title: Feasibility, acceptability, and preliminary efficacy of a smartphone intervention for schizophrenia.
abstract: The FOCUS smartphone intervention was developed to provide automated real-time/real-place illness management support to individuals with schizophrenia. The system was specifically designed to be usable by people with psychotic disorders who may have cognitive impairment, psychotic symptoms, negative symptoms, and/or low reading levels. FOCUS offers users both prescheduled and on-demand resources to facilitate symptom management, mood regulation, medication adherence, social functioning, and improved sleep. In this study, 33 individuals with schizophrenia or schizoaffective disorder used FOCUS over a 1-month period in their own environments. Participants were able to learn how to use the intervention independently, and all but one participant completed the trial successfully and returned the smartphones intact. Completers used the system on 86.5% of days they had the device, an average of 5.2 times a day. Approximately 62% of use of the FOCUS intervention was initiated by the participants, and 38% of use was in response to automated prompts. Baseline levels of cognitive functioning, negative symptoms, persecutory ideation, and reading level were not related to participants' use of the intervention. Approximately 90% of participants rated the intervention as highly acceptable and usable. Paired samples t tests found significant reductions in psychotic symptoms, depression, and general psychopathology, after 1 month of FOCUS use. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the FOCUS intervention for schizophrenia and introduces a new treatment model which has promise for extending the reach of evidence-based care beyond the confines of a physical clinic using widely available technologies.
authors.affiliation: Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH; dror.ben-zeev@dartmouth.edu.
authors.forename: Dror
authors.initials: D
authors.lastname: Ben-Zeev
authors.affiliation: Thresholds, Chicago, IL;
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Brenner
authors.affiliation: Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL;
authors.forename: Mark
authors.initials: M
authors.lastname: Begale
authors.affiliation: Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Duffecy
authors.affiliation: Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL;
authors.forename: David C
authors.initials: DC
authors.lastname: Mohr
authors.affiliation: Department of Psychiatry, Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, NH; Center for Psychiatric Rehabilitation, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
mesh_terms: D000328:Adult; D040421:Cell Phone; D019468:Disease Management; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011618:Psychotic Disorders / Q000628:therapy*; D012559:Schizophrenia / Q000628:therapy*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Mobile Health (mHealth); depression; hallucinations; medication adherence; mobile interventions; sleep; social functioning