mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge

Abstract

BackgroundmHealth interventions that use mobile phones as instruments for illness management are gaining popularity. Research examining mobile phone‒based mHealth programs for people with psychosis has shown that these approaches are feasible, acceptable, and clinically promising. However, most mHealth initiatives involving people with schizophrenia have spanned periods ranging from a few days to several weeks and have typically involved participants who were clinically stable.ObjectiveOur aim was to evaluate the viability of extended mHealth interventions for people with schizophrenia-spectrum disorders following hospital discharge. Specifically, we set out to examine the following: (1) Can individuals be engaged with a mobile phone intervention program during this high-risk period?, (2) Are age, gender, racial background, or hospitalization history associated with their engagement or persistence in using a mobile phone intervention over time?, and (3) Does engagement differ by characteristics of the mHealth intervention itself (ie, pre-programmed vs on-demand functions)?MethodsWe examined mHealth intervention use and demographic and clinical predictors of engagement in 342 individuals with schizophrenia-spectrum disorders who were given the FOCUS mobile phone intervention as part of a technology-assisted relapse prevention program during the 6-month high-risk period following hospitalization.ResultsOn average, participants engaged with FOCUS for 82% of the weeks they had the mobile phone. People who used FOCUS more often continued using it over longer periods: 44% used the intervention over 5-6 months, on average 4.3 days a week. Gender, race, age, and number of past psychiatric hospitalizations were associated with engagement. Females used FOCUS on average 0.4 more days a week than males. White participants engaged on average 0.7 days more a week than African-Americans and responded to prompts on 0.7 days more a week than Hispanic participants. Younger participants (age 18-29) had 0.4 fewer days of on-demand use a week than individuals who were 30-45 years old and 0.5 fewer days a week than older participants (age 46-60). Participants with fewer past hospitalizations (1-6) engaged on average 0.2 more days a week than those with seven or more. mHealth program functions were associated with engagement. Participants responded to prompts more often than they self-initiated on-demand tools, but both FOCUS functions were used regularly. Both types of intervention use declined over time (on-demand use had a steeper decline). Although mHealth use declined, the majority of individuals used both on-demand and system-prompted functions regularly throughout their participation. Therefore, neither function is extraneous.ConclusionsThe findings demonstrated that individuals with schizophrenia-spectrum disorders can actively engage with a clinically supported mobile phone intervention for up to 6 months following hospital discharge. mHealth may be useful in reaching a clinical population that is typically difficult to engage...

Barriers to and Facilitators of Engagement With Remote Measurement Technology for Managing Health: Systematic Review and Content Analysis of Findings (Preprint)

“…However, in another study that compared within group differences, only 20% of participants (10/51) aged between 50 and 94 years were reported to be capable of using a smartphone, as opposed to a larger smart tablet for data entry and active monitoring, and of these 10 people, only three considered the smaller device easy to use [28]. Lost or damaged device was a clear barrier to usability and participation, mentioned in four studies [8,13,15,26]. Further disruptions to response collection due to changes in service plans such that participants could no longer receive text messages [17] or excessive consumption of the smartphone batery [29] and was mentioned as a barrier to data entry completion in another study [10].…”

“…The average total number of interactions varied between 8.5 and 29.7 and may have depended on the type and length of the intervention [6,11,12]; the lowest level of interaction was with video content and the highest with a person via a text message. The average numbers of interactions per week also varied between 3.5 [13], and 12 times per week [14]. The average percentage of people who wore the wearable device for the duration of the study ranged from 50-75% [15,16] and the percentage of people meeting a pre-specified threshold for adherence varied from 41.7-81.8% [7,9,12,17].…”

“…The average percentage of people who wore the wearable device for the duration of the study ranged from 50-75% [15,16] and the percentage of people meeting a pre-specified threshold for adherence varied from 41.7-81.8% [7,9,12,17]. Although studies reported varying degrees of attrition [10, 13,18], dropout rate reporting was more frequent and ranged from 0-44% with a mean of 11.0% (SD = 11.4).…”

“…Naslund et al [16] reported that commercially available, wearable tracking devices alone were seen to be expensive and difficult to obtain for individuals with a low income. Some participants who were provided with devices perceived to be expensive were found to sell or pawn them [13].…”

Barriers to and Facilitators of Engagement With mHealth Technology for Remote Measurement and Management of Depression: Qualitative Analysis (Preprint)

“…Physical abilities were never mentioned. While in Simblett et al, few previous studies reported on the acceptability and feasibility of mHealth resources for people with mental health conditions [e.g., 18,[19][20][21], none of these explored barriers and facilitators across several countries. This study uniquely provides views from participants living in different countries and revealed both similar and potentially some different issues that were a consideration by the different groups.…”