MFIT

1. MFIT Brock University Department of Nursing

2. Presentation Outline • Walkthrough of the App • Journaling in Relation to Reflective Practice • Music • Pop-ups • The Purpose • The development of the Mood Scale • The REB forms and the Importance of speaking to the Students • Ethical Issues • Resources

3. Wendy Writer, CEO Robyn Reeves Mood Scale Development Ronny Reader, CFO Joseph Remington Interactive Design Coordinator Abby Author, CTO Vanessa Sjaarda Team Communications and Resource Centre Berry Books, CPO Joseph Vigo Ethics and Liability Coordinator The Team

4. The Rationale

5. Four suicide deaths at the University of Guelph has some students calling it a crisis... (CTV News Kitchener, 2017)

7. To create a resource for Blessed Trinity students which can be used to encourage and raise awareness of mental fitness. Project Objective

8. Mental Health and Wellness • Mental health is a relevant issue • Improved outcomes when continually monitoring mental health and providing resources (Reid et al., 2011) • Interest in self monitoring mental health apps (Bakker, Kazantzis, & Rickard, 2016) • Creation of mental health apps within the past 10 years has increased (Bakker, Kazantzis, & Rickard, 2016)

9. The Mood Scale

10. Mental Health and Wellness • Our original idea • Identify mental health indicators relevant to the students • Identify a mental health assessment which can be transferred to the students

11. How our Original Idea has Changed • Original idea with the creation or modification of a mental health assessment would be more labour intensive, as well as time consuming • Need to research • Need to test • Would require more time to complete • Superintendent, principal and mental health lead expressed interest in mood scale and reflective practice • Able to achieve this in a shorter time without formal research

12. Mood Scale • Mood has a large effect on a young adults life • Coping • Behaviours • Thoughts and thought process • The ability to link to reflective practice and self monitoring • Provides something to monitor • Aim is to build emotional intelligence • Will be discussed in more detail later in the presentation (Reid et al., 2008)

13. Mood Scale • Wording • The scale needs to be a self rated device • “Rate How You Feel” • How it Should Function • Use of symbols • A middle point • Reduced response bias (C. Smith, Personal Communication, September 25th 2018; Joffer et al., 2016; Bastable, 2017; Baumgartner et al., 2001)

14. The REB Forms and Importance of Speaking to the Students

15. Talking to the Students Why do we want to talk to students? • We need their input and thoughts on what to include in the app. • They are the experts! • Different perspectives. • Increase the usability of the app. What will we say? • Written script prepared before entering the classroom. • 10 question semi-structured interview guide used when talking to students. What do the students need to do? • 10 question SurveyMonkey Questionnaire for students to fill out online. • Participate in discussion and write down ideas (Pelletier et al., 2013)

16. Talking to the Students • Complete two Research Ethics Board (REB) forms in order to have access and speak with the students • Niagara District Catholic School Board • Brock University • Received approval from the Niagara District Catholic School Board • By doing this process we promoted a project that would have more longevity, as it can be continued by other university students • Aids in confidentiality and privacy

17. Written Script Hey guys my name is ________ and _________. We are 4th Year Nursing Students from Brock University and we are doing a big project about mental fitness. Mental fitness is a big topic no one really likes to talk about but we are breaking down those barriers. With all the stressors in high school we figured a phone app would be helpful. We are here because we need your input in the creation of an app, it’s a phone app designed by you for you! You guys are the expert in your own mental fitness and that’s why we want your opinion. We are hoping to launch this app next year for you guys so we want to make sure we cover all of your needs and wants. We have a questionnaire we would like you to fill out on SurveyMonkey. (Write the link on the board) And then after everyone is done the questionnaire we are going to have a small group discussion We are going to ask the teacher if they could leave the room for a bit while we talk to the students so that the students feel more comfortable talking about their preferences. Does anyone have any questions? If you have any other inquiries just email us at mfitnessapp@gmail.com (Write email on the board)

18. Talking to the Students ●Go in pairs to classroom with one female and one male in each pair. ●First to fill out SurveyMonkey ●Allow students to form their own small groups within the classroom. ●Students will be provided with a large sheet of paper and a marker. During the informal discussion, students will jot down notes on the paper (emphasize that everything is confidential and anonymous). ●Joe, Joe, Vanessa and Robyn will mingle throughout the classroom and validate students thoughts. ●Will make a time slot where students who feel the need to say things to us in private can come and discuss the ideas. This will be held at a time after the classroom discussion is over.

19. SurveyMonkey Questionnaire The information gathered in this survey will be used to direct the content of an app which is under development. For this app, we would like to know what you, as a student, would find the most beneficial. Thank you in advance. 1. Would you appreciate positive messages and notifications around mental awareness? Yes Sometimes No 2. Would you be interested in tracking your mood over an extended period of time (for example feelings of joy over 10 days)? Yes Maybe No 3. Do you have a cell phone plan? Yes No

20. SurveyMonkey Questionnaire 4. Do you prefer yes or no questions or open ended questions? Yes/No Open Ended 5. Do you want to set reminders for yourself to use the app? Yes No 6. Do you want music to play in the app? Yes No 7. Do you want to be able to customize the colours of your app? Yes No 8. Do you want to be able to create an avatar for yourself? Yes No

21. SurveyMonkey Questionnaire 9. Do you think that a mental health application would be a good resource? Yes No 10. Do you think that students would use a mental health application? Yes No Sometimes

22. Open-Ended Informal Discussion 1. What mental health issues do you feel are relevant to this school? 2. What would you like to improve at this school in terms of mental health (e.g. more resources, individual support or support groups, more marketing of resources, etc)? 3. What resources do you feel are most beneficial (e.g. in person type meetings, crisis call lines, texting, online)? 4. What do you do when you’re stressed? 5. What sort of stressors do you feel are relevant to this school? 6. Who would you go to if you needed help?

23. Open-Ended Informal Discussion 7. Who do you consider your biggest support person? (Can be multiple) 8. Would you use a resource that was far away/outside the school (ie attending groups). 9. In 10 words or less, describe what you want to see in a mobile app (e.g. interactive, games, emoticons, resources, music, etc). 10. If you could create a mental health resource, what would you include? 11. Would you be comfortable asking your friends for help? 12. Is there anything else that you would like to talk about that we haven’t mentioned yet that would be important to you?

24. REB Returned: What needed to be Changed Section C: Possible risks and benefits Section D: Consent process Consent form Participant feedback Participant withdrawal Section E: Confidentiality and anonymity Section A: General detail Conflict of interest Section B: Detail regarding methods

25. REB Returned: What needed to be Changed • Necessary changes were made • Application edited • Forms edited • Methods edited • Resubmitted to Brock University twice. Still was not approved by November 24, 2018.

26. REB Returned: What needed to be Changed • The REB form was necessary • Requested by the superintendent • Helps promote the longevity of this project • Allows the possibility for this app to be used outside of this school in the future

27. REB Withdrawal • Withdrew from the Brock University REB on November 27, 2018 • Not enough time left in the semester. • Too many complications with consent regarding minors. • Josephine went in to talk to students herself • Was able to gather data from 30 students at Blessed Trinity. • Provided us with the information need to complete project.

28. REB Withdrawal “This project is now being adapted where the NCDSB has already collected this data in the classroom as part of their usual assessment activities (not contingent on Brock’s involvement). The NCDSB would like to share the data with Brock undergraduate students to pass on to the Business department to help those in business in the development/creation of the app (as described in your application). The data will strictly be used to inform the development of the app, and not for research purposes as defined by the TCPS2 (“an undertaking intended to extend knowledge through a disciplined inquiry and/or systematic investigation. The term “disciplined inquiry” refers to an inquiry that is conducted with the expectation that the method, results, and conclusions will be able to withstand the scrutiny of the relevant research community”). As such, the REB review of this project is no longer required.” Carly- Brock REB

29. Walkthrough of the Mobile Application

30. Initial App Sign Up Tree Opening Screen Download How to use app Your positivity bank Home Screen Terms and Ethics What makes you feel better Mood Tracker Log in Quick App Outline Pick EMOJI Contact information Create nickname Password My Journal Supports Coping

31. Frequent User App Tree Resources Home Screen Positivity Bank My Journal Prompts

32. Page layout • Quick tab links • User engagement strategies Exploring Different Applications • Interactive emoji scale • Notification prompting

33. Page layout • User engagement strategies The MFit Application • Interactive emoji scale • Notification prompting

35. Initial Plan “Positivity Bank” • Essentially self identified coping mechanisms • Will include: • User identified coping strategies • For example: • Physical activity or sports • Music • Spending time with a pet • Promotes personalization, which ideally will increase app use and applicability (Kenny et al., 2017) • Promotes user control and power (Kenny et al., 2017) • By recognising and using calming techniques (coping mechanisms), this should aid in emotional regulation and overall resilience (Halter et al., 2013; Boyatzis & McKee, 2005)

36. Journaling and Reflective Practice • Want students to be able to look back on their mood over a certain period of time. • Looking back helps students to identify and explore why they think, feel and do certain things at particular times (Emslie, 2009). • Reflecting aims to generate new and deeper accounts of identity and experience (Emslie, 2009). • Highlight why their mood was good or bad when they reflect. • What can they do differently next time when they are feeling down. • What worked the last time. • How can they improve the next time they feel this.

37. Calendar • Emoji Log • Able to view the past month or more • Allows user to see change over time • Change in mood related to time? • Change in mood related to life or scheduled events? • E.g. a test

38. Positive Affirmation There is a need for positive affirmation in youth. • The daily stressors of school (tests, bullying, grades, social interaction) can threaten students perspective on their own personal adequacy. • Small acts can increase one’s feelings of self-adequacy. The Impact of Positive Affirmations • Self- affirmations can impact self worth, decrease stress, increase well being and performance • Works with self awareness • Link to emotional intelligence • Increased activity in certain areas of the brain • Self-processing areas (Cascio et al., 2016; Cohen & Sherman, 2014)

39. Pop Ups • Check Ups - follow ups • Motivational pop ups to keep going • Keep streaks • Guidance pop ups • Reminders to use the app (infrequent) weekly one

40. Pop Ups: Based on emotions • Family dynamics • Mental health indicators • Stress • Anxiety • Depression • Gender Identity • Isolation (Social) • Bullying

41. Anxiety • You can’t stop the waves, but you can learn to surf. • Take a deep breath. It’s just a bad day, not a bad life. • There is no shame in fear, what matters is how we face it.

42. Depression • One positive thought in the morning can change your whole day. • HOPE, hold on, pain ends.

43. Gender Identity • Love is never wrong. • Role, gender, religion, sexuality. We are people and that’s it. • You don’t come out as gay, lesbian, bisexual, asexual, pansexual, transgender, etc. You come out as YOURSELF. • Only you know who you were born to be, and you need to be free to be that person. -Ruby Rose

44. Isolation • Check your positivity bank. Is it time to call a friend? • The ones who notice your struggle are the ones you need to let in • You don’t have to do everything on your own • Sometimes asking for help is the most meaningful example of self reliance

45. Bullying • Stop letting people who do so little for you control so much of your mind, feelings and emotions. • Never be afraid to be yourself. Remember an original is always worth more than a copy. • The hardest walk is walking alone, but it is the walk which makes you the strongest • Once you accept your flaws, no one can use them against you

46. Family Dynamics • It’s not what we have in life, but who we have in our lives that matters. • The most memorable people in your life are the ones that love you when you aren’t very lovable. • Relationships are filled with laughing and crying, sadness and happiness, honesty and joy

47. Stress • If you stress too much about something before it happens, you basically put yourself through it twice. • One day at a time, one moment at a time. • I hope your dreams stay big, your worries stay small. • Today I will not stress over things I cannot control. • Everyone has their problems, some just hide them better than others

48. Mental Health Indicators • The secret to getting ahead is getting started. • Find joy in the ordinary • Building relationships is about finding people who make you happy

49. Reminders to use the App • What’s your mood today? • Have you rated your mood today? • Have you checked in today?

50. MFit & Ethics