Improving CommonGround, an online peer support intervention for people living with long-term physical health conditions and sub-threshold depression: a Theory of Change driven evaluation and thematic analysis (Preprint)

BACKGROUND People living with long-term physical health conditions who are also experiencing subthreshold depression are at risk of developing major depression. In partnership with lived experience experts, clinicians, and software developers we co-designed CommonGround, an online peer support and psychoeducation platform. CommonGround’s Theory of Change (ToC) was also conceptualised that outlines the intermediate outcomes (and associated indicators of whether such outcome is achieved) needed to improve the mental health of the target population. OBJECTIVE This qualitative study, informed by the ToC, aimed to examine the acceptability, usability, and intervention mechanisms of CommonGround, ultimately aiming to refine the ToC and corresponding intervention design ahead of definitive evaluation. METHODS A nested qualitative study was conducted within a 12-week feasibility randomised controlled trial comparing CommonGround (intervention group) to signposting to NHS webpages (control group). Thirty-nine participants were interviewed about their experiences of CommonGround and trial participation. The interview schedule and thematic framework analysis were rooted in a pre-trial ToC whilst being responsive to emergent themes. RESULTS Testing the assumptions and intermediate outcomes (via their indicators) refined our understanding of how CommonGround may support mental wellbeing. Overall, participants viewed CommonGround as an appropriate, safe space to access self-management information and support from others with unique shared understanding of chronic illness. However, many participants felt more time was needed for genuine social relations and community culture to evolve. Anonymity helped foster a sense of safety but, for some, limited the formation of genuine connections. Other factors contributing to low engagement included personal circumstances (e.g., limited time). Key suggestions for future development included creating a mobile application that would be easier and more intuitive to access and navigate. CONCLUSIONS CommonGround was considered an acceptable and appropriate space to access peer support, with potential to positively impact psychological wellbeing by fostering shared understanding, support and knowledge exchange. Future evaluation should allow the community to operate for a longer period to enable genuine connections to form and to accommodate varying engagement needs. The refined ToC provides a foundation for the future evaluation of the clinical and cost-effectiveness of CommonGround within a definitive trial and accompanying process evaluation. CLINICALTRIAL ClinicalTrials.gov: NCT06222346 INTERNATIONAL REGISTERED REPORT RR2-10.2196/71513