qualitative study activation therapy for depression : a Acceptability of the Fitbit in behavioural and

Introduction Major depressive disorder is characterised by low mood and poor motivation. Literature suggests that increased physical activity has positive effects on alleviating depression. Fitness-tracking devices may complement behavioural activation (BA) therapy to improve physical activity and mental health in patients with depression. Objectives To understand patients’ perceived benefit from the Fitbit and explore themes associated with patient experiences. To compare perceived benefit, patient factors, Fitbit usage and Beck’s Depression Inventory (BDI) scores. Methods Semistructured interviews were conducted with patients (n=36) who completed a 28-week BA group programme in a mood disorders outpatient clinic. All patients were asked to carry a Fitbit One device. We conducted thematic analyses on the interviews and exploratory quantitative analyses on patient characteristics, Fitbit usage, steps recorded, perceived benefit and BDI scores. Findings Twenty-three patients found the Fitbit helpful for their physical activity. Themes of positive experiences included self-awareness, peer motivation and goal-setting opportunities. Negative themes included inconvenience, inaccuracies and disinterest. Age, baseline and change in BDI scores, prior physical activity goals and familiarity with technology were not associated with perceived benefit from the Fitbit or usage. Perceived benefit was significantly (p<0.01) associated with usage. Conclusions Overall, the Fitbit is an acceptable tool to complement BA therapy for patients with depression. Many positive themes were concordant with current literature; however, patients also reported negative aspects that may affect use. Clinical implications Clinicians and researchers should consider both strengths and limitations of activity trackers when implementing them to motivate patients with depression. Trial Registration Number NCT02045771; Pre-results. BACkgROuNd Depression is one of the highest contributors to the global burden of disease, ranking second in terms of years lived with disability.1 Moreover, depression has high costs associated with morbidity and care, costing the Canadian economy an estimated $C32.3 billion in gross domestic product per year.2 It is also the most important risk factor for lifetime suicide attempts.3 Finally, individuals with depression are at greater risk of comorbidities such as cardiovascular disease and obesity.4 Physical activity has many benefits, including reduction in cardiovascular risk, body weight, visceral adiposity and improved cardiorespiratory fitness.5–7 Current literature suggests that physical activity can be impactful in managing depression. A randomised controlled trial (RCT) including 35 inpatients with depression found that addition of adjuvant exercise treatment can be helpful in improving depressive symptoms.8 Furthermore, a recent meta-analysis found exercise to have a significant effect on depression.9 Thus, interventions to improve physical activity may prove to be a valuable treatment addition in depression. As technology continues to improve and become more integrated in our lives, new mobile health innovations are arising, with some aimed at improving physical activity. In particular, wearable activity trackers were shown to be helpful in improving physical activity and weight loss in the general population.10–12 A growing body of evidence has shown that such devices may be useful in clinical settings, such as cancer care.13 14 Moreover, recent studies have shown that wearable devices such as the Fitbit can measure step count, stairs climbed and distance travelled with comparable accuracy to a well-validated pedometer and other consumer-level activity trackers.15 The Fitbit is also capable of connecting data to personal online accounts, making it possible to collect aggregate data from these accounts given permission. As such, these devices may be useful in informing clinicians to improve management as well as for research purposes. A small number of studies explored the use of such devices in mental health. A pilot study demonstrated the benefit of pedometer support in improving weekly step counts and overall mood for mild-tomoderate depression.16 One study of 10 patients with serious mental illness demonstrated that patients were receptive and accepting of these devices.17 Another exploratory study showed that increased steps measured on Fitbit wearable devices were associated with improved fitness and weight loss.18 Such evidence suggests that wearable activity tracking devices may have a place in mental health treatment; however, more evidence is required to understand their value, effectiveness and for whom it might be most beneficial. OBjeCTIveS We examined (1) the proportion of participants who perceived benefit from the Fitbit and (2) themes that led to positive and negative experiences with Fitbits. Secondary to this qualitative analysis, we aimed to perform exploratory quantitative analysis to examine (1) how participants’ baseline characteristics related to perceived Fitbit benefit and use and (2) relationships O ri gi na l a rt ic le O ri gi na l a rt ic le Acceptability of the Fitbit in behavioural activation therapy for depression: a qualitative study Jenny Chum,1 Min Suk Kim,1 Laura Zielinski,2 Meha Bhatt,3 Douglas Chung,1 Sharon Yeung,1 Kathryn Litke,4 Kathleen McCabe,4,5 Jeff Whattam,4 Laura Garrick,4 Laura O’Neill,4,5 Stefanie Goyert,4 Colleen Merrifield,4 Yogita Patel,4 Zainab Samaan3,4,5,6,7 Evidence-Based Mental Health Online First, published on October 22, 2017 as 10.1136/eb-2017-102763 Copyright Ar icle author (or their employer) 2017. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on January 5, 2018 Published by http://ebmh.bmj.com/ Downloaded from