.03). However, differences from the control group were not significant. No differences were found in patients’ self-esteem or other subscales in illness cognition comparing before and after scores or comparing groups.

Conclusions:

The study’s feasibility is poor, with high drop-out and refusal rates. However, acceptability seems good. Larger sample sizes, individual randomization and more effective monitoring are needed to decrease refusal and drop-out rates and to get more reliable results.