A mixed methods study on the use of IBDiary: an application used to track and map the relationship between stress and IBD symptoms
Although a connection between psychological stress and increased disease activity in IBD exists, most treatment modalities for IBD tend to be medication focused. Medication is of course extremely necessary; IBD can be an incredibly difficult thing to treat, and no one treatment option works for each patient. However, as nurses we always say to focus on the entire patient, not just the disease.
Although I do not have it within my power to create entire treatment plans for patients with the various forms of IBD, I have been slowly developing a way to maybe help them help themselves.
Introduction
Stress is a well-documented factor in the exacerbation of many chronic diseases. This paper aims to explore the complex relationship between psychological stress and IBD flares. IBD, or inflammatory bowel disease, is a group of inflammatory conditions of the GI tract, primarily Corhn's disease and ulcerative colitis.
Ulcerative colitis is limited to the colon and rectum (e.g the large intestine), while Crohn's can affect any portion of the gastrointestinal tract. Treatment modalities for these conditions include a combination of anti-inflammatory drugs, immunosuppressants, biologics and lifestyle modifications.
The specific relationship between stress and IBD has been explored by a multitude of publications and yet, there continue to be large gaps in our understanding. Some publications find strong correlations between the two and others find no link at all. Furthermore, of those publications that find a strong correlation, the exact mechanism by which stress causes increased IBD symptoms is not well understood.
The goal of this study is not necessarily to prove that their is a link between psychological stress and IBD symptoms. The purpose is to help individuals gain an understanding of their personal stress and symptoms, and if the two happen to be connected, provide a space in which they can explore that relationship and how they feel about it.
The Application
IBDiary is a rather simple application. It may look like a calendar at first glance, but it's primary function is as a journal of sorts. In this journal users are encouraged to document the severity of their daily stress on a 0 to 4 scale, and their daily symptom severity on a 0 to 4 scale.
At any point in time, they are able to click the 'Graph it!' button and view a visual representation of the relationship between these two variables over the course of the month (or multiple months, or years, for that matter).
These data points will be stored in a database along with some additional app usage information.
The application is a web application that is designed to work well with the user's smartphone or tablet. It may also be viewed easily on any up-to-date browser, whether it be Chrome, Safari, Firefox, or Edge.
Methods
A total of 20 individuals, aged 18 years an older with a confirmed diagnosis of Inflammatory Bowel Disease (IBD), will be recruited for this study. Inclusion criteria will include proficiency with mobile / web application and a willingness to complete daily application tasks and a post-study interview.
This study employs a mixed-methods design. The quantitative component includes daily self-reported data that is collected via the IBDiary application. The qualitative compoenent involves semi-structured interviews before IBDiary is used, and 60 days after the start of the study.
Participants will be recruited through IBD clinics, online patient communities and social media channels. Each participant will provide informed consent and will receive training on how to use IBDiary.