What influences engagement with a bipolar disorder self-management app? A qualitative investigation of use of the PolarUs app.

Interventions delivered via smartphone apps may support individuals with bipolar disorder (BD) to learn about and implement evidence-based self-management strategies in the context of their daily lives. However, app usage rates are often suboptimal. The subjective experience of users may provide insights into factors influencing engagement (and disengagement) with an mHealth intervention. The present study describes a qualitative investigation of the experiences of people with BD who participated in the evaluation of a novel app-based intervention for BD self-management, the PolarUs app. Twenty-five individuals with BD were provided with access to an app-based self-management intervention over a three-month study period, and were later interviewed about personal experiences of engagement with the intervention, including attempts to enact self-management strategies. Thematic analysis was used to identify important aspects of the experience of engaging with a self-management app. Three themes describing drivers of engagement with the PolarUs app and associated features were generated: 1) Motivations, 2) Salience, and 3) Perceived effort. Drivers of engagement were shaped by contextual influences, summarised in four themes: 1) The smartphone ecosystem, 2) Daily life, 3) Mood symptoms, and 4) Involvement in a research study. The findings of this research generate insights into how individuals with BD engage with app-based interventions. Lived experience perspectives can inform the design of engaging app-based interventions for BD. Further, these findings emphasise the importance of considering the context in which people use self-management apps for BD for both research studies and implementation.