The purpose of this report is to develop a theoretical model based on empirical evidence that can serve as a foundation for the science of peer-support factors that facilitate engagement in digital health interventions for people with serious mental illness (SMI). A review of the literature on how peer-support specialist interaction with consumers with SMI in digital health behavior change interventions enhances engagement. Unlike relationships with other health providers, peer-to-consumer relationships are based on reciprocal accountability —meaning that peer-support specialists and consumer mutually help and learn from each other. Under the recovery model of mental illness, reciprocal accountability suggests autonomy, flexible expectations, shared lived experience, and bonding influence engagement in digital interventions. Separate yet related components of reciprocal accountability in the context of digital health intervention engagement include (1) goal setting, (2) task agreement, and (3) bonding. Hope and sense of belonging are hypothesized moderators of peer-support factors in digital health interventions. Peer-support factors help people with SMI learn to live successfully both in the clinic and community. Peer-support specialists add value and complement traditional mental health treatment through their professional training and lived experience with a mental illness. The proposed model is a pioneering step towards understanding how peer-support factors impact engagement in digital health behavior change interventions among people with a lived experience of SMI. The model presents proposed factors underlying the reciprocal accountability processes in the context of digital health intervention engagement. This model and related support factors can be used to examine or identify research questions and hypotheses.
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Anttila, M., Välimäki, M., Hätönen, H., Luukkaala, T., & Kaila, M. (2012). Use of web-based patient education sessions on psychiatric wards. International Journal of Medical Informatics, 81(6), 424–433. https://doi.org/10.1016/j.ijmedinf.2012.02.004.
Aschbrenner, K. A., Naslund, J. A., Gorin, A. A., Mueser, K. T., Scherer, E. A., Viron, M., Kinney, A., & Bartels, S. J. (2018). Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: protocol for a randomized controlled trial. Contemporary Clinical Trials, 74, 97–106.
Badcock, J. C., Shah, S., Mackinnon, A., Stain, H. J., Galletly, C., Jablensky, A., & Morgan, V. A. (2015). Loneliness in psychotic disorders and its association with cognitive function and symptom profile. Schizophrenia Research, 169(1–3), 268–273.
Bandura, A. (1994). Self-efficacy. In R. J. Corsini. Encyclopedia of psychology 2 (3),368–369. New York: Wiley.
Bandura, A., & Ramachaudran, V. S. (1994). Encyclopedia of human behavior. New York: Academic Press.
Barnes, A. L., Murphy, M. E., Fowler, C. A., & Rempfer, M. V. (2012). Health-related quality of life and overall life satisfaction in people with serious mental illness. Schizophrenia Research and Treatment, 2012, 1–6. https://doi.org/10.1155/2012/245103.
Baumeister, R. F., & Leary, M. R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529.
Beckner, V., Vella, L., Howard, I., & Mohr, D. C. (2007). Alliance in two telephone-administered treatments: relationship with depression and health outcomes. Journal of Consulting and Clinical Psychology, 75(3), 508–512.
Beebe, L. H. (2010). What community living problems do persons with schizophrenia report during periods of stability? Perspectives in Psychiatric Care, 46(1), 48–55.
Borkman, T. J. (1999). Understanding self-help/mutual aid: experiential learning in the commons. New Brunswick, NJ: Rutgers University Press.
Borrero, M., Martens, P., & Gubelman Borrero, G. (1979). Toward a theory of accountability. Journal of Sociology & Social Welfare, 6, 876–894.
Bracke, P., & Verhaeghe, M. (2006). The balance of peer support among persons with chronic mental health problems: consequences and antecedents. Paper presented at The 11th international congress of the European Society for Health and Medical Sociology.
Brehm, S., & Brehm, J. W. (1981). Psychological reactance: a theory of freedom and control. New York, NY: Academic Press.
Cabassa, L. J., Camacho, D., Vélez-Grau, C. M., & Stefancic, A. (2017). Peer-based health interventions for people with serious mental illness: a systematic literature review. Journal of Psychiatric Research, 84, 80–89.
Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006). Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychology and Aging, 21(1), 140–151.
Campbell, S. R., Holter, M. C., Manthey, T. J., & Rapp, C. A. (2014). The effect of CommonGround software and decision support center. American Journal of Psychiatric Rehabilitation, 17(2), 166–180.
Castelein, S., Bruggeman, R., Van Busschbach, J. T., Van Der Gaag, M., Stant, A., Knegtering, H., & Wiersma, D. (2008). The effectiveness of peer support groups in psychosis: a randomized controlled trial. Acta Psychiatrica Scandinavica, 118(1), 64–72.
Chapman, S. A., Blash, L. K., Mayer, K., & Spetz, J. (2018). Emerging roles for peer providers in mental health and substance use disorders. American Journal of Preventive Medicine, 54(6), S267–S274.
Christensen, H., Griffiths, K. M., & Korten, A. (2002). Web-based cognitive behavior therapy: analysis of site usage and changes in depression and anxiety scores. Journal of Medical Internet Research, 4(1), e3.
Christensen, H., Griffiths, K. M., & Farrer, L. (2009). Adherence in internet interventions for anxiety and depression: systematic review. Journal of Medical Internet Research, 11(2), e13.
Cook, J. A., Copeland, M. E., Corey, L., Buffington, E., Jonikas, J. A., Curtis, L. C., Grey, D. D., & Nichols, W. H. (2010). Developing the evidence base for peer-led services: changes among participants following wellness recovery action planning (WRAP) education in two statewide initiatives. Psychiatric Rehabilitation Journal, 34(2), 113–120.
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16–20.
Corrigan, P. W., McCracken, S. G., & Holmes, E. P. (2001). Motivational interviews as goal assessment for persons with psychiatric disability. Community Mental Health Journal, 37(2), 113–122.
Darkins, A., Kendall, S., Edmonson, E., Young, M., & Stressel, P. (2015). Reduced cost and mortality using home telehealth to promote self-management of complex chronic conditions: a retrospective matched cohort study of 4,999 veteran patients. Telemedicine and e-Health, 21(1), 70–76.
Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: a report from the field. Schizophrenia Bulletin, 32(3), 443–450.
Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry, 11(2), 123–128.
de Leeuw, J. R. J., van Splunteren, P., & Boerema, I. (2012). Personal control in rehabilitation: an internet platform for patients with schizophrenia and their caregivers. Open Journal of Psychiatry, 2(04), 355–361.
Deci, E. L., & Ryan, R. M. (1985). The general causality orientations scale: self-determination in personality. Journal of Research in Personality, 19(2), 109–134.
Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: review and update. World Psychiatry, 15(1), 13–20.
Eliacin, J., Coffing, J. M., Matthias, M. S., Burgess, D. J., Bair, M. J., & Rollins, A. L. (2018). The relationship between race, patient activation, and working alliance: implications for patient engagement in mental health care. Administration and Policy in Mental Health and Mental Health Services Research, 45(1), 186–192.
El-Mallakh, P. (2007). Doing my best: poverty and self-care among individuals with schizophrenia and diabetes mellitus. Archives of Psychiatric Nursing, 21(1), 49–60.
Eysenbach, G. (2005). The law of attrition. Journal of Medical and Internet Research, 7(1), e11.
Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117–140. https://doi.org/10.1177/001872675400700202.
Finnerty, M., Austin, E., Chen, Q., Layman, D., Kealey, E., Ng-Mak, D., Rajagopalan, K., & Hoagwood, K. (2018). Implementation and use of a client-facing web-based shared decision-making system (MyCHOIS-CommonGround) in two specialty mental health clinics. Community Mental Health Journal, 1–10.
Firth, J., Cotter, J., Torous, J., Bucci, S., Firth, J. A., & Yung, A. R. (2015). Mobile phone ownership and endorsement of “mHealth” among people with psychosis: a meta-analysis of cross-sectional studies. Schizophrenia Bulletin, 42(2), 448–455.
Fortuna, K. L., Lohman, M. C., Batsis, J. A., DiNapoli, E. A., DiMilia, P. R., Bruce, M. L., & Bartels, S. J. (2017). Patient experience with healthcare services among older adults with serious mental illness compared to the general older population. The International Journal of Psychiatry in Medicine, 52(4–6), 381–398.
Fortuna, K., Aschbrenner, K., & Bartels, S. (2018a). Integration of peer philosophy in clinical workflow. Psychiatric Quarterly, 89(4), 795–800. https://doi.org/10.1007/s11126-018-9578-3.
Fortuna, K., Aschbrenner, K., Lohman, M., Salzer, M., & Bartels, S. (2018b). Text message exchanges between older adults with serious mental illness and older certified peer specialists in a smartphone-supported self-management intervention. Psychiatric Rehabilitation Journal., 42, 57–63. https://doi.org/10.1037/prj0000305. [Epub ahead of print].
Fortuna, K. L., DiMilia, P. R., Lohman, M. C., Bruce, M. L., Zubritsky, C. D., Halaby, M. R., Walker, R. M., Brooks, J. M., & Bartels, S. J. (2018c). Feasibility, acceptability, and preliminary effectiveness of a peer-delivered and technology supported self-management intervention for older adults with serious mental illness. Psychiatric Quarterly, 89(2), 293–305.
Fortuna, K., Barr, P., Goldstein, C., Walker, R., Brewer, L., Zagaria, A., Bartels, S. (2019). Application of Community-engaged research to inform the development and implementation of a peer-delivered mobile health intervention for adults with serious mental illness. Journal of Participatory Medicine, 11(1), e12380.
Frank, A. F., & Gunderson, J. G. (1990). The role of the therapeutic alliance in the treatment of schizophrenia: relationship to course and outcome. Archives of General Psychiatry, 47(3), 228–236.
Gagne, C. A., Finch, W. L., Myrick, K. J., & Davis, L. M. (2018). Peer workers in the behavioral and integrated health workforce: opportunities and future directions. American Journal of Preventive Medicine, 54(6), S258–S266.
Graffigna, G., Barello, S., & Riva, G. (2013). How to make health information technology effective: the challenge of patient engagement. Archives of Physical Medicine and Rehabilitation, 94, 2034–2035. https://doi.org/10.1016/j.apmr.2013.04.024.
Hagborg, W. J. (1998). An investigation of a brief measure of school membership. Adolescence, 33(130), 461–468.
Hales, S. B., Davidson, C., & Turner-McGrievy, G. M. (2014). Varying social media post types differentially impacts engagement in a behavioral weight loss intervention. Translational Behavioral Medicine, 4(4), 355–362.
Hidalgo-Mazzei, D., Reinares, M., Mateu, A., Nikolova, V. L., del Mar Bonnin, C., Samalin, L., Garcia-Estela, A., Perez-Sola, V., Young, A. H., Strejilevich, S., & Vieta, E. (2018). OpenSIMPLe: a real-world implementation feasibility study of a smartphone-based psychoeducation programme for bipolar disorder. Journal of Affective Disorders, 241, 436–445.
Horvath, A. O., Del Re, A., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9–16.
Kaufman, L., Kuhn, W., & Stevens Manser, S. (2016). Peer specialist training and certification programs: a National Overview. Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin.
Kukla, M., Salyers, M. P., & Lysaker, P. H. (2013). Levels of patient activation among adults with schizophrenia: associations with hope, symptoms, medication adherence, and recovery attitudes. The Journal of Nervous and Mental Disease, 201(4), 339–344.
Lazarus, R. S. (1999). Hope: an emotion and a vital coping resource against despair. Social Research, 66(2), 653–678.
Lerner, J. S., & Tetlock, P. E. (1999). Accounting for the effects of accountability. Psychological Bulletin, 125(2), 255–275.
Linz, S. J., & Sturm, B. A. (2013). The phenomenon of social isolation in the severely mentally ill. Perspectives in Psychiatric Care, 49(4), 243–254.
Maslow, A. H. (1954). The instinctoid nature of basic needs. Journal of Personality, 22, 326–347.
Mead, S., & MacNeil, C. (2006). Peer support: what makes it unique. International Journal of Psychosocial Rehabilitation, 10(2), 29–37.
Melau, M., Harder, S., Jeppesen, P., Hjorthøj, C., Jepsen, J., Thorup, A., & Nordentoft, M. (2015). The association between working alliance and clinical and functional outcome in a cohort of 400 patients with first-episode psychosis: a cross-sectional study. The Journal of Clinical Psychiatry, 76(1), 83–90.
Mohr, D. C., Cuijpers, P., & Lehman, K. (2011). Supportive accountability: a model for providing human support to enhance adherence to eHealth interventions. Journal of Medical Internet Research, 13(1). https://doi.org/10.2196/2Fjmir.1602.
Mueller, N. E., Panch, T., Macias, C., Cohen, B. M., Ongur, D., & Baker, J. T. (2018). Using smartphone apps to promote psychiatric rehabilitation in a peer-led community support program: pilot study. JMIR Mental Health, 5(3), e10092.
Myrick, K., & del Vecchio, P. (2016). Peer support services in the behavioral healthcare workforce: state of the field. Psychiatric Rehabilitation Journal, 39(3), 197–206.
Naslund, J. A., Grande, S. W., Aschbrenner, K. A., & Elwyn, G. (2014). Naturally occurring peer support through social media: the experiences of individuals with severe mental illness using YouTube. PLoS One, 9(10), e110171. https://doi.org/10.1371/journal.pone.0110171.
Naslund, J. A., Marsch, L. A., McHugo, G. J., & Bartels, S. J. (2015). Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature. Journal of Mental Health, 24(5), 321–332.
Naslund, J., Aschbrenner, K., Marsch, L., & Bartels, S. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and Psychiatric Sciences, 25(2), 113–122.
Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., McHugo, G. J., & Bartels, S. J. (2018). Facebook for supporting a lifestyle intervention for people with major depressive disorder, bipolar disorder, and schizophrenia: an exploratory study. Psychiatric Quarterly, 89(1), 81–94.
Ordóñez, L. D., Schweitzer, M. E., Galinsky, A. D., & Bazerman, M. H. (2009). Goals gone wild: the systematic side effects of overprescribing goal setting. Academy of Management Perspectives, 23(1), 6–16.
Palmier-Claus, J. E., Ainsworth, J., Machin, M., Barrowclough, C., Dunn, G., Barkus, E., Rogers, A., Wykes, T., Kapur, S., Buchan, I., & Salter, E. (2012). The feasibility and validity of ambulatory self-report of psychotic symptoms using a smartphone software application. BMC Psychiatry, 12(1), 1–39.
Peh, C. X., Kua, E. H., & Mahendran, R. (2016). Hope, emotion regulation, and psychosocial well-being in patients newly diagnosed with cancer. Supportive Care in Cancer, 24(5), 1955–1962.
Polivy, J. (2001). The false hope syndrome: unrealistic expectations of self-change. International Journal of Obesity, 25(S1), 80–84.
Poole, R., Simpson, S. A., & Smith, D. J. (2012). Internet-based psychoeducation for bipolar disorder: a qualitative analysis of feasibility, acceptability and impact. BMC Psychiatry, 12(1), 139. https://doi.org/10.1186/1471-244X-12-139.
Ritterband, L. M., Thorndike, F. P., Cox, D. J., Kovatchev, B. P., & Gonder-Frederick, L. A. (2009). A behavior change model for internet interventions. Annals of Behavioral Medicine, 38(1), 18–27.
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78.
Salyers, M. P., Fukui, S., Bonfils, K. A., Firmin, R. L., Luther, L., Goscha, R., Rapp, C. A., & Holter, M. C. (2016). Consumer outcomes after implementing CommonGround as an approach to shared decision making. Psychiatric Services, 68(3), 299–302.
Salzer, M. S. (2002). Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. Psychiatric Rehabilitation Skills, 6(3), 355–382. https://doi.org/10.1080/10973430208408443.
Salzer, M. S., Darr, N., Calhoun, G., Boyer, W., Loss, R. E., Goessel, J., Schwenk, E., & Brusilovskiy, E. (2013). Benefits of working as a certified peer specialist: results from a statewide survey. Psychiatric Rehabilitation Journal, 36(3), 219–221. https://doi.org/10.1037/prj0000016.
Sarason, I. G., Levine, H. M., Basham, R. B., & Sarason, B. R. (1983). Assessing social support: the social support questionnaire. Journal of Personality and Social Psychology, 44(1), 127–139. https://doi.org/10.1037/0022-3522.214.171.124.
Schutt, R. K., & Rogers, E. S. (2009). Empowerment and peer support: structure and process of self-help in a consumer-run center for individuals with mental illness. Journal of Community Psychology, 37(6), 697–710.
Shorey, H. S., Snyder, C. R., Rand, K. L., Hockemeyer, J. R., & Feldman, D. B. (2002). Authors’ response: somewhere over the rainbow: hope theory weathers its first decade. Psychological Inquiry, 13(4), 322–331. https://doi.org/10.1207/S15327965PLI1304_03.
Skovholt, T. M. (1974). The client as helper: a means to promote psychological growth. The Counseling Psychologist, 4(3), 58–64. https://doi.org/10.1177/001100007400400308.
Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., Yoshinobu, L., Gibb, J., Langelle, C., & Harney, P. (1991). The will and the ways: development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585. https://doi.org/10.1037/0022-35126.96.36.1990.
Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27(4), 392–401.
Sue, D. W., & Sue, D. (1990). Counseling the culturally different: theory and practice. Oxford, England: John Wiley & Sons.
Teo, H.-H., Chan, H.-C., Wei, K.-K., & Zhang, Z. (2003). Evaluating information accessibility and community adaptivity features for sustaining virtual learning communities. International Journal of Human-Computer Studies, 59(5), 671–697. https://doi.org/10.1016/S1071-5819(03)00087-9.
Todd, N. J., Jones, S. H., & Lobban, F. A. (2013). What do service users with bipolar disorder want from a web-based self-management intervention? A qualitative focus group study. Clinical Psychology & Psychotherapy, 20(6), 531–543. https://doi.org/10.1002/cpp.1804.
Torous, J., Staples, P., Shanahan, M., Lin, C., Peck, P., Keshavan, M., & Onnela, J.-P. (2015). Utilizing a personal smartphone custom app to assess the Patient Health Questionnaire-9 (PHQ-9) depressive symptoms in patients with major depressive disorder. JMIR mental health, 2(1), e8. https://doi.org/10.2196/mental.3889.
Tracey, T. J., & Kokotovic, A. M. (1989). Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology, 1(3), 207–210. https://doi.org/10.1037/1040-35188.8.131.52.
Tyler, T. R. (1997). The psychology of legitimacy: a relational perspective on voluntary deference to authorities. Personality and Social Psychology Review, 1(4), 323–345. https://doi.org/10.1207/s15327957pspr0104_4.
Vance, K., Howe, W., & Dellavalle, R. P. (2009). Social internet sites as a source of public health information. Dermatologic Clinics, 27(2), 133–136. https://doi.org/10.1016/j.det.2008.11.010.
Wampold, B. E. (2015). How important are the common factors in psychotherapy? An update. World Psychiatry, 14(3), 270–277.
World Health Organization. (2018). Guidelines for the management of physical health conditions in adults with severe mental disorders. Geneva: World Health Organization.
Wright, D. (1997). Getting out of the asylum: understanding the confinement of the insane in the nineteenth century. Social History of Medicine, 10(1), 137–155.
Zhao, L., Lu, Y., Wang, B., Chau, P. Y. K., & Zhang, L. (2012). Cultivating the sense of belonging and motivating user participation in virtual communities: a social capital perspective. International Journal of Information Management, 32(6), 574–588. https://doi.org/10.1016/j.ijinfomgt.2012.02.006.
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Fortuna, K.L., Brooks, J.M., Umucu, E. et al. Peer Support: a Human Factor to Enhance Engagement in Digital Health Behavior Change Interventions. J. technol. behav. sci. 4, 152–161 (2019). https://doi.org/10.1007/s41347-019-00105-x