Adults with serious mental illness (SMI) are disproportionately affected by medical comorbidity, earlier onset of disease, and 10 to 25 years reduced life expectancy compared to the general population. These high rates of morbidity and early mortality are associated with inadequately managed medical and psychiatric illnesses. Our systematic review found nine effective self-management interventions that address medical and psychiatric illnesses in adults with SMI. However, there has been limited adoption of these interventions due to both provider and consumer-based factors. Provider-based barriers consist of the lack of an adequate workforce with the capacity, time, and knowledge of effective approaches to self-management support for adults with SMI and chronic health conditions. Consumer-based barriers associated with limited participation in self- management programs include lack of access, engagement, and ongoing community-based support for persons with SMI. Peer support specialists have the potential to address these barriers as they comprise one of the fastest growing sectors of the mental health workforce, have ?lived experience? in self-management practices, and offer access to support in the community. However, challenges need to be resolved for peers to be effective providers of evidence-based interventions. For example, peers are frequently trained to provide ?peer support? described as ?giving and receiving help founded on key principles of respect, shared responsibility, and mutual agreement of what is helpful?. Peer support has been associated with increased sense of control, ability to make changes, and decreased psychiatric symptoms. Despite benefits, peer support does not adhere to evidence-based practices for psychiatric and medical self-management and does not follow protocols that ensure fidelity and systematically monitor outcomes. We hypothesize that mobile technology has the potential to overcome these limitations of peer support by providing real-time guidance in fidelity adherent delivery of a peer-delivered, technology-assisted evidence-based self-management intervention (PDTA-IIMR). The purpose of this K01 award is to build the necessary expertise to pursue a career developing and testing novel approaches to peer-delivered evidence-based self-management interventions. Training will include: development of peer-delivered interventions; development and design of mobile health-supported interventions; and intervention clinical trials research. Concurrently, I propose to refine the intervention protocol with input from peers and consumers; then, I will enhance this protocol through user-centered design; and lastly, I will conduct a pilot study evaluating the feasibility and potential effectiveness of PDTA-IIMR compared to routine peer support for N=6 peers and N=40 adults with SMI and chronic health conditions. Outcomes include feasibility, medical and psychiatric self-management skills, and functional ability. We will explore mortality risk factors and examine self-efficacy and social support as mechanisms on outcomes.
This training and research plan are designed to assist the applicant in acquiring the skills to become to an independent investigator in developing and testing novel approaches to peer-delivered evidence-based self- management interventions for adults with serious mental illness (SMI). Mentored activities and training will include: development of peer-delivered interventions; development and design of mobile health-supported interventions; and intervention clinical trials research. Concurrently, I will conduct a program of research aimed at developing and evaluating a peer-delivered, technology-assisted medical and psychiatric self-management intervention (PDTA-IIMR), including (1) a qualitative study designed to inform the development of PDTA-IIMR by identifying barriers and facilitators of (a) peer specialists delivering evidence-based medical and psychiatric self-management support; and of (b) consumers engaging in medical and psychiatric self-management interventions through semi-structured interviews with peers (N=20) and consumers with SMI (N=20); (2) a field test designed to evaluate the usability and acceptability of eModules (i.e., eModules are guided web-based curriculum) as an assistive tool in guiding peer specialists (N=6) in the delivery of an evidenced based medical and psychiatric self-management intervention in a one-month field test including adults with SMI (N=15); and (3) a randomized pilot study evaluating the feasibility and potential effectiveness of a PDTA-IIMR compared to routine peer support for N=6 peers and N=40 adults with SMI and chronic health conditions. .
