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https://www.infirmiere-canadienne.com/blogs/ic-contenu/2022/01/31/un-service-de-textos-a-faible-technicite-tres-prom

SaskWell pilot project connects users to self-care tools and tips

Jan 31, 2022, By: Hwayeon Danielle Shin

Highlights

In the fall of 2020, our research team, led by two nurse scientists and our patient partner, was awarded a Canadian Institutes of Health Research (CIHR) operating grant. We partnered with a digital patient engagement company, MEMOTEXT, to create a two-way texting service, SaskWell. In collaboration with a community advisory committee, we incorporated the voices and needs of Saskatchewan residents into this text-based service.

SaskWell aims to connect with individuals across all regions of Saskatchewan through the most commonly accessible technology: text messaging. This service connects users with free tools, interventions and resources for their mental health and well-being.

We have conducted three consecutive 10-week iterative cycles as part of the project. SaskWell was a pilot project offering service at a provincial level. However, the lessons we learned highlight opportunities to expand this service across Canada.

How SaskWell works

People signed up for SaskWell by texting “JOIN” to a number using their mobile device. When users enrolled in SaskWell (see Image 1), they were matched with a wellness tool (e.g., an app, an online course, a discussion forum, a self-guided tool) based on their internet connectivity.

For example, users who indicated that they have reliable and consistent access to the internet received wellness tools that required internet use. In contrast, those without good internet access were matched with a wellness tool that required minimal to no internet access. Further to this, if users did not like the wellness tool they were paired with, they had the option to change the tool at weeks 2 and 5.

The two-way functionality of SaskWell allowed users to respond to the text messages. For example, some of the messages prompted users to respond with “yes” or “no” (see Image 2). In addition to wellness tools, users also received wellness tips throughout the week. These tips included, but were not limited to, a 30-day self-care challenge and muscle relaxation exercise.

Users also received weekly polling questions. Through these questions, our research team captured additional data related to understanding service use and acceptability. (The questions included the following: How did you hear about SaskWell? Why did you choose to sign up? Have you used a digital mental health wellness resource before? Would you recommend SaskWell to others?)

Implementation

We leveraged traditional and innovative ways to share and promote the uptake of SaskWell. Posters were hung up around communities in Saskatchewan. Our community advisory committee, research partners and colleagues shared SaskWell through word of mouth. Promotion also took place on our social media platforms (Twitter, Instagram and Facebook). The research team reached out to the Saskatchewan Union of Nurses, Canadian Union of Public Employees, Saskatchewan government and General Employees’ Union to inform Saskatchewan nurses of this texting service. Lastly, one of our nurse scientists was invited to speak about SaskWell on CBC Saskatchewan’s shows The Afternoon Edition and Global News Morning.

Results

SaskWell was launched in March 2021 and by June, 85 people were enrolled in the program. By tracking the total number of user clicks, we found that the most liked wellness tips were:

• Micro-journaling: prompting the user to write down thoughts in a quick and informal manner to help them focus on other daily tasks
• Sleep routine: encouraging the user to adopt and stick to regular sleep patterns
• Tips for working from home: providing advice and reminders to the user about how to make the most out of remote work
• Grounding techniques: encouraging users to connect with their immediate surroundings to help overcome feelings of being overwhelmed

SaskWell had a positive effect on users’ mental wellness. As one person stated, “Sometimes we become overwhelmed with things, but the breathing exercises were a great help when I felt that way.” Not only has SaskWell had a positive effect on mental well-being, but it also has increased users’ awareness and access to available mental health tools. As one user stated, “I now have many tools and resources that I didn’t have (before).”

As we progressed with the project, we continued to integrate feedback received from the users and the community advisory committee to further improve the service to meet the needs of Saskatchewan residents.

Lessons learned

SaskWell can bridge accessibility divides and increase awareness of digital mental wellness tools and resources.

SaskWell promotes individual awareness and connection to existing mental health and wellness supports. It connects with individuals through texting, and as a relatively low-tech intervention with widespread reach, it provides a promising opportunity to bridge known digital divisions in Saskatchewan communities. Furthermore, considering limitations in available mental health supports across the province, SaskWell can bridge accessibility divides and increase awareness of digital mental wellness tools and resources.

For nurses, the minimal effort required for a texting service aligns well with their busy schedules, as it does not require undivided attention. Spending a few moments each week to check in with mental wellness and learn new skills are excellent strategies to boost a person’s self-support capacity. One user echoed this benefit of SaskWell: “The service made me stop and take a moment to be present with myself.”

A texting service like SaskWell can help support self-care practice for nurses during and after the pandemic. As nurses’ wellness and health are as important as patients’, we want to tell our nurse colleagues that it is okay to feel exhausted or stressed because those are natural feelings, and they should not feel guilty about doing what is best for their well-being. We want to encourage our nurse colleagues to acknowledge the importance of practising self-care, even if only for a few moments each week.

Next steps

This low-tech approach is an effort to harness the power of digital connectivity to deliver more equitable and effective access to mental health resources during the pandemic and the post-pandemic period. Our research team initially intended SaskWell for residents in Saskatchewan, but with its promising benefits and acceptability, we hope the service can be offered across Canada to support mental health and wellness as the long-term effects of COVID-19 continue to be revealed. In particular, we are exploring options to evolve a version of this service specifically for Canadian nurses

We recognize the impact of the pandemic’s aftermath. A recent survey conducted at the Centre for Addiction and Mental Health (CAMH) found that nearly 30 per cent of Canadians are reporting moderate to severe anxiety about returning to pre-pandemic routines (CAMH, 2021). Additionally, we recognize the high prevalence of burnout symptoms among nurses. Before the pandemic, a global review found that at least one in every 10 nurses experiences burnout symptoms such as emotional exhaustion (Woo, Ho, Tang, & Tam, 2020).

As cumulative occupational stress leads to burnout (Sun, Lin, Zhang, Li, & Cao, 2018), the impact of the COVID-19 pandemic on psychological health will increase over time among Canadian nurses. SaskWell can help support nurses’ mental health and wellness.

To learn more about SaskWell and participate in future initiatives, please contact the author at danielle.shin@camh.ca.

Acknowledgment

Our research project team includes Tracie Risling from the College of Nursing at the University of Saskatchewan, Gillian Strudwick from the Centre for Addiction and Mental Health, patient partner representative Tyler Moss, our Community Advisory Committee, the digital patient engagement company MEMOTEXT, research coordinator Courtney Carlberg and research analyst Iman Kassam. This project is funded by the Canadian Institutes of Health Research (CIHR) and Saskatchewan Health Research Foundation (SHRF).

References

Centre for Addition and Mental Health. (2021, July 28). A third of Canadians report moderate to severe anxiety over return to pre-pandemic routines. Retrieved from https://www.camh.ca/en/camh-news-and-stories/a-third-of-canadians-report-anxiety--over-return-to-pre-pandemic-routines

Sun, J.-W., Lin, P.-Z., Zhang, H.-H., Li, J.-H., & Cao, F.-L. (2018). A non-linear relationship between the cumulative exposure to occupational stressors and nurses’ burnout and the potentially emotion regulation factors. Journal of Mental Health, 27(5), 409–415. doi: 10.1080/09638237.2017.1385740

Woo, T., Ho, R., Tang, A., & Tam, W. (2020). Global prevalence of burnout symptoms among nurses: A systematic review and meta-analysis. Journal of Psychiatric Research, 123, 9–20. doi:10.1016/j.jpsychires.2019.12.015

Hwayeon Danielle Shin, MScN, RN, is a PhD student in the University of Toronto’s Institute of Health Policy, Management and Evaluation, and a research analyst at the digital mental health research lab in the Centre for Addiction and Mental Health.