Multicentre, England-wide randomised controlled trial of the 'Foundations' smartphone application in improving mental health and well-being in a healthcare worker population

Sam N. Gnanapragasam*, Rose Tinch-Taylor, Hannah R. Scott, Siobhan Hegarty, Emilia Souliou, Rupa Bhundia, Danielle Lamb, Danny Weston, Neil Greenberg, Ira Madan, Sharon Stevelink, Rosalind Raine, Ben Carter, Simon Wessely

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)

Abstract

Background: Healthcare workers (HCWs) have faced considerable pressures during the COVID-19 pandemic. For some, this has resulted in mental health distress and disorder. Although interventions have sought to support HCWs, few have been evaluated. 

Aims: We aimed to determine the effectiveness of the 'Foundations' application (app) on general (non-psychotic) psychiatric morbidity. 

Method: We conducted a multicentre randomised controlled trial of HCWs at 16 NHS trusts (trial registration number: EudraCT: 2021-001279-18). Participants were randomly assigned to the app or wait-list control group. Measures were assessed at baseline, after 4 and 8 weeks. The primary outcome was general psychiatric morbidity (using the General Health Questionnaire). Secondary outcomes included: well-being; presenteeism; anxiety; depression and insomnia. The primary analysis used mixed-effects multivariable regression, presented as adjusted mean differences (aMD). 

Results: Between 22 March and 3 June 2021, 1002 participants were randomised (500:502), and 894 (89.2%) followed-up. The sample was predominately women (754/894, 84.3%), with a mean age of 44.3 years (interquartile range (IQR) 34-53). Participants randomised to the app had a reduction in psychiatric morbidity symptoms (aMD = -1.39, 95% CI -2.05 to -0.74), improvement in well-being (aMD = 0.54, 95% CI 0.20 to 0.89) and reduction in insomnia (adjusted odds ratio (aOR) = 0.36, 95% CI 0.21 to 0.60). No other significant findings were found, or adverse events reported. 

Conclusions: The app had an effect in reducing psychiatric morbidity symptoms in a sample of HCWs. Given it is scalable with no adverse effects, the app may be used as part of an organisation's tiered staff support package. Further evidence is needed on long-term effectiveness and cost-effectiveness.

Original languageEnglish
Pages (from-to)58-66
Number of pages9
JournalBritish Journal of Psychiatry
Volume222
Issue number2
Early online date6 Sept 2022
DOIs
Publication statusPublished - 11 Feb 2023

Keywords

  • epidemiology
  • information technologies
  • outcome studies
  • psychosocial interventions
  • Randomised controlled trial

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