Assessing the Feasibility of a Web-based Outcome Measurement System in Child and Adolescent Mental Health Services: myHealthE (MHE) a Randomised Controlled Feasibility Pilot Study
Authors: Morris Anna C , Ibrahim Zina , Heslin Margaret , Moghraby Omer S , Stringaris Argyris , Grant Ian M , Zalewski Lukasz , Pritchard Megan , Stewart Robert , Hotopf Matthew , Pickles Andrew , Dobson Richard J B , Simonoff Emily , Downs Johnny 
Published: October 2021

Background

Interest in internet-based patient reported outcome measure (PROM) collection is increasing. The NHS myHealthE (MHE) web-based monitoring system was developed to address the limitations of paper-based PROM completion. MHE provides a simple and secure way for families accessing Child and Adolescent Mental Health Services to report clinical information and track their child’s progress. This study aimed to assess whether MHE improves the completion of the Strengths and Difficulties Questionnaire (SDQ) compared with paper collection. Secondary objectives were to explore caregiver satisfaction and application acceptability.

Methods

A twelve-week single-blinded randomised controlled feasibility pilot trial of MHE was conducted with 196 families accessing neurodevelopmental services in south London to examine whether electronic questionnaires are completed more readily than paper-based questionnaires over a 3-month period. Follow up process evaluation phone calls with a subset (n=8) of caregivers explored system satisfaction and usability.

Results

MHE group assignment was significantly associated with an increased probability of completing an SDQ-P in the study period (adjusted hazard ratio, (HR) 12.1, 95% CI 4.7-31.0; p= <0.001). Of those caregivers’ who received the MHE invitation (n=68) 69.1% completed an SDQ using the platform compared to 8.8% in the control group (n=68). The system was well received by caregivers, who cited numerous benefits of using MHE, for example, real time feedback and ease of completion.

Conclusions

MHE holds promise for improving PROM completion rates. Research is needed to refine MHE, evaluate large scale MHE implementation, cost effectiveness and explore factors associated with differences in electronic questionnaire uptake.

Key practitioner messages

Patient reported outcome measures (PROMs) are considered an important tool for measuring treatment success and outcomes in healthcare systems.

Adherence to routine PROM guidance in Child and Adolescent Mental Health Services (CAMHS) remains low, largely driven by limitations associated with paper-based data collection.

Paperless monitoring systems (i.e., digital) as an alternative to traditional outcome measure delivery and collection are growing in healthcare settings.

Remote questionnaire completion using the myHealthE (MHE) system is feasible and acceptable to caregivers of children accessing CAMHS in South London, yielding a 60.3 % increase in Strengths and Difficulties questionnaire reporting compared to standard practice.

More research is required to understand whether MHE implementation affords similar improvements in remote PROM completion at scale and whether electronic questionnaire uptake is equal for different socio-demographic and clinical populations.