Skip to main content
PMC home page
Medline Book to support NIHPA logoLink to Medline Book to support NIHPA
. 2020 Jun;24(32):1–142. doi: 10.3310/hta24320

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

Fiona Lobban, Nadia Akers, Duncan Appelbe, Rossella Iraci Capuccinello, Lesley Chapman, Lizzi Collinge, Susanna Dodd, Sue Flowers, Bruce Hollingsworth, Mahsa Honary, Sonia Johnson, Steven H Jones, Ceu Mateus, Barbara Mezes, Elizabeth Murray, Katerina Panagaki, Naomi Rainford, Heather Robinson, Anna Rosala-Hallas, William Sellwood, Andrew Walker, Paula R Williamson
PMCID: PMC7355407  PMID: 32608353

Abstract

BACKGROUND

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.

OBJECTIVE

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).

DESIGN AND SETTING

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.

PARTICIPANTS

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.

INTERVENTION

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.

MAIN OUTCOME MEASURE

The main outcome was the level of participants' distress, as measured by the General Health Questionnaire-28 items.

RESULTS

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 (n = 399) or the resource directory only (n = 401). Retention at 24 weeks was 75% (REACT arm, n = 292; resource directory-only arm, n = 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; p = 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; p = 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; p = 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; p = 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.

LIMITATIONS

The sample comprised predominantly white British females, 25% of participants were lost to follow-up and dropout in the REACT arm was not random.

CONCLUSIONS

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.

FUTURE WORK

Further research in improving the effectiveness of online carer support interventions is required.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN72019945.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 32. See the NIHR Journals Library website for further project information.

Plain language summary

Relatives of people with severe mental health problems need better access to information and emotional support. The Relatives’ Education And Coping Toolkit (REACT) is a website designed to do this. It includes lots of information presented in text and video, an online forum for relatives to share knowledge and experience, a messaging system where they can ask questions in confidence and a comprehensive directory of contact details for national organisations offering relevant support. Trained relatives support the forum and messaging. In the UK, we recruited 800 relatives of people with severe mental health problems: all were aged ≥ 16 years, had high levels of distress, had access to the internet and wanted help. We divided them into two equal groups: one group received REACT (including the resource directory), whereas the other group received the resource directory only. To ensure that there were no differences between groups at the start, relatives were allocated to the two groups randomly, so they had an equal chance of being in either group. We followed up with both groups at 12 and 24 weeks, and received data from approximately three-quarters of the participants. This trial found that REACT was acceptable, safe and inexpensive to deliver (£62.27 per relative), compared with face-to-face interventions, and that relatives using it felt well supported. However, once we accounted for missing data (relatives who dropped out of the trial or did not complete the follow-up questionnaires), there were no significant differences between the groups. There was no evidence that REACT increased relatives’ quality of life or saved money for the NHS.

Full text of this article can be found in Bookshelf.

References

  1. Honary M, Fisher NR, McNaney R, Lobban F. A web-based intervention for relatives of people experiencing psychosis or bipolar disorder: design study using a user-centered approach. JMIR Ment Health 2018;5:e11473. https://doi.org/10.2196/11473 doi: 10.2196/11473. [DOI] [PMC free article] [PubMed]
  2. Lobban F, Glentworth D, Chapman L, Wainwright L, Postlethwaite A, Dunn G, et al. Feasibility of a supported self-management intervention for relatives of people with recent-onset psychosis: REACT study. Br J Psychiatry 2013;203:366–72. https://doi.org/10.1192/bjp.bp.112.113613 doi: 10.1192/bjp.bp.112.113613. [DOI] [PubMed]
  3. Lobban F, Glentworth D, Haddock G, Wainwright L, Clancy A, Bentley R, React Team. The views of relatives of young people with psychosis on how to design a Relatives’ Education And Coping Toolkit (REACT). J Ment Health 2011;20:567–79. https://doi.org/10.3109/09638237.2011.593592 doi: 10.3109/09638237.2011.593592. [DOI] [PubMed]
  4. McGrath JJ, Saha S, Al-Hamzawi AO, Alonso J, Andrade L, Borges G, et al. Age of onset and lifetime projected risk of psychotic experiences: cross-national data from the World Mental Health Survey. Schizophr Bull 2016;42:933–41. https://doi.org/10.1093/schbul/sbw011 doi: 10.1093/schbul/sbw011. [DOI] [PMC free article] [PubMed]
  5. Johns LC, Kompus K, Connell M, Humpston C, Lincoln TM, Longden E, et al. Auditory verbal hallucinations in persons with and without a need for care. Schizophr Bull 2014;40(Suppl. 4):255–64. https://doi.org/10.1093/schbul/sbu005 doi: 10.1093/schbul/sbu005. [DOI] [PMC free article] [PubMed]
  6. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ, Erskine HE, et al. Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study 2010. Lancet 2013;382:1575–86. https://doi.org/10.1016/S0140-6736(13)61611-6 doi: 10.1016/S0140-6736(13)61611-6. [DOI] [PubMed]
  7. Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Arch Gen Psychiatry 2007;64:543–52. https://doi.org/10.1001/archpsyc.64.5.543 doi: 10.1001/archpsyc.64.5.543. [DOI] [PMC free article] [PubMed]
  8. McCrone PR, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S . Paying the Price: The Cost of Mental Health Care in England to 2026. London: The King’s Fund; 2008.
  9. Paykel ES, Abbott R, Morriss R, Hayhurst H, Scott J. Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. Br J Psychiatry 2006;189:118–23. https://doi.org/10.1192/bjp.bp.105.013870 doi: 10.1192/bjp.bp.105.013870. [DOI] [PubMed]
  10. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review. Arch Gen Psychiatry 2005;62:975–83. https://doi.org/10.1001/archpsyc.62.9.975 doi: 10.1001/archpsyc.62.9.975. [DOI] [PubMed]
  11. Drancourt N, Etain B, Lajnef M, Henry C, Raust A, Cochet B, et al. Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment. Acta Psychiatr Scand 2013;127:136–44. https://doi.org/10.1111/j.1600-0447.2012.01917.x doi: 10.1111/j.1600-0447.2012.01917.x. [DOI] [PubMed]
  12. Awad AG, Voruganti LN. The burden of schizophrenia on caregivers: a review. PharmacoEconomics 2008;26:149–62. https://doi.org/10.2165/00019053-200826020-00005 doi: 10.2165/00019053-200826020-00005. [DOI] [PubMed]
  13. Barrowclough C, Gooding P, Hartley S, Lee G, Lobban F. Factors associated with distress in relatives of a family member experiencing recent-onset psychosis. J Nerv Ment Dis 2014;202:40–6. https://doi.org/10.1097/NMD.0000000000000072 doi: 10.1097/NMD.0000000000000072. [DOI] [PubMed]
  14. Kingston C, Onwumere J, Keen N, Ruffell T, Kuipers E. Posttraumatic stress symptoms (PTSS) in caregivers of people with psychosis and associations with caregiving experiences. J Trauma Dissociation 2016;17:307–21. https://doi.org/10.1080/15299732.2015.1089969 doi: 10.1080/15299732.2015.1089969. [DOI] [PubMed]
  15. Onwumere J, Bebbington P, Kuipers E. Family interventions in early psychosis: specificity and effectiveness. Epidemiol Psychiatr Sci 2011;20:113–19. https://doi.org/10.1017/s2045796011000187 doi: 10.1017/s2045796011000187. [DOI] [PubMed]
  16. Tennakoon L, Fannon D, Doku V, O’Ceallaigh S, Soni W, Santamaria M, et al. Experience of caregiving: relatives of people experiencing a first episode of psychosis. Br J Psychiatry 2000;177:529–33. https://doi.org/10.1192/bjp.177.6.529 doi: 10.1192/bjp.177.6.529. [DOI] [PubMed]
  17. McDonell MG, Short RA, Berry CM, Dyck DG. Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality. Fam Process 2003;42:91–103. https://doi.org/10.1111/j.1545-5300.2003.00091.x doi: 10.1111/j.1545-5300.2003.00091.x. [DOI] [PubMed]
  18. Magliano L, Fadden G, Madianos M, de Almeida JM, Held T, Guarneri M, et al. Burden on the families of patients with schizophrenia: results of the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 1998;33:405–12. https://doi.org/10.1007/s001270050073 doi: 10.1007/s001270050073. [DOI] [PubMed]
  19. Möller-Leimkühler AM. Burden of relatives and predictors of burden. Baseline results from the Munich 5-year-follow-up study on relatives of first hospitalized patients with schizophrenia or depression. Eur Arch Psychiatry Clin Neurosci 2005;255:223–31. https://doi.org/10.1007/s00406-004-0550-x doi: 10.1007/s00406-004-0550-x. [DOI] [PubMed]
  20. Lobban F, Barrowclough C, Jones S. Does expressed emotion need to be understood within a more systemic framework? Soc Psychiatry Psychiatr Epidemiol 2006;41:50–5. https://doi.org/10.1007/s00127-005-0993-z doi: 10.1007/s00127-005-0993-z. [DOI] [PubMed]
  21. Onwumere J, Lotey G, Schulz J, James G, Afsharzadegan R, Harvey R, et al. Burnout in early course psychosis caregivers: the role of illness beliefs and coping styles. Early Interv Psychiatry 2017;11:237–43. https://doi.org/10.1111/eip.12227 doi: 10.1111/eip.12227. [DOI] [PubMed]
  22. Kuipers E, Watson P, Onwumere J, Bebbington P, Dunn G, Weinman J, et al. Discrepant illness perceptions, affect and expressed emotion in people with psychosis and their carers. Soc Psychiatry Psychiatr Epidemiol 2007;42:277–83. https://doi.org/10.1007/s00127-007-0165-4 doi: 10.1007/s00127-007-0165-4. [DOI] [PubMed]
  23. Chessick CA, Perlick DA, Miklowitz DJ, Dickinson LM, Allen MH, Morris CD, et al. Suicidal ideation and depressive symptoms among bipolar patients as predictors of the health and well-being of caregivers. Bipolar Disord 2009;11:876–84. https://doi.org/10.1111/j.1399-5618.2009.00765.x doi: 10.1111/j.1399-5618.2009.00765.x. [DOI] [PMC free article] [PubMed]
  24. Ostacher MJ, Nierenberg AA, Iosifescu DV, Eidelman P, Lund HG, Ametrano RM, et al. Correlates of subjective and objective burden among caregivers of patients with bipolar disorder. Acta Psychiatr Scand 2008;118:49–56. https://doi.org/10.1111/j.1600-0447.2008.01201.x doi: 10.1111/j.1600-0447.2008.01201.x. [DOI] [PubMed]
  25. Steele A, Maruyama N, Galynker I. Psychiatric symptoms in caregivers of patients with bipolar disorder: a review. J Affect Disord 2010;121:10–21. https://doi.org/10.1016/j.jad.2009.04.020 doi: 10.1016/j.jad.2009.04.020. [DOI] [PubMed]
  26. Chessick CA, Perlick DA, Miklowitz DJ, Kaczynski R, Allen MH, Morris CD, et al. Current suicide ideation and prior suicide attempts of bipolar patients as influences on caregiver burden. Suicide Life Threat Behav 2007;37:482–91. https://doi.org/10.1521/suli.2007.37.4.482 doi: 10.1521/suli.2007.37.4.482. [DOI] [PubMed]
  27. Fletcher K, Parker GB, Manicavasagar V. Coping profiles in bipolar disorder. Compr Psychiatry 2013;54:1177–84. https://doi.org/10.1016/j.comppsych.2013.05.011 doi: 10.1016/j.comppsych.2013.05.011. [DOI] [PubMed]
  28. Hosang GM, Uher R, Maughan B, McGuffin P, Farmer AE. The role of loss and danger events in symptom exacerbation in bipolar disorder. J Psychiatr Res 2012;46:1584–9. https://doi.org/10.1016/j.jpsychires.2012.07.009 doi: 10.1016/j.jpsychires.2012.07.009. [DOI] [PubMed]
  29. Morriss R, Yang M, Chopra A, Bentall R, Paykel E, Scott J. Differential effects of depression and mania symptoms on social adjustment: prospective study in bipolar disorder. Bipolar Disord 2013;15:80–91. https://doi.org/10.1111/bdi.12036 doi: 10.1111/bdi.12036. [DOI] [PubMed]
  30. Lowenstein JA, Butler DW, Ashcroft K. The efficacy of a cognitively orientated carers group in an early intervention in psychosis service – a pilot study. J Psychiatr Ment Health Nurs 2010;17:628–35. https://doi.org/10.1111/j.1365-2850.2010.01564.x doi: 10.1111/j.1365-2850.2010.01564.x. [DOI] [PubMed]
  31. Zendjidjian X, Richieri R, Adida M, Limousin S, Gaubert N, Parola N, et al. Quality of life among caregivers of individuals with affective disorders. J Affect Disord 2012;136:660–5. https://doi.org/10.1016/j.jad.2011.10.011 doi: 10.1016/j.jad.2011.10.011. [DOI] [PubMed]
  32. Chen FP, Greenberg JS. A positive aspect of caregiving: the influence of social support on caregiving gains for family members of relatives with schizophrenia. Community Ment Health J 2004;40:423–35. https://doi.org/10.1023/b:comh.0000040656.89143.82 doi: 10.1023/b:comh.0000040656.89143.82. [DOI] [PubMed]
  33. Veltman A, Cameron J, Stewart DE. The experience of providing care to relatives with chronic mental illness. J Nerv Ment Dis 2002;190:108–14. https://doi.org/10.1097/00005053-200202000-00008 doi: 10.1097/00005053-200202000-00008. [DOI] [PubMed]
  34. Andrew A, Knapp M, McCrone P, Parsonage M, Trachtenberg M. Effective Interventions in Schizophrenia – The Economic Case. A Report Prepared for the Schizophrenia Commission. London: Rethink Mental Illness; 2012.
  35. Buckner L, Yeandle S. Valuing Carers 2015. London: Carers UK; 2015.
  36. Lowyck B, De Hert M, Peeters E, Wampers M, Gilis P, Peuskens J. A study of the family burden of 150 family members of schizophrenic patients. Eur Psychiatry 2004;19:395–401. https://doi.org/10.1016/j.eurpsy.2004.04.006 doi: 10.1016/j.eurpsy.2004.04.006. [DOI] [PubMed]
  37. Perlick D, Clarkin JF, Sirey J, Raue P, Greenfield S, Struening E, Rosenheck R. Burden experienced by care-givers of persons with bipolar affective disorder. Br J Psychiatry 1999;175:56–62. https://doi.org/10.1192/bjp.175.1.56 doi: 10.1192/bjp.175.1.56. [DOI] [PubMed]
  38. Pharoah F, Mari J, Rathbone J, Wong W. Family intervention for schizophrenia. Cochrane Database Syst Rev 2010;12:CD000088. https://doi.org/10.1002/14651858.CD000088.pub2 doi: 10.1002/14651858.CD000088.pub2. [DOI] [PMC free article] [PubMed]
  39. Lobban F, Postlethwaite A, Glentworth D, Pinfold V, Wainwright L, Dunn G, et al. A systematic review of randomised controlled trials of interventions reporting outcomes for relatives of people with psychosis. Clin Psychol Rev 2013;33:372–82. https://doi.org/10.1016/j.cpr.2012.12.004 doi: 10.1016/j.cpr.2012.12.004. [DOI] [PubMed]
  40. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003;60:904–12. https://doi.org/10.1001/archpsyc.60.9.904 doi: 10.1001/archpsyc.60.9.904. [DOI] [PubMed]
  41. Perlick DA, Miklowitz DJ, Lopez N, Chou J, Kalvin C, Adzhiashvili V, Aronson A. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord 2010;12:627–37. https://doi.org/10.1111/j.1399-5618.2010.00852.x doi: 10.1111/j.1399-5618.2010.00852.x. [DOI] [PMC free article] [PubMed]
  42. Yesufu-Udechuku A, Harrison B, Mayo-Wilson E, Young N, Woodhams P, Shiers D, et al. Interventions to improve the experience of caring for people with severe mental illness: systematic review and meta-analysis. Br J Psychiatry 2015;206:268–74. https://doi.org/10.1192/bjp.bp.114.147561 doi: 10.1192/bjp.bp.114.147561. [DOI] [PubMed]
  43. Sin J, Gillard S, Spain D, Cornelius V, Chen T, Henderson C. Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta-analysis. Clin Psychol Rev 2017;56:13–24. https://doi.org/10.1016/j.cpr.2017.05.002 doi: 10.1016/j.cpr.2017.05.002. [DOI] [PubMed]
  44. Geddes JR, Miklowitz DJ. Treatment of bipolar disorder. Lancet 2013;381:1672–82. https://doi.org/10.1016/S0140-6736(13)60857-0 doi: 10.1016/S0140-6736(13)60857-0. [DOI] [PMC free article] [PubMed]
  45. Reinares M, Colom F, Sánchez-Moreno J, Torrent C, Martínez-Arán A, Comes M, et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trial. Bipolar Disord 2008;10:511–19. https://doi.org/10.1111/j.1399-5618.2008.00588.x doi: 10.1111/j.1399-5618.2008.00588.x. [DOI] [PubMed]
  46. Miklowitz DJ . Bipolar Disorder: A Family-focused Treatment Approach. 2nd edn. New York, NY: Guilford Press; 2010.
  47. Addington J, McCleery A, Addington D. Three-year outcome of family work in an early psychosis program. Schizophr Res 2005;79:107–16. https://doi.org/10.1016/j.schres.2005.03.019 doi: 10.1016/j.schres.2005.03.019. [DOI] [PubMed]
  48. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med 2003;26:1–7. https://doi.org/10.1207/S15324796ABM2601_01 doi: 10.1207/S15324796ABM2601_01. [DOI] [PubMed]
  49. Butzlaff RL, Hooley JM. Expressed emotion and psychiatric relapse: a meta-analysis. Arch Gen Psychiatry 1998;55:547–52. https://doi.org/10.1001/archpsyc.55.6.547 doi: 10.1001/archpsyc.55.6.547. [DOI] [PubMed]
  50. Miklowitz DJ, Goldstein MJ, Nuechterlein KH, Snyder KS, Mintz J. Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988;45:225–31. https://doi.org/10.1001/archpsyc.1988.01800270033004 doi: 10.1001/archpsyc.1988.01800270033004. [DOI] [PubMed]
  51. Kim EY, Miklowitz DJ. Expressed emotion as a predictor of outcome among bipolar patients undergoing family therapy. J Affect Disord 2004;82:343–52. https://doi.org/10.1016/j.jad.2004.02.004 doi: 10.1016/j.jad.2004.02.004. [DOI] [PubMed]
  52. Great Britain. Care Act 2014. London: The Stationery Office; 2014.
  53. National Institute for Health and Care Excellence. Bipolar Disorder: Assessment and Management of Bipolar Disorder. Clinical guideline [CG185]. London: NICE; 2014. [PubMed]
  54. National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Adults: Prevention and Management. Clinical guideline [CG178]. London: NICE; 2014.
  55. Healthcare Quality Improvement Partnership, Royal College of Psychiatrists. Report of the Early Intervention in Psychosis Audit. London: NHS England; 2016.
  56. Vermeulen B, Lauwers H, Spruytte N, Van Audenhove C, Magro C, Saunders J, Jones K. Experiences of Family Caregivers for Persons with Severe Mental Illness: An International Exploration. Leuven: LUCAS KU Leuven/EUFAMI; 2015. https://doi.org/10.1016/S0924-977X(15)30484-3 doi: 10.1016/S0924-977X(15)30484-3. [DOI]
  57. Eassom E, Giacco D, Dirik A, Priebe S. Implementing family involvement in the treatment of patients with psychosis: a systematic review of facilitating and hindering factors. BMJ Open 2014;4:e006108. https://doi.org/10.1136/bmjopen-2014-006108 doi: 10.1136/bmjopen-2014-006108. [DOI] [PMC free article] [PubMed]
  58. Department of Health and Social Care. Achieving Better Access to Mental Health Services by 2020. London: Department of Health and Social Care; 2014.
  59. Worthington A, Rooney P, Hannan R. The Triangle of Care. Carers Included: A Guide to Best Practice in Mental Health Care in England. 2nd edn. London: Carers Trust; 2013.
  60. Lobban F, Glentworth D, Wainwright L, Pinfold V, Chapman L, Larkin W, et al. Relatives’ Education And Coping Toolkit – REACT. Study protocol of a randomised controlled trial to assess the feasibility and effectiveness of a supported self management package for relatives of people with recent onset psychosis. BMC Psychiatry 2011;11:100. https://doi.org/10.1186/1471-244X-11-100 doi: 10.1186/1471-244X-11-100. [DOI] [PMC free article] [PubMed]
  61. Goldberg DP, Hillier VF. A scaled version of the General Health Questionnaire. Psychol Med 1979;9:139–45. https://doi.org/10.1017/s0033291700021644 doi: 10.1017/s0033291700021644. [DOI] [PubMed]
  62. Quirk A, Smith SC, Hamilton S, Lamping DL, Lelliott P, Stahl D et al. Development and Validation of the Carer Well-Being and Support (CWS) Questionnaire: Report for the National Institute for Health Research Service Delivery and Organisation Programme. Southampton: National Institute for Health Research; 2009.
  63. Quinn J, Barrowclough C, Tarrier N. The Family Questionnaire (FQ): a scale for measuring symptom appraisal in relatives of schizophrenic patients. Acta Psychiatr Scand 2003;108:290–6. https://doi.org/10.1034/j.1600-0447.2003.00156.x doi: 10.1034/j.1600-0447.2003.00156.x. [DOI] [PubMed]
  64. Wainwright L, Lancaster University. Relatives’ Experiences of Supporting and Caring for a Family Member with First Episode Psychosis, with or without a Self-management Intervention. Lancaster: Lancaster University; 2015.
  65. Gafoor R, Nitsch D, McCrone P, Craig TK, Garety PA, Power P, McGuire P. Effect of early intervention on 5-year outcome in non-affective psychosis. Br J Psychiatry 2010;196:372–6. https://doi.org/10.1192/bjp.bp.109.066050 doi: 10.1192/bjp.bp.109.066050. [DOI] [PubMed]
  66. Bertelsen M, Jeppesen P, Petersen L, Thorup A, Øhlenschlaeger J, le Quach P, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs. standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 2008;65:762–71. https://doi.org/10.1001/archpsyc.65.7.762 doi: 10.1001/archpsyc.65.7.762. [DOI] [PubMed]
  67. Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U. Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLOS ONE 2014;9:e98118. https://doi.org/10.1371/journal.pone.0098118 doi: 10.1371/journal.pone.0098118. [DOI] [PMC free article] [PubMed]
  68. Alvarez-Jimenez M, Alcazar-Corcoles MA, González-Blanch C, Bendall S, McGorry PD, Gleeson JF. Online, social media and mobile technologies for psychosis treatment: a systematic review on novel user-led interventions. Schizophr Res 2014;156:96–106. https://doi.org/10.1016/j.schres.2014.03.021 doi: 10.1016/j.schres.2014.03.021. [DOI] [PubMed]
  69. Hidalgo-Mazzei D, Mateu A, Reinares M, Matic A, Vieta E, Colom F. Internet-based psychological interventions for bipolar disorder: review of the present and insights into the future. J Affect Disord 2015;188:1–13. https://doi.org/10.1016/j.jad.2015.08.005 doi: 10.1016/j.jad.2015.08.005. [DOI] [PubMed]
  70. Scott JL, Dawkins S, Quinn MG, Sanderson K, Elliott KE, Stirling C, et al. Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers. Aging Ment Health 2016;20:793–803. https://doi.org/10.1080/13607863.2015.1040724 doi: 10.1080/13607863.2015.1040724. [DOI] [PubMed]
  71. Ziebland S, Wyke S. Health and illness in a connected world: how might sharing experiences on the internet affect people’s health? Milbank Q 2012;90:219–49. https://doi.org/10.1111/j.1468-0009.2012.00662.x doi: 10.1111/j.1468-0009.2012.00662.x. [DOI] [PMC free article] [PubMed]
  72. Sin J, Henderson C, Spain D, Cornelius V, Chen T, Gillard S. eHealth interventions for family carers of people with long term illness: a promising approach? Clin Psychol Rev 2018;60:109–25. https://doi.org/10.1016/j.cpr.2018.01.008 doi: 10.1016/j.cpr.2018.01.008. [DOI] [PubMed]
  73. Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health 2011;20:392–411. https://doi.org/10.3109/09638237.2011.583947 doi: 10.3109/09638237.2011.583947. [DOI] [PubMed]
  74. Faulkner A, Basset T. A helping hand: taking peer support into the 21st century. Ment Health Soc Incl 2012;16:41–7. https://doi.org/10.1108/20428301211205892 doi: 10.1108/20428301211205892. [DOI]
  75. Walker G, Bryant W. Peer support in adult mental health services: a metasynthesis of qualitative findings. Psychiatr Rehabil J 2013;36:28–34. https://doi.org/10.1037/h0094744 doi: 10.1037/h0094744. [DOI] [PubMed]
  76. National Institute for Health and Care Excellence. Implementing the Early Intervention in Psychosis Access and Waiting Time Standard: Guidance. London: NICE; 2016.
  77. Murray E, Khadjesari Z, White IR, Kalaitzaki E, Godfrey C, McCambridge J, et al. Methodological challenges in online trials. J Med Internet Res 2009;11:e9. https://doi.org/10.2196/jmir.1052 doi: 10.2196/jmir.1052. [DOI] [PMC free article] [PubMed]
  78. Mathieu E, McGeechan K, Barratt A, Herbert R. Internet-based randomized controlled trials: a systematic review. J Am Med Inform Assoc 2013;20:568–76. https://doi.org/10.1136/amiajnl-2012-001175 doi: 10.1136/amiajnl-2012-001175. [DOI] [PMC free article] [PubMed]
  79. Department of Health and Social Care. A Framework for Mental Health Research. London: Department of Health and Social Care; 2017.
  80. Wainwright LD, Glentworth D, Haddock G, Bentley R, Lobban F. What do relatives experience when supporting someone in early psychosis? Psychol Psychother 2015;88:105–19. https://doi.org/10.1111/papt.12024 doi: 10.1111/papt.12024. [DOI] [PubMed]
  81. Eysenbach G, CONSORT-EHEALTH Group. CONSORT-EHEALTH: improving and standardizing evaluation reports of Web-based and mobile health interventions. J Med Internet Res 2011;13:e126. https://doi.org/10.2196/jmir.1923 doi: 10.2196/jmir.1923. [DOI] [PMC free article] [PubMed]
  82. Norman DA. Cognitive Engineering. In Norman DA, Draper SW, editors. User Centered System Design: New Perspectives on Human–Computer Interaction. Hillsdale, NJ: Lawrence Erlbaum Associates Inc.; 1986. pp. 31–62. https://doi.org/10.1201/b15703 doi: 10.1201/b15703. [DOI]
  83. Lancaster University. The Spectrum Centre for Mental Health Research. URL: www.lancaster.ac.uk/shm/research/spectrum/ (last accessed 28 October 2019).
  84. Anderson CM, Reiss DJ, Hogarty GE. Schizophrenia and the Family: A Practitioner’s Guide to Psychoeducation and Management. New York, NY: Guilford Press; 1986.
  85. Barrowclough C, Tarrier N. Families of Schizophrenic Patients: Cognitive Behavioural Intervention. Cheltenham: Stanley Thornes Publishers Ltd; 1992.
  86. Falloon IR. Handbook of Behavioural Family Therapy. London: Routledge; 1988.
  87. Kuipers L, Birchwood M, McCreadie RG. Psychosocial family intervention in schizophrenia: a review of empirical studies. Br J Psychiatry 1992;160:272–5. https://doi.org/10.1192/bjp.160.2.272 doi: 10.1192/bjp.160.2.272. [DOI] [PubMed]
  88. McFarlane WR. Family Therapy in Schizophrenia. New York, NY: Guilford Press; 1983.
  89. NHS England. Five Year Forward View. London: NHS England; 2014.
  90. Berry N, Lobban F, Emsley R, Bucci S. Acceptability of interventions delivered online and through mobile phones for people who experience severe mental health problems: a systematic review. J Med Internet Res 2016;18:e121. https://doi.org/10.2196/jmir.5250 doi: 10.2196/jmir.5250. [DOI] [PMC free article] [PubMed]
  91. O’Connor S, Hanlon P, O’Donnell CA, Garcia S, Glanville J, Mair FS. Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Med Inform Decis Mak 2016;16:120. https://doi.org/10.1186/s12911-016-0359-3 doi: 10.1186/s12911-016-0359-3. [DOI] [PMC free article] [PubMed]
  92. Van Dijk J. Digital Divide: Impact of Access. In Rössler P, editor. The International Encyclopedia of Media Effects. Hoboken, NJ: John Wiley & Sons; 2017. pp. 1–11. https://doi.org/10.1002/9781118783764.wbieme0043 doi: 10.1002/9781118783764.wbieme0043. [DOI]
  93. Christensen H, Griffiths KM, Farrer L. Adherence in internet interventions for anxiety and depression. J Med Internet Res 2009;11:e13. https://doi.org/10.2196/jmir.1194 doi: 10.2196/jmir.1194. [DOI] [PMC free article] [PubMed]
  94. Andersson G, Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn Behav Ther 2009;38:196–205. https://doi.org/10.1080/16506070903318960 doi: 10.1080/16506070903318960. [DOI] [PubMed]
  95. Kaufman L, Brooks W, Steinley-Bumgarner M, Stevens-Manser S. Peer Specialist Training and Certification Programs: A National Overview. Austin, TX: Center for Social Work Research, University of Texas at Austin: 2012.
  96. Mental Health Commission. Blueprint II: Improving Mental Health and Wellbeing for all New Zealanders: How Things Need To Be. Wellington: Mental Health Commission; 2012.
  97. National Institute for Health and Care Excellence. Transition Between Inpatient Mental Health Settings and Community or Care Home Settings. NICE guideline [NG53]. London: NICE; 2016.
  98. Joint Commissioning Panel for Mental Health. Guidance for Commissioners of Acute Care – Inpatient and Crisis Home Treatment. London: Joint Commissioning Panel for Mental Health; 2012.
  99. Joint Commissioning Panel for Mental Health. Guidance for Commissioners of Community Specialist Mental Health Services. London: Joint Commissioning Panel for Mental Health; 2012.
  100. Mental Health Commission of Canada. Changing Directions, Changing Lives: The Mental Health Strategy for Canada. Ottawa, ON: Mental Health Commission of Canada; 2012.
  101. Schulz KF, Altman DG, Moher D, CONSORT Group. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010;8:18. https://doi.org/10.1186/1741-7015-8-18 doi: 10.1186/1741-7015-8-18. [DOI] [PMC free article] [PubMed]
  102. Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008;337:a2390. https://doi.org/10.1136/bmj.a2390 doi: 10.1136/bmj.a2390. [DOI] [PMC free article] [PubMed]
  103. Eysenbach G. Improving the quality of web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004;6:e34. https://doi.org/10.2196/jmir.6.3.e34 doi: 10.2196/jmir.6.3.e34. [DOI] [PMC free article] [PubMed]
  104. Lobban F, Appleton V, Appelbe D, Barraclough J, Bowland J, Fisher NR, et al. IMPlementation of A Relatives’ Toolkit (IMPART study): an iterative case study to identify key factors impacting on the implementation of a web-based supported self-management intervention for relatives of people with psychosis or bipolar experiences in a National Health Service: a study protocol. Implement Sci 2017;12:152. https://doi.org/10.1186/s13012-017-0687-4 doi: 10.1186/s13012-017-0687-4. [DOI] [PMC free article] [PubMed]
  105. Gu LL, Skierkowski D, Florin P, Friend K, Ye Y. Facebook, Twitter, & QR codes: an exploratory trial examining the feasibility of social media mechanisms for sample recruitment. Comput Hum Behav 2016;60:86–96. https://doi.org/10.1016/j.chb.2016.02.006 doi: 10.1016/j.chb.2016.02.006. [DOI]
  106. O’Connor A, Jackson L, Goldsmith L, Skirton H. Can I get a retweet please? Health research recruitment and the Twittersphere. J Adv Nurs 2014;70:599–609. https://doi.org/10.1111/jan.12222 doi: 10.1111/jan.12222. [DOI] [PubMed]
  107. Bailey JV, Pavlou M, Copas A, McCarthy O, Carswell K, Rait G, et al. The Sexunzipped trial: optimizing the design of online randomized controlled trials. J Med Internet Res 2013;15:e278. https://doi.org/10.2196/jmir.2668 doi: 10.2196/jmir.2668. [DOI] [PMC free article] [PubMed]
  108. Morgan AJ, Jorm AF, Mackinnon AJ. Internet-based recruitment to a depression prevention intervention: lessons from the Mood Memos study. J Med Internet Res 2013;15:e31. https://doi.org/10.2196/jmir.2262 doi: 10.2196/jmir.2262. [DOI] [PMC free article] [PubMed]
  109. British Psychological Society. Ethics Guidelines for Internet-mediated Research. Leicester: British Psychological Society; 2013.
  110. European Parliament, Council of the European Union. Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the Protection of Natural Persons With Regard to the Processing of Personal Data and on the Free Movement of Such Data, and Repealing Directive 95/46/EC (General Data Protection Regulation). URL: https://eur-lex.europa.eu/eli/reg/2016/679/oj (accessed 28 January 2020).
  111. Harvey K, Catty J, Langman A, Winfield H, Clement S, Burns E, et al. A review of instruments developed to measure outcomes for carers of people with mental health problems. Acta Psychiatr Scand 2008;117:164–76. https://doi.org/10.1111/j.1600-0447.2007.01148.x doi: 10.1111/j.1600-0447.2007.01148.x. [DOI] [PubMed]
  112. Whittaker W, Sutton M. Mental Health, Work Incapacity and State Transfers: An Analysis of the British Household Panel Survey. York: Department of Economics, University of York; 2010.
  113. Whittaker W, Sutton M, Macdonald S, Maxwell M, Smith M, Wilson P, Morrison J. The effect of mental ill health on absence from work in different occupational classifications: analysis of routine data in the British Household Panel Survey. J Occup Environ Med 2012;54:1539–44. https://doi.org/10.1097/JOM.0b013e3182677d12 doi: 10.1097/JOM.0b013e3182677d12. [DOI] [PubMed]
  114. Whittaker W, Sutton M, Maxwell M, Munoz-Arroyo R, Macdonald S, Power A, et al. Predicting which people with psychosocial distress are at risk of becoming dependent on state benefits: analysis of routinely available data. BMJ 2010;341:c3838. https://doi.org/10.1136/bmj.c3838 doi: 10.1136/bmj.c3838. [DOI] [PMC free article] [PubMed]
  115. Russ TC, Stamatakis E, Hamer M, Starr JM, Kivimäki M, Batty GD. Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ 2012;345:e4933. https://doi.org/10.1136/bmj.e4933 doi: 10.1136/bmj.e4933. [DOI] [PMC free article] [PubMed]
  116. Quirk A, Smith S, Hamilton S, Lamping D, Lelliott P, Stahl D, et al. Development of the Carer Well-being and Support (CWS) Questionnaire. Ment Health Rev 2012;17:128–38. https://doi.org/10.1108/13619321211287184 doi: 10.1108/13619321211287184. [DOI]
  117. Broadbent E, Petrie KJ, Main J, Weinman J. The Brief Illness Perception Questionnaire. J Psychosom Res 2006;60:631–7. https://doi.org/10.1016/j.jpsychores.2005.10.020 doi: 10.1016/j.jpsychores.2005.10.020. [DOI] [PubMed]
  118. Carver CS. You want to measure coping but your protocol’s too long: consider the Brief COPE. Int J Behav Med 1997;4:92–100. https://doi.org/10.1207/s15327558ijbm0401_6 doi: 10.1207/s15327558ijbm0401_6. [DOI] [PubMed]
  119. Beck JS. Cognitive Behavior Therapy: Basics and Beyond. New York, NY: Guilford Press; 2011.
  120. Szmukler GI, Herrman H, Colusa S, Benson A, Bloch S. A controlled trial of a counselling intervention for caregivers of relatives with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 1996;31:149–55. https://doi.org/10.1007/bf00785761 doi: 10.1007/bf00785761. [DOI] [PubMed]
  121. Woods RT, Bruce E, Edwards RT, Elvish R, Hoare Z, Hounsome B, et al. REMCARE: reminiscence groups for people with dementia and their family caregivers – effectiveness and cost-effectiveness pragmatic multicentre randomised trial. Health Technol Assess 2012;16(48). https://doi.org/10.3310/hta16480 doi: 10.3310/hta16480. [DOI] [PubMed]
  122. Brueton VC, Tierney JF, Stenning S, Meredith S, Harding S, Nazareth I, Rait G. Strategies to improve retention in randomised trials: a Cochrane systematic review and meta-analysis. BMJ Open 2014;4:e003821. https://doi.org/10.1136/bmjopen-2013-003821 doi: 10.1136/bmjopen-2013-003821. [DOI] [PMC free article] [PubMed]
  123. Khadjesari Z, Murray E, Kalaitzaki E, White IR, McCambridge J, Thompson SG, et al. Impact and costs of incentives to reduce attrition in online trials: two randomized controlled trials. J Med Internet Res 2011;13:e26. https://doi.org/10.2196/jmir.1523 doi: 10.2196/jmir.1523. [DOI] [PMC free article] [PubMed]
  124. David MC, Ware RS. Meta-analysis of randomized controlled trials supports the use of incentives for inducing response to electronic health surveys. J Clin Epidemiol 2014;67:1210–21. https://doi.org/10.1016/j.jclinepi.2014.08.001 doi: 10.1016/j.jclinepi.2014.08.001. [DOI] [PubMed]
  125. Lobban F. REACT Statistical Analysis Plan v1.0; An Online Randomised Controlled Trial to Evaluate the Clinical and Cost Effectiveness of a Peer Supported Self-management Intervention for Relatives of People with Psychosis or Bipolar Disorder: Relatives Education And Coping Toolkit (REACT). Journal contribution. figshare; 2017. URL: https://figshare.com/articles/REACT_Statistical_Analysis_Plan_v1_0_An_online_randomised_controlled_trial_to_evaluate_the_clinical_and_cost_effectiveness_of_a_peer_supported_self-management_intervention_for_relatives_of_people_with_psychosis_or_bipolar_disorder_Relatives_Education_And_/4775539 (accessed 28 October 2019). doi: 10.1136/bmjopen-2017-016965. [DOI] [PMC free article] [PubMed]
  126. Nonnecke B, Andrews D, Preece J. Non-public and public online community participation: needs, attitudes and behavior. Electron Commerce Res 2006;6:7–20. https://doi.org/10.1007/s10660-006-5985-x doi: 10.1007/s10660-006-5985-x. [DOI]
  127. Gleeson JF, Lederman R, Wadley G, Bendall S, McGorry PD, Alvarez-Jimenez M. Safety and privacy outcomes from a moderated online social therapy for young people with first-episode psychosis. Psychiatr Serv 2014;65:546–50. https://doi.org/10.1176/appi.ps.201300078 doi: 10.1176/appi.ps.201300078. [DOI] [PubMed]
  128. NHS Digital. Patient Health Questionnaire-9 (PHQ-9). URL: www.datadictionary.nhs.uk/data_dictionary/nhs_business_definitions/p/patient_health_questionnaire-9_de.asp (accessed 28 October 2019).
  129. Great Britain. Data Protection Act 2018. London: The Stationery Office; 2018.
  130. Lobban F, Robinson H, Appelbe D, Barraclough J, Bedson E, Collinge L, et al. Protocol for an online randomised controlled trial to evaluate the clinical and cost-effectiveness of a peer-supported self-management intervention for relatives of people with psychosis or bipolar disorder: Relatives’ Education And Coping Toolkit (REACT). BMJ Open 2017;7:e016965. https://doi.org/10.1136/bmjopen-2017-016965 doi: 10.1136/bmjopen-2017-016965. [DOI] [PMC free article] [PubMed]
  131. Lobban F, Akers N, Appelbe D, Chapman L, Collinge L, Dodd S, et al. Clinical effectiveness of a web-based peer-supported self-management intervention for relatives of people with psychosis or bipolar (REACT): online, observer-blind, randomised controlled superiority trial. BMC Psychiatry 2020;20:160. https://doi.org/10.1186/s12888-020-02545-9 doi: 10.1186/s12888-020-02545-9. [DOI] [PMC free article] [PubMed]
  132. GL Assessment. General Health Questionnaire. URL: www.gl-assessment.co.uk/products/general-health-questionnaire-ghq/ (accessed 23 August 2019).
  133. Goldberg D. Manual of the General Health Questionnaire. Windsor: NFER Nelson; 1978.
  134. Jones CJ, Hayward M, Brown A, Clark E, Bird D, Harwood G, et al. Feasibility and participant experiences of a written emotional disclosure intervention for parental caregivers of people with psychosis. Stress Health 2016;32:485–93. https://doi.org/10.1002/smi.2644 doi: 10.1002/smi.2644. [DOI] [PubMed]
  135. National Institute for Health and Care Excellence. Guide to the Methods of Technology Appraisal 2013. London: NICE; 2013. [PubMed]
  136. Frick KD. Microcosting quantity data collection methods. Med Care 2009;47(Suppl. 7):76–81. https://doi.org/10.1097/MLR.0b013e31819bc064 doi: 10.1097/MLR.0b013e31819bc064. [DOI] [PMC free article] [PubMed]
  137. Li J, Parrott S, Sweeting M, Farmer A, Ross J, Dack C, et al. Cost-effectiveness of facilitated access to a self-management website, compared to usual care, for patients with type 2 diabetes (HeLP-Diabetes): randomized controlled trial. J Med Internet Res 2018;20:e201. https://doi.org/10.2196/jmir.9256 doi: 10.2196/jmir.9256. [DOI] [PMC free article] [PubMed]
  138. Curtis L, Burns A. Unit Costs of Health and Social Care 2017. Canterbury: Personal Social Services Research Unit, University of Kent; 2017.
  139. NHS Improvement. National Schedule of Reference Costs 2017/18. London: NHS Improvement; 2017.
  140. Devlin NJ, Shah KK, Feng Y, Mulhern B, van Hout B. Valuing health-related quality of life: an EQ-5D-5L value set for England. Health Econ 2018;27:7–22. https://doi.org/10.1002/hec.3564 doi: 10.1002/hec.3564. [DOI] [PMC free article] [PubMed]
  141. Faria R, Gomes M, Epstein D, White IR. A guide to handling missing data in cost-effectiveness analysis conducted within randomised controlled trials. PharmacoEconomics 2014;32:1157–70. https://doi.org/10.1007/s40273-014-0193-3 doi: 10.1007/s40273-014-0193-3. [DOI] [PMC free article] [PubMed]
  142. Department for Business, Energy and Industrial Strategy. Ethnicity Facts and Figures: Average Hourly Pay. London: Department for Business, Energy and Industrial Strategy; 2018.
  143. Iribarren SJ, Cato K, Falzon L, Stone PW. What is the economic evidence for mHealth? A systematic review of economic evaluations of mHealth solutions. PLOS ONE 2017;12:e0170581. https://doi.org/10.1371/journal.pone.0170581 doi: 10.1371/journal.pone.0170581. [DOI] [PMC free article] [PubMed]
  144. Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev 2006;63:217–35. https://doi.org/10.1177/1077558705285298 doi: 10.1177/1077558705285298. [DOI] [PubMed]
  145. Petrou S, Murray L, Cooper P, Davidson LL. The accuracy of self-reported healthcare resource utilization in health economic studies. Int J Technol Assess Health Care 2002;18:705–10. https://doi.org/10.1017/s026646230200051x doi: 10.1017/s026646230200051x. [DOI] [PubMed]
  146. Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) – explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health 2013;16:231–50. https://doi.org/10.1016/j.jval.2013.02.002 doi: 10.1016/j.jval.2013.02.002. [DOI] [PubMed]
  147. Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D, et al. Long-term clinical and cost-effectiveness of psychological intervention for family carers of people with dementia: a single-blind, randomised, controlled trial. Lancet Psychiatry 2014;1:539–48. https://doi.org/10.1016/S2215-0366(14)00073-X doi: 10.1016/S2215-0366(14)00073-X. [DOI] [PubMed]
  148. Ritchie J, Spencer L. Qualitative Data Analysis for Applied Policy Research. In Bryman A, Burgess RG, editors. Analyzing Qualitative Data. Abingdon: Routledge; 2002. pp. 187–208.
  149. Rayson P . Wmatrix: A Web-based Corpus Processing Environment. Lancaster: Computing Department, Lancaster University; 2009. URL: http://ucrel.lancs.ac.uk/wmatrix/ (accessed 9 March 2020).
  150. Glynn SM, Randolph ET, Garrick T, Lui A. A proof of concept trial of an online psychoeducational program for relatives of both veterans and civilians living with schizophrenia. Psychiatr Rehabil J 2010;33:278–87. https://doi.org/10.2975/33.4.2010.278.287 doi: 10.2975/33.4.2010.278.287. [DOI] [PubMed]
  151. Rotondi AJ, Haas GL, Anderson CM, Newhill CE, Spring MB, Ganguli R, et al. A clinical trial to test the feasibility of a telehealth psychoeducational intervention for persons with schizophrenia and their families: intervention and 3-month findings. Rehabil Psychol 2005;50:325–36. https://doi.org/10.1037/0090-5550.50.4.325 doi: 10.1037/0090-5550.50.4.325. [DOI] [PMC free article] [PubMed]
  152. Mohr DC, Cuijpers P, Lehman K. Supportive accountability: a model for providing human support to enhance adherence to eHealth interventions. J Med Internet Res 2011;13:e30. https://doi.org/10.2196/jmir.1602 doi: 10.2196/jmir.1602. [DOI] [PMC free article] [PubMed]
  153. Baumeister H, Reichler L, Munzinger M, Lin J. The impact of guidance on internet-based mental health interventions – a systematic review. Internet Interventions 2014;1:205–15. https://doi.org/10.1016/j.invent.2014.08.003 doi: 10.1016/j.invent.2014.08.003. [DOI]
  154. Mental Health Taskforce. The Five Year Forward View for Mental Health. London: NHS England; 2016.
  155. NHS Digital. Health Secretary: My Tech Vision will Help Build Most Advanced Health and Care System in the World. Press release, 17 October 2018. URL: https://digital.nhs.uk/news-and-events/latest-news/nhs-technology-vision (accessed 18 February 2020).
  156. Craig P, Matthews L, Moore L, Simpson S, Skivington K, Baird J, et al. Developing and Evaluating Complex Interventions: Draft of Updated Guidance. URL: www.sphsu.gla.ac.uk/stakeholder-survey-2019/Full%20complex%20guidance%20draft%20for%20consultation%20v1.1%2026.03.19.pdf (accessed 28 February 2020).
  157. Mohr DC, Schueller SM, Riley WT, Brown CH, Cuijpers P, Duan N, et al. Trials of intervention principles: evaluation methods for evolving behavioral intervention technologies. J Med Internet Res 2015;17:e166. https://doi.org/10.2196/jmir.4391 doi: 10.2196/jmir.4391. [DOI] [PMC free article] [PubMed]
  158. Perle JG, Langsam LC, Randel A, Lutchman S, Levine AB, Odland AP, et al. Attitudes toward psychological telehealth: current and future clinical psychologists’ opinions of internet-based interventions. J Clin Psychol 2013;69:100–13. https://doi.org/10.1002/jclp.21912 doi: 10.1002/jclp.21912. [DOI] [PubMed]
  159. Hollis C, Falconer CJ, Martin JL, Whittington C, Stockton S, Glazebrook C, Davies EB. Annual research review: digital health interventions for children and young people with mental health problems – a systematic and meta-review. J Child Psychol Psychiatry 2017;58:474–503. https://doi.org/10.1111/jcpp.12663 doi: 10.1111/jcpp.12663. [DOI] [PubMed]
  160. Queen’s University Belfast. SWAT 65: Strategies to Optimise Retention to an Online Randomised Controlled Trial for Relatives of People with Severe Mental Illness. URL: www.qub.ac.uk/sites/TheNorthernIrelandNetworkforTrialsMethodologyResearch/FileStore/Filetoupload,786657,en.pdf (accessed 28 October 2019).
  161. Deci E, Ryan RM. Intrinsic Motivation and Self-determination in Human Behavior. Berlin: Springer Science+Business Media; 1985. https://doi.org/10.1007/978-1-4899-2271-7 doi: 10.1007/978-1-4899-2271-7. [DOI]

RESOURCES