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 due to the patient’s psychosocial impairment and corresponding functional disability. 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 in 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) or TAU and the technology-assisted intervention. Results: 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. Preliminary results suggest that service users engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores. The care coordinators did not utilise the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure (PROM) on subjective quality of life, self-efficacy/competence and medication adherence) did not reveal significant differences between groups over time, 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 service users 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 ISRCTN 34124141; retrospectively registered, date of registration 05/11/2019.