Online peer support in long-term conditions: A feasibility randomised controlled trial

Background: Thirty per cent of the UK population live with a long-term physical health condition, and many also experience symptoms of low mood. Limited psychosocial support is currently available for people living with long-term physical health conditions and subthreshold depression, who are at risk of developing major depressive disorder. Online peer support offers a low-cost, scalable solution to intervene early and prevent the worsening of depressive symptoms. Partnering with lived experience experts, we co-designed CommonGround, an online peer support platform with embedded psychoeducation. This feasibility randomised controlled trial aimed to assess the usability and acceptability of CommonGround for people with long-term physical health conditions experiencing subthreshold depression and assess the feasibility of a larger confirmatory trial.Methods: We conducted a mixed-methods, two-arm, parallel-group, unblinded feasibility randomised controlled trial. We recruited adults living with at least one long-term physical health condition who had access to the internet and subthreshold depression (scoring 5-9 on the Patient Health Questionnaire-8). Participants were randomised to either the CommonGround platform or a control condition where fortnightly emails shared links to the National Health Service mental health webpages. Outcome assessments were administered at baseline (0 weeks), mid-intervention (6 weeks), and post-intervention (12 weeks) timepoints. The primary outcome was the number of participants recruited to the trial. A purposive sample was interviewed to evaluate participant experiences of the CommonGround platform, control condition, and trial procedures. Results: Recruitment targets were met, and it was feasible to obtain follow-up questionnaire responses. Of participants consenting to screening, 25% were found to be eligible, which was lower than expected (30%), indicating that recruitment or screening processes may need refinement. Participants reported psychosocial benefits from using CommonGround but felt that a longer intervention period was needed for the community to evolve. Participants suggested creating a CommonGround smartphone application (‘app’) to improve the login experience, navigation, and future engagement. Conclusions: People with long-term health conditions found the CommonGround platform usable and acceptable for accessing peer support. With minor modifications to trial design and further platform development, a confirmatory randomised controlled trial to evaluate clinical and cost-effectiveness is feasible and warranted.Trial Registration: ClinicalTrials.gov: NCT06222346; https://clinicaltrials.gov/study/NCT06222346. Protocol version: Version 1.3; 4th September 2024.