Supporting Successful PhDs: Dr Sarah Rees and the Arbour App

Sarah Rees recently passed her viva and gained her PhD: The development of an intervention to support doctors and medical students in their decision whether to disclose their mental ill health. With support from Professor Debbie Cohen, School of Medicine, and Professor Michael Robling from the Centre for Trials Research. The Centre supports a number of PhD students. Here Sarah explains the research she carried out, her journey and the development of an innovative app called Arbour.

What was the background to your PhD research?

The idea for my PhD developed from a previous study on which I worked on for the School of Medicine.  I was employed on a study (funded by the postgraduate training body, the Wales Deanery) that surveyed UK doctors anonymously about disclosure of their own mental ill health to the workplace (Cohen, Winstanley, & Greene, 2016).  The online survey of 1% of UK doctors found a discrepancy.  Those doctors with a history of mental ill health behaved differently to how doctors with no such history expected they would behave if faced with mental ill health in the future.  It was clear from this work that a full understanding of how disclosure decisions are made by doctors was lacking.  Intention to disclose mental ill health did not translate into actual disclosures.  Qualitative comments highlighted how doctors struggle with disclosure decision-making.

My background is in Health Psychology.  My interest in behaviour change interventions led to the idea of this PhD: could an intervention based on behaviour change principles support doctors and medical students in their decision-making about whether to disclose their mental ill health?

Cohen, D., Winstanley, S., & Greene, G. (2016). Understanding doctors’ attitudes towards self-disclosure of mental ill health. Occupational Medicine, 66(5), 383-389.

What research question was your study looking to address?

My study sought to understand the attitudes and experiences of doctors and medical students in their decision-making about disclosing their mental ill health, and to develop an intervention to aid doctors and medical students in their decision-making about whether to disclose their mental ill health.  Doctors and medical students under-disclose their mental ill health.  Delaying treatment for mental ill health is associated with negative outcomes.  Non-disclosure to the workplace or medical school is an obstacle to doctors and medical students receiving appropriate support and workplace adjustments. 

What was novel about the study idea or research approach for the PhD?

The intervention was a new application of the counselling method Motivational Interviewing (MI). It aims to support individual doctors and medical students in their decision-making about their mental ill health, and is the first to address this need.

The literature shows that some electronic health behaviour change interventions using MI have attempted to replicate a practitioner-client interaction.  The intervention developed for my thesis used an alternative approach more aligned with ‘self-help’.

How did the Arbour app fit in with the PhD?

Early in the development process a preference was expressed by potential users for an electronic intervention.  Further work then suggested that an app would be the best option.  Within the limitations of time and money within my PhD, I was only able to create a web version of the intervention.  Funding was then obtained from the National Centre for Mental Health (NCMH) beyond the scope of my PhD to create the app version.

What did the results / app demonstrate?

My PhD concluded with a preliminary evaluation of the acceptability, feasibility and content validity of the web version of the intervention.  Findings suggested that the intervention was generally acceptable, and that there is value in supporting doctors and medical students in their decision-making about their mental ill health.  Further work is needed to understand whether the intervention tool is effective in addressing its key aims, and among which demographics of users.  The study provided a range of findings to inform further development. 

Where can interested members of the public and researchers access the app?

• The app is available for both smartphones and tablets (android devices version 5.0 and above, and iOS version 8 and above).
• To download the app please visit Google Play or the App Store and search for Arbour. 

What next?

The work in my thesis sits under the ‘development’ stage of the MRC guidelines for the development of complex interventions.  Now that the tool has been created as an app, it will require further evaluation in that format.  The remaining stages of feasibility/piloting, evaluation, and implementation can be carried out.  This will help understand the impacts in the short, medium and long term.  The intervention may have further applications in allied health professions (e.g. vets) and beyond.

An evaluation of the intervention in its app form is underway (there’s a very brief questionnaire at the end of it).  Together with colleagues I am looking to build engagement and endorsement with the app, and am currently pursuing this with various interested organisations.  Further work is needed to determine the suitability of the app for different types of mental ill health, and whether it’s suitable for all grades and specialties of doctors and medical students.

Two key uncertainties remain: Will those doctors and medical students who are struggling with their decision whether to disclose their mental ill health use the app?  A secondary uncertainty is will the app help individuals in their decision-making?

The first (of several, hopefully!) publications from my thesis is in press.

• Rees, S., Cohen, D., Marfell, N., Robling, M. (In press).  Doctors’ decisions when disclosing their mental ill health.  Occupational Medicine.

Who were your supervisors and what role did they play?

My supervisors were Professor Debbie Cohen and Professor Michael Robling in the Centre for Trials Research.  Between them they had such a wealth of experience to draw on, I felt very lucky to have such knowledgeable and thoughtful supervisors providing me with support and guidance throughout the sometimes arduous PhD journey!