dc.description.abstract | Background: There are significant psychological challenges faced by people throughout their
lives and many of these challenges can be readily understood from a contextual behavioural
science perspective, and Acceptance and Commitment Therapy (ACT) shows promise as a
theoretically and practically relevant intervention. Some problems faced in delivering such an
intervention are volume and access to healthcare. A potential solution to this is to design
theoretically driven interventions which can be delivered through technology. These need to
be interactive, individually shaped and will combine mindfulness, acceptance and values. Such
interventions need to be evaluated scientifically according to acceptability, quality, safety and
effectiveness.
Aims: This thesis has two sections. Firstly, a systematic review aiming to assess the
acceptability and effectiveness of using technology to deliver ACT. Secondly, an empirical
research study aiming to analyse the experiences of using an ACT based app for young people
with type 1 diabetes (TD1).
Methods: The review searched 11 databases, and a related website. Included studies were
required to use a form of technology to deliver ACT, with no real-time therapist. Two
independent researchers determined inclusion of articles into the review and rated the studies
according to the quality criteria. Where there was uncertainty a third reviewer was used. For
the empirical study, individual interviews of 9 young people aged 13-22 years with TD1 were
asked about their experiences of using the ACT based app. Framework analysis was used to
determine themes.
Results: The review search yielded 18 studies which met inclusion criteria. Findings
highlighted that generally these interventions were seen as acceptable and satisfactory. All of
these interventions were conducted in an adult population, and qualitative data was not
robustly accounted for. The empirical research found two main themes: ‘Desire for apps to
represent my needs’ and ‘How diabetes impacts me and how this could potentially be
addressed in an app’.
Discussion: Both the review and empirical study found that participants were positive about
the use of technology to deliver ACT. Developmental progress needs to be made in the app to
truly represent the needs of young people with TD1. These interventions could enhance the
availability of psychological therapies. This has been highlighted as a government objective
in several countries. Methodological weaknesses limit conclusions, such as underpowered
studies. As this is a fast growing body of research it is hoped that future studies could be more
similar methodologically. It would still be interesting to determine whether asynchronous
contact enhances the cost-effectiveness of this form treatment. This thesis has provided me with the opportunity to design an ACT protocol for young people
with type 1 diabetes (TD1). It has helped me to fully understand the undertaking which goes
into designing apps and the scope of how responsive apps can be. It has given me the chance
to communicate with people from different professional backgrounds to create a shared
language, an opportunity to lead and manage a project and much more. With the help of my
supervisor in my first year of training, we established links with the informatics department to
see if students would be able to help with the programming of such an app. We had to create
a synopsis of the proposed study to entice students to undertake the project as part of their
degree. An interested student was assigned the project and meetings were held to determine
our expectations and to establish the scope of what could be created. A second student took on
the project during my second year or training. During this time my supervisor and I created a
protocol of the content for the app. This was based on previous ACT protocols and tools we
were aware of, which we thought might be helpful. A lot of thought had to go into trying to
keep the content concise, including different modes of delivery (MP3s, video, animation etc),
making the content applicable to young people with TD1 based on previous literature, and
thinking about how interactive the app could be. Friends were also relied on to create graphics
for the app. I went to different health boards across Scotland to meet with Diabetes teams to
inform them about the project and to gather advice on the appropriateness of the diabetes
information within the content of the app, and to determine whether they were interested in
taking part in the study. I tested the initial prototype and glitches were ironed out. The next
stage was to test the app on professionals working in the field, and to gather their feedback
through focus groups. Adaptations to the app were made based on this. The app was initially
made for Android phone devices based on general market research indicating that there was
little evidence that one platform was more popular in adolescents. The diabetes teams and I
tried to recruit young people with TD1 from their usual diabetes clinics. Initial barriers to
recruitment were that at least 50% of young people had iPhones so could not download the
app, and others did not seem interested in downloading the app to take part in the study.
Funding of 10 Android tablets was agreed by the University. I attended the usual diabetes
clinics in NHS Lothian and young people with TD1 started to volunteer to take part in the
study. Originally it was hoped a trial of the effectiveness of the app would be carried out, but
the difficulties in recruitment meant that instead I decided to use a qualitative methodology to
explore young people’s experiences of using the app. | en |