Introduction: Suicide prevention Introduction MyPlan The Case - - PowerPoint PPT Presentation

The University of Sydney

Brugerinvolvering i udviklingen af testen af MinPlan kriseplanen til mobiltelefonen

Presenteret af: Niels Buus

The University of Sydney 2

• There is a need for developing evidence-based, low-cost suicide

prevention that can be scaled up and distributed to high-risk groups

• There is no single, staged suicide process and people’s

trajectories through suicidal behaviour vary significantly

• Suicide prevention can be strengthened by including interventions

that extend people’s already existing personal coping strategies

Introduction: Suicide prevention

Introduction MyPlan The Case Study Results Discussion

The University of Sydney

Introduction MyPlan The Case Study Results Discussion

• Safety planning is regarded as best practice in suicide

prevention

• Stanley and Brown’s (2012) safety planning tool
• MyPlan was originally modelled after this tool, but augments it

by adding smart phone functions (e.g. GPS, memory, automated actions)

3

The MyPlan safety planning app

The University of Sydney

Introduction MyPlan The Case Study Results Discussion

• Safety planning is regarded as best practice in suicide

prevention

• Stanley and Brown’s (2012) safety planning tool
• MyPlan was originally modelled after this tool, but augments it

by adding smart phone functions (e.g. GPS, memory, automated actions)

4

The MyPlan safety planning app

Front page Menu Be safe Warning signs Strategies Hope Box Quick Messages

The University of Sydney 5

• The aims of the study was: 1) to explore different stakeholder

perspectives on the MYPLAN safety planning app and 2) to examine significant developments of the app during the participatory research and development strategy

• Design: Qualitative case study
• Participants: Australian and Danish MyPlan stakeholders
• Data collection: Four focus groups in Denmark and five

workshops (three workshops in Australia and two in Denmark)

• Data were subjected to thematic and discourse analyses

The Case Study

Introduction MyPlan The Case Study Results Discussion

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• The participants embraced the MYPLAN app as a tool that, to

some extent, could interrupt the suicidal process and give them a sense of increased personal control

• However, they also identified limitations, in particular that it was

not regarded as useful for persons who were very distressed

• Learning how to effectively use the safety plan was not

perceived as an intuitive process and face-to-face psychosocial support and additional online support should be considered

Findings 1: Benefits and limitations of the app

Introduction MyPlan The Case Study Results Discussion

The University of Sydney 7

• The participants embraced the MYPLAN app as a tool that, to

some extent, could interrupt the suicidal process and give them a sense of increased personal control

• However, they also identified limitations, in particular that it was

not regarded as useful for persons who were very distressed

• Learning how to effectively use the safety plan was not

perceived as an intuitive process and face-to-face psychosocial support and additional online support should be considered

Findings 1: Benefits and limitations of the app

Introduction MyPlan The Case Study Results Discussion

Josie: I think it is hard to stick to it [the safety plan] when you are so far out that it almost gives you peace of mind to feel bad. Then it’ s hard to turn round and start using a tool to get better. You have to put effort into it. Sigourney: Yes, when you are so far into the red zone. It’ s hard to use any tool in that space because your thoughts [about self-harm/ suicide] are fixed. There is one thing you want and that is how it is and you forget everything else.

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• The participants embraced the MYPLAN app as a tool that, to

some extent, could interrupt the suicidal process and give them a sense of increased personal control

• However, they also identified limitations, in particular that it was

not regarded as useful for persons who were very distressed

• Learning how to effectively use the safety plan was not

perceived as an intuitive process and face-to-face psychosocial support and additional online support should be considered

Findings 1: Benefits and limitations of the app

Introduction MyPlan The Case Study Results Discussion

Josie: I think it is hard to stick to it [the safety plan] when you are so far out that it almost gives you peace of mind to feel bad. Then it’ s hard to turn round and start using a tool to get better. You have to put effort into it. Sigourney: Yes, when you are so far into the red zone. It’ s hard to use any tool in that space because your thoughts [about self-harm/ suicide] are fixed. There is one thing you want and that is how it is and you forget everything else.

The University of Sydney 9

• The analyses identified three consecutive phases in the

development of the app:

• Phase one: ‘Suggesting core functions’
• Phase two: ‘Refining functions’
• Phase three: ‘Negotiating the finish’.
• The user involving processes continued to prevent ‘closure’ and

challenged researchers and app developers

Findings 2: Phased user-involving

Introduction MyPlan The Case Study Results Discussion

The University of Sydney 10

• The analyses identified three consecutive phases in the

development of the app:

• Phase one: ‘Suggesting core functions’
• Phase two: ‘Refining functions’
• Phase three: ‘Negotiating the finish’.
• The user involving processes continued to prevent ‘closure’ and

challenged researchers and app developers

Findings 2: Phased user-involving

Introduction MyPlan The Case Study Results Discussion

Sarah: “It says the word suicide a lot and it says a lot of words that probably when you are in distress you don’t need to be confronted

• with. And more importantly, it is talking about and not to you again,

which is really kind of demoralising. I feel like it could be a lot shorter and more pleasant very easily.”

The University of Sydney 11

• The analyses identified three consecutive phases in the

development of the app:

• Phase one: ‘Suggesting core functions’
• Phase two: ‘Refining functions’
• Phase three: ‘Negotiating the finish’.
• The user involving processes continued to prevent ‘closure’ and

challenged researchers and app developers

Findings 2: Phased user-involving

Introduction MyPlan The Case Study Results Discussion

Sarah: “It says the word suicide a lot and it says a lot of words that probably when you are in distress you don’t need to be confronted

• with. And more importantly, it is talking about and not to you again,

which is really kind of demoralising. I feel like it could be a lot shorter and more pleasant very easily.”

Phase 1: Suggesting core functions. DK Focus group #1-4 Between Phase 1 and Phase 2 Phase 2: Refining functions. DK Workshop #1 and #2 and AUS Workshop #3 Between Phase 2 and Phase 3 Phase 3: Negotiating the finish. AUS Workshop #4 and #5 After Phase 3 Users suggested speed-dialling

• buttons. The colours
• f the buttons should

reflect ‘the degree of emergency’ (yellow/ red). They should be simple to use: an emergency call should be made with no more than two clicks Development

• f wireframes

with different types of menus and different

• pportunities

for placing an alarm button The location of the two buttons was discussed and they were placed at the bottom of the front page. The yellow button should be named ‘Help’ and was assigned a telephone icon. The red button should be named ‘Alarm’ and was assigned an exclamation mark

• icon. The way to assign

contacts to buttons was discussed and the number of possible contacts to assign to the yellow button should be ten Implementation of two buttons on front

• page. A yellow ‘Help’

button with a telephone icon and a red ‘Emergency’ button with a white exclamation mark. Alarm call in two clicks from front page (but a four-digit access code was also added). Maximum of 10 ‘yellow’ contacts The need for better

• n-boarding

information, explaining the way to add contacts to buttons, was noted. The icon on the yellow button should be a telephone and a head in a circle. The icon on the red button should be a white cross in a red circle On-boarding information about how to assign contacts to the two buttons was discussed. Implementation of two buttons on front page. A yellow ‘Help’ button with a telephone icon and a red ‘Emergency’ button with a telephone icon

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• The analyses identified three consecutive phases in the

development of the app:

• Phase one: ‘Suggesting core functions’
• Phase two: ‘Refining functions’
• Phase three: ‘Negotiating the finish’.
• The user involving processes continued to prevent ‘closure’ and

challenged researchers and app developers

Findings 2: Phased user-involving

Introduction MyPlan The Case Study Results Discussion

Sarah: “It says the word suicide a lot and it says a lot of words that probably when you are in distress you don’t need to be confronted

• with. And more importantly, it is talking about and not to you again,

which is really kind of demoralising. I feel like it could be a lot shorter and more pleasant very easily.”

The University of Sydney 13

• Uncertainty about the effect of MyPlan as a stand-alone

mHealth intervention

• The electronically augmented communication did not

fundamentally transform the communicational modes and did to some extent leave participants’ issues of isolation, uncertainty, and over-responsiveness unchanged

• While the user involving processes analysed in the present study

clearly included elements of consultation, it remained debatable to which extent the researchers were committed to collaborate and genuinely share control

Discussion

Introduction MyPlan The Case Study Results Discussion

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Methods/design: The trial is designed as a two-arm, observer-blinded, parallel- group randomized clinical superiority trial, where participants will either receive: (1) Experimental intervention: the safety plan provided as the app MyPlan, or (2) Treatment as Usual: the safety plan in the original paper format. Based on a power calculation, a total of 546 participants, 273 in each arm will be included.

Discussion - next steps

Introduction MyPlan The Case Study Results Discussion

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Thank you for your attention Contact: niels.Buus@sydney.edu.au Find resources: https://www.researchgate.net/profile/Niels_Buus2

The University of Sydney 16

Literature

• Andreasson, K., Krogh, J., Bech, P., Frandsen, H., Buus, N., Stanley, B., . . . Erlangsen, A.

(2017). MYPLAN - mobile phone application to manage crisis of persons at risk of suicide: study protocol for a randomized controlled trial. Trials, 18(1), 171

• Buus N, Juel A, Haskelberg H, Frandsen H, Larsen JLS, River J, Andreasson K, Nordentoft M,

Davenport T & Erlangsen A. User involvement in developing the MYPLAN mobile phone safety plan app: a case study (Accepted for publication JMIR-MH)

• Buus N, Erlangsen A, River J, Andreasson K, Frandsen H, Larsen JLS, Nordentoft M & Juel A.

Stakeholder perspectives on using and developing the MYPLAN suicide prevention mobile phone application: A focus group study, Archives of Suicide Research, 2018, DOI: 10.1080/13811118.2018.1489319

• Larsen JLS, Frandsen H & Erlangsen A. MYPLAN - A Mobile Phone Application for

Supporting People at Risk of Suicide. Crisis. 37 (3): 236-240, 2016; DOI: 10.1027/0227-5910/a000371

• Stanley B & Brown GK. Safety planning intervention: a brief intervention to mitigate suicide
• risk. Cogn Behav Pract. 19: 256-264, 2012; doi.org/10.1016/j.cbpra.2011.01.001.
• Thomas G. How to do your case study. London: Sage, 2011.