Simple Mobile technology health management tool for people with severe mental illness: a randomised controlled feasibility trial

Abstract

Background Severe mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient’s psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness. Methods This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called ‘Florence’, and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36). Results Preliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. Conclusion It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. Trial registration ISRCTN34124141; retrospectively registered, date of registration 05/11/2019.

Digital health interventions to improve adherence to oral antipsychotics among patients with schizophrenia: a scoping review

“…Few studies required patients to have smartphones and the ability to use apps on smartphones provided by researchers 34 35. Some patients allocated to the intervention arm who did not own mobile phones were provided the same for the study 36 37…”

“…Text messages were used to send medication-taking reminders 31 34 36 41 43–48. The frequency and content of SMS delivery varied across the studies.…”

“…Seven studies included the Brief Adherence Rating Scale 34 35 43 44 47 52 53. It was followed by Drug Attitude Inventory-10 (6 studies),29 43–45 47 67 Medication Adherence Rating Scale (5 studies),30 36 39 48 59 and Medication Adherence Questionnaire (3 studies) 45 54 67. Finally, five studies used other self-reporting tools,30 32 41 50 52 and seven tools were not validated 28 29 33 42 49 60 70.…”

“…Overall, all DHI types to improve medication adherence of patients with schizophrenia reviewed were acceptable and feasible. Their implementation was practical, even if this aspect was not thoroughly explored 35 36 48 50 52 53 56–58 63 65 72–78…”

Psychosocial Exoskeletons

“…By using adaptive psy-exoskeletons, help-seeking individuals can stabilize, grow, and enhance their coping abilities. Self-help and peer-based recovery efforts can provide psy-exoskeletal functions for individuals experiencing psychological afflictions through online and in-person mutual support and recovery-oriented groups (Lyons et al, 2021), self-help Web sites, books, tapes, and mental health apps (Röhricht et al, 2021), and by providing service and other support animals (Chen et al, 2021; Schreiner, 2016; Yarborough et al, 2018). Many individuals with alcohol use disorder adopt 12-step lifestyles through Alcoholics Anonymous after years of unsuccessfully wrestling with alcoholism on their own, sometimes after hitting “rock bottom.”…”