FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study

Abstract

Background Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). Objective This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. Methods A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. Results Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. Conclusions The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population.

Pilot randomized, crossover trial of prolonged exposure with and without the PE Coach mobile application: A mixed-methods study of patient-centered outcomes among veterans with PTSD.

“…Mobile apps have demonstrated promise to increase engagement and adherence to evidence-based interventions (Buck et al, 2020; Luxton, 2018). Only a few studies have tested whether adjunctive mHealth enhances patient experiences among veterans (e.g., Buck et al, 2022; Kuhn et al, 2022), and none have examined this question in the context of psychotherapy for PTSD. During a course of PE treatment wherein veterans experienced large, clinically meaningful, decreases in PTSD (Hedge’s g = 1.25) and depressive symptoms (Hedge’s g = .93), veteran patients were given the opportunity to experience PE with and without PE Coach .…”

A systematic review of users experiences of using digital interventions within psychosis: a thematic synthesis of qualitative research

“…Fifteen out of the nineteen studies were rated as high quality, with a score of 9 or above [12,[33][34][35][36][37][38][39][40][41][42][43][44][45][46]. The rest of the studies were rated as moderate quality, scoring either 7 or 8 [14,[47][48][49]. None of the included studies were rated as low quality (scoring 6 or below).…”

“…In all of the studies, there was a clear statement of aims, and the methods were deemed appropriate to address these aims. For five of the studies, the method used to analyse the data was stated, however a more detailed reporting of the steps used to analyse the qualitative data was not clearly stated [14,42,43,47,49]. The item that was scored most poorly across the included studies was in relation to reflexivity and bias.…”

“…Being able to customise and tailor interventions to individual needs was reported as an important feature. This included being able to see visual representations of their own experiences, personalising reminders, and having the option to write qualitative feedback [33,35,40,43,[46][47][48]. ''I would've changed my prompts to check in with my sleep'' [p. 6,47].…”

Adapting and Implementing Apps for Mental Healthcare

“…In a much smaller study with 17 veterans in the USA, acceptability and willingness to recommend a smartphone-based self-management intervention for people with severe mental illness were very good in that all but one veteran would have recommended the app to a friend. However, the question whether the veterans would have preferred a face-to-face service was not included [15]. Thus, acceptability may depend on the usability of the app, the care setting, and the target patient group, indicating that user group-specific and care setting-specific app adaptations may lead to increased rates of usability and acceptance.…”