This document summarizes the results of a Delphi study on self-management strategies for bipolar disorder. The study involved two rounds of surveys with panels of healthcare providers and community members living with bipolar disorder. In the first round, the panels rated over 400 potential self-management strategies. Strategies related to early warning signs and relationships were highly rated. Maintaining mood balance strategies were rated higher than those for stopping mood progression. There was consensus between the panels but also some differences, such as healthcare providers prioritizing medication-related strategies more. The top strategies from the first round were carried forward to the second round for further rating.

1. 2014 Network Meeting
Delphi Project
Main cast: Erin Michalak, Sara Lapsley,
Jehannine Austin, Michael Scott, Lesley Berk,
Steven Barnes, Melinda Suto
Supporting cast: Sally McBride, Sharon Hou,
Nusha Balram Elliott, Chandra Jade

2. Study Objective
To generate knowledge on what self-management
strategies work best for:
- Keeping balance in mood
- Stopping progression in hypomania and mania
Self-Management Strategies (SMS)
- Sleep, diet, rest and exercise
- Regular monitoring and adjustment
- Reflective, meditative, spiritual practices
- Understanding BD, educating others
- Connecting with others
- Enacting a plan

3. CREST.BD definition of ‘self-management’
• Wide ranges of plans and/or routines and
activities that a person with BD uses to
promote health and QoL
• Healthcare providers, friends, family or
caregivers can be involved in developing
strategies and supporting their use
• Outside of hospital settings, it’s typically
the person with BD who chooses, enacts
their self-management approach and
tailors their self-management strategies

4. Recruitment
Techniques

5. Round 1 Sample (Round 2 Sample)
Gender & Age
Healthcare Providers: Community Members:
Female
70%
Male
30%
Female
78%
Male
22%
• 79 female (68 female)
• 22 male, mean age 43 (range 19-68)
(15 male)
• 101 total (83)
91% response rate
• 35 female (29 female)
• 15 male, mean age 47 (range 24-81)
(14 male)
• 51 total (43)
81% response rate

6. Choosing which SMSs to include in Round 2
• Round 1: 436 strategies
• Round 2: 154 strategies
• 70 strategies for both Maintaining Balance and
Stopping Progression
• 42 each for only MB or SP
• Approximately 20 minutes to complete

7. Top Self-Management Strategies
Maintaining Balance: CM
• Learn to manage stress
• Prioritize rest and sleep
• Never run out of meds
• Cultivate loving, healthy
relationships
• End unhealthy
relationships
Maintaining Balance: HCP
• Learn to manage stress
• Commit to getting to
sleep
• Exercise regularly

8. Top Self-Management Strategies
Stopping Progression to
Hypomania & Mania: CM
• Be aware of early
warning signs (EWS)
• Use past experience to
identify EWS
• Prioritize rest and sleep
• Never run out of
medication
Stopping Progression to
Hypomania & Mania: HCP
• Be aware of early warning
signs (EWS)
• Use past experience to
identify EWS
• Commit to getting to sleep
• Take medications as
prescribed; don’t adjust
without consulting doctor
• Find the right medication
regime

9. Research - Most
important findings from
the Delphi survey:
• Maintaining Balance SMS
more highly endorsed than
Stopping Progression SMS
• SMS to address EWS highly
endorsed by both panels
• For Maintaining Balance, CM
highly endorsed relationship-related
SMS
• For Stopping Progression,
HCP highly endorsed
medication-related SMS
Knowledge Exchange -
Key learning to share with
network members:
• Communicate robust SMS to
HCP and CM living with BD
• Address different learning
styles and needs of diverse
communities
• Determine ways to include
under-accessed
communities in a broader
survey
• Develop methods for
evaluating uptake of SMS

10. With thanks to…
Our 152 Delphi participants –
you rock!

13. Round 1 Results
SMS ratings
There was a very high
level of consensus
between both panels
on the ratings
Strategies about early
warning signs were
prominent for Stopping
Progression
Strategies about
relationships and
emotions were
prominent for
Maintaining Balance
Strategies for
Maintaining Balance
were rated higher than
those for Stopping
Progression

14. Round 1 Results
And while there was consensus…
…there were also interesting, though slight,
differences between the opinions of the panels.
HCPs had more
strategies for Stopping
Progression in their top
quartile than CMs did
CMs rated strategies
about social supports
lower than HCPs for
both MB and SP

15. Round 1 Results
What about low-rated strategies?
The lowest-rated
strategy for both panels
was “Take St. John’s
Wort”
Strategies that
referenced spirituality
received low ratings
from panels
Strategies about
regulating diet generally
did not rate highly in
either panel
No strategies on
parenting and only one
on sex in the highest
quartile for either
panel

16. Choosing which SMSs to include in Round 2
• We chose an equal number (X) of both types
of strategies: Maintaining Balance & Stopping
Progression.
• We chose the strategies in the top quartile
(highest 25%) for both Maintaining Balance
and Stopping Progression
This gave us an equal number of both types of
strategy

17. Phase 1
Re-analysis
of Wellness
Study
Peer-reviewed
literature

18. Last slide: should address 2 Qs:

19. Phase 1
Grey
Literature
Search
Materials NOT published in
academic journals
Books
Government Documents
Blogs
Websites
Conference Proceedings
Videos

20. Phase 2
Organisation

21. Phase 3
Panel
Recruitment

22. Phase 4
Sharing
Research
Findings

23. Round 1 Results
Healthcare providers, discipline
22%
2%
26%
0%
50%
Psychiatrist (11)
Nurse Practitioner (1)
Psychologist (13)
Family physician (0)
Other (25)
“Other” included: Occupational Therapist (5), Social Worker (4),
Psychotherapist (2), Mental Health Worker (2), Did not specify (2),
Researcher (2), Peer Support Worker, Nurse, Genetic Counsellor, Nurse
Educator, Family Counsellor, CBT & EMDR Therapist.