Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness

Abstract

Health and wellness interventions addressing risk factors for early mortality among individuals with serious mental illness have demonstrated success and can be further augmented with digital technology. These programs may be suitable for delivery in psychosocial rehabilitation clubhouses, especially given many services have transitioned to digital platforms during the pandemic. This qualitative study aimed to: (a) explore clubhouse members’ experiences engaging with the virtual clubhouse platform, and their preferences for accessing digital wellness and health promotion content; and, (b) gauge members’ interest in an online peer-driven lifestyle intervention and their suggestions for program design. This study was guided by a community-based participatory action research framework. Ten focus groups were conducted with clubhouse members. Focus groups were coded and analyzed thematically by trained clubhouse members and the research team. Thirty-three members participated in the focus groups. Participants expressed the importance of having technical support from staff; that one-on-one support and consistent communication are important to keep them engaged in health and wellness programming; and described mixed views about use of the virtual platform, but generally were open to engaging in lifestyle intervention programming virtually. Participants who joined the clubhouse during the pandemic expressed feeling overwhelmed by in-person gatherings, and were especially interested in opportunities for remote participation. This study can inform health and wellness programming for delivery on the virtual clubhouse platform for members. The taxonomy of codes, created to generate a framework with recommendations, will inform the design of a virtual health and wellness intervention.

Clubhouse virtual programming: A trend analysis of member engagement patterns before, during, and after pandemic lockdown.

“…The present study adds to these considerations and discussions by revealing significant findings in the longitudinal trends of clubhouse virtual and in-person engagements, with findings consistent with previous research on member experiences reporting the meaningful impact of virtual offerings and the resources associated with them (Hinchey et al, 2022; O’Neill et al, 2023). Such virtual appeal and experiences from engaging in clubhouse virtual mental health platforms may also be explained by having greater access to sources of social capital (Stewart Loane & Webster, 2017) and information and work collaborations (Nadeem et al, 2014), which in turn positively influence adherence and engagement (Gibbs et al, 2019; Killikelly et al, 2017; Sharma & Khadka, 2019).…”

“…These two observations of engagement rates across time periods and virtual ratios in the after period for both the prior and pandemic cohort suggest that members exposed to the virtual-only programming within the during period and who became familiar with the virtual platforms under forced conditions of the lockdown found value and benefit in virtual offerings within both conditions of the lockdown and reopening. Such findings would be consistent with qualitative studies of Fountain House members describing their sense of benefit and community on virtual platforms both during lockdown and the reopening of the Fountain House (O'Neill et al, 2023) and with prepandemic studies on online health communities that highlight the benefits of peer support and social connectedness (Bernardi & Wu, 2017).…”

“…Although Fountain House is a highly resourced clubhouse program, the Zoom and Slack platforms utilized in its virtual programming have free versions, with the largest resource investment being staffing and management of virtual programming, with at least one to two full-time and dedicated virtual programming staff during the after period supported by members and general programming staff in the clubhouse units. The present study adds to these considerations and discussions by revealing significant findings in the longitudinal trends of clubhouse virtual and in-person engagements, with findings consistent with previous research on member experiences reporting the meaningful impact of virtual offerings and the resources associated with them (Hinchey et al, 2022;O'Neill et al, 2023). Such virtual appeal and experiences from engaging in clubhouse virtual mental health platforms may also be explained by having greater access to sources of social capital (Stewart Loane & Webster, 2017) and information and work collaborations (Nadeem et al, 2014), which in turn positively influence adherence and engagement (Gibbs et al, 2019;Killikelly et al, 2017;Sharma & Khadka, 2019).…”

“…Yet virtual or telehealth models centered on community-based models for recovery from SMI have lagged (Kilbourne et al, 2018). Indeed, the continued utilization of the virtual programming by both the prior and pandemic cohort within the after period appears to be independent of social distancing measures and could be explained by other recent qualitative research identifying the sustainable appeal and benefit for Fountain House members engaging virtually even after in-person services resumed (O'Neill et al, 2023). The present study advances these understandings by showing that meaningful engagement on virtual platforms occurs simultaneous to in-person programming.…”