Evaluation of a Digital Pre-therapy Patient Education Program (StartHjelp) in Outpatient Mental Health Care

Patient satisfaction with the client satisfaction questionnaire (CSQ). The CSQ prompts the patient to evaluate different aspects of the care received with an 4 point ordinal scale (very dissatisfied, somewhat dissatisfied, somewhat satisfied, very satisfied).

Patient activation measure 13 will be used. This questionaire measures patient activation by asking about knowledge, skills, and ability to manage one's own health, and health care usage. It consists of 13 items which is answered on an 4 point ordinal scale (Strongly disagree, somewhat disagree, somewhat agree, and strongly agree. Respondents have the option to answer "not applicable to me" as well.

Knowledge will be measured by five questions. All questions are introduced by "how much knowledge do you have about" (how outpatient clinics work; what happens in therapy; self management and user participation; patient rights; treatment options available to you). These questions are answered on a six-point ordinal scale ranging from "Nothing" to "Very much". After these 5 questions a follow up question "do you know what type of treatment you want?", answered either "yes", "no", or "don't know", is asked. If the answer is "yes" the patient is prompted to write what it is that they want.

To measure patient enablement the PEN-13 will be used. The PEN-13 is a 13 item questionnaire which measure patient enablement across two domains (patient practitioner interaction and self management). The answers are given on a five-point Likert scale (strongly disagree, disagree, neither/nor, agree, and strongly agree).

Work and social adjustment, or level of functioning, is measured by the Work and Social Adjustment Scale (WSAS). The WSAS have five items that measure functioning across different domains: Work, home management, social leisure activities, private leisure activities, and close relationships. Each question is answered on a 0 to 8 scale, where 0 means "not at all" impaired, and 8 means "very severely" impaired.

Mental health will be measured the Patient Health questionnaire 4. A four-item questionnaire with two items measuring the severity of anxiety symptoms and two items measuring the severity of depression symptoms.

Perceived stress will be measured by Perceived stress Scale-4, which comprise of four items scored on a five-point ordinal scale scored 0-4. Answers range from Never to very often.

Health related quality of life will be measured with the EQ-5D-5L. This questionnaire measure health related quality of life with five items, where each items prompts the patient to evaluate their "problem level" across a specific domain (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). Question responses are ordinal and include "no problems", "slight problems", "moderate problems", "severe problems" and "extreme problems". Respondents are also asked to rate their health on a 0-100 scale.

Intentions for patient involvement were measured by asking the question "How much do you want to participate in decisions related to your treatment measured on a six point ordinal scale ranging from "nothing" to "very much".

To investigate patients' expectations about the interventions an open question "What are your expectations for this intervention".

Cost of app development and maintenance are being tracked to compare it against its outcomes to evaluate its cost-benefit.

To measure app engagement, anonymized data of app usage will be gathered through the app itself.

Data from official patient registries will be used to track (drop out, number of consultations, type of treatment)

To test the usability of the app itself the System Usability Scale will be used, a widely used 10-item scale that measure how the user experience using and trying to understand a digital tool.

To screen for alcohol use disorders Alcohol Use Disorders Identification Test (AUDIT) will be used. AUDIT has 10 items and uses the last 12 months as a reference for answering.

To screen for drug use disorders Drug Use Disorders Identification Test (DUDIT) will be used. DUDIT has 11 items and uses the last 12 months as a reference for answering.

Data from official patient registries will be used to track work status (disability status, employment or sick leave).