'Thriving with Bipolar Disorder': Co-design and Evaluation of a Peer-Led Education Program Focused on Quality of Life

Self-management strategies can be used by individuals with bipolar disorder (BD) to cope with symptoms and improve quality of life (QoL). Peer-facilitated education programs have the potential to diversify delivery of self-management information by capitalizing on the expertise of individuals who live well with BD. We have co-designed a novel, peer-facilitated, QoL-focused, group education program for people living with BD. This project will involve administration of the program and an evaluation of the feasibility, acceptability, and efficacy of this program for self-management of BD.

Background and Purpose:

Peer support (where individuals with shared lived experience of a mental health condition provide each other with informational, emotional, and social support) may be an acceptable way to disseminate information on self-management strategies, capitalizing on the expertise and knowledge of people who live well with BD.

Peer-facilitated group psychoeducation includes the benefits of evidence-based self-management information and tools, with the added advantage of providing role models for recovery and modelling of self-management skills. Unfortunately, there is a dearth of BD-specific peer-facilitated self-management psychoeducation programs, and corresponding evaluations of their efficacy.

To capitalize on the potential of peer support to enhance the delivery of BD self-management information, content from two, web-based, self-directed psychoeducational interventions was adapted to create a peer-facilitated psychoeducation program using a community-based participatory research (CBPR) framework. The resulting program contains eight, weekly, two-hour sessions. Each session focuses on a topic related to QoL in BD (including Mood, Sleep, Physical Health, Relationships, Money, Self-esteem, and Independence), and contains a combination of education, opportunities for peer-to-peer knowledge exchange, and activities that facilitate practice of self-management strategies. A facilitator and attendee manual have been created for use in this program.

Methods:

The project will be implemented across two phases:

In the first phase, which we have already completed, we have applied CBPR principles to develop a peer-facilitated, QoL-focused group psychoeducation program for individuals with BD. The resulting program, entitled 'Thriving with bipolar disorder' will be delivered in eight, weekly, two-hour sessions that will be co-facilitated by two peer facilitators with lived experience of BD.

In the second phase, we will conduct a pilot evaluation of the feasibility, acceptability, and preliminary efficacy of the program. The program will be delivered through Hope+Me, an Ontario-based charity that supports people living with mood and anxiety disorders through education, advocacy, training, and support services. Four peer facilitators will be recruited through Hope+Me and will attend a \~5.5 hour training session prior to commencing the program. We will aim to recruit 32-40 program participants (8-10 per group) given previous research summarizing the ideal group size.

The evaluation will be conducted as a single-arm, uncontrolled, pilot feasibility trial. An explanatory sequential mixed-methods design will be used. The following data will be collected:

* Participants will provide baseline demographic and clinical information in a survey as part of their consent.
* Participants will complete surveys for efficacy measures at baseline, immediately after completing the program and 1 month after completing the program.
* Program feedback will be collected from participants immediately after completing the program through a Qualtrics survey.
* Peer facilitators will complete a brief, post-session Qualtrics survey each week, recording attendance, fidelity, and session feedback.

At the end of the intervention period, a subset of consenting participants (\~n=12) and peer facilitators (\~n=4) will be invited to participate in a one-hour qualitative individual interview over Zoom.

Study Population:

Four peer facilitators will be recruited through Hope+Me. We hope to recruit \~fourty program participants. Inclusion and exclusion criteria are specified in the 'Eligibility' section.

Eligibility Criteria:
Inclusion Criteria:

1. Program facilitators

   * aged 18 or older
   * a self-reported diagnosis of BD
   * sufficient access to an internet-enabled computer or smartphone device to access the Zoom teleconferencing platform
   * ability to understand, read and write English
   * at least one year of prior experience leading peer support groups or recovery programs through Hope+Me
   * previously received training through Hope+Me
   * completed a Vulnerable Sector Check (https://rcmp.ca/en/criminal-records/criminal-record-checks/vulnerable-sector-checks)
2. Program participants

   * aged 18 or older
   * residing in Canada
   * a self-reported diagnosis of BD
   * ability to understand, read and write English
   * sufficient access to an internet-enabled computer or smartphone device to access the Zoom teleconferencing platform

Exclusion Criteria:

* inability to communicate in written and verbal English to a sufficient level to allow participation in the program and research activities