title: A Qualitative Study of Client-Clinician Text Exchanges in a Mobile Health Intervention for Individuals With Psychotic Disorders and Substance Use.
abstract: OBJECTIVE
  Mobile health (mHealth) approaches have the potential to transform prevention, wellness, and illness management for people with dual diagnosis consisting of co-occurring mental illness and substance use disorders by providing timely and cost-effective interventions in clients' natural environments. However, little is known about how clients interact with mHealth interventions to manage their illness. This qualitative study explored the content of mobile phone text messages between clients with dual diagnosis and a clinician who engaged them in daily assessment and intervention text exchanges.
  
  
  METHODS
  Seventeen participants with psychotic disorders and substance use were enrolled in a 12-week single-arm trial of an mHealth intervention focusing on illness management. The clinician (i.e., mobile interventionist) sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The clinician provided other illness management and wellness suggestions flexibly, in response to participants' needs and preferences. In this qualitative study we conducted a thematic analysis of the client-clinician text exchanges that occurred over the course of the intervention.
  
  
  RESULTS
  Seven major content themes in client-clinician text message exchanges were identified: mental health symptoms; mental health coping strategies; mental health treatment and management; lifestyle behaviors; social relationships and leisure activities; motivation and personal goal setting; and independent living. Participants were interested in discussing strategies for coping with mental health symptoms (e.g., cognitive restructuring, social support) and health behavior change (e.g., increased physical activity, dietary changes).
  
  
  CONCLUSIONS
  Our findings suggest that client-centered text messaging has the potential to be an important component of illness management for people with dual diagnosis. This approach is able to offer coping strategies that are tailored to clients' needs and preferences in real time when help is needed.
authors.affiliation: a Health Promotion Research Center at Dartmouth , Lebanon , New Hampshire , USA.|b The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College , Lebanon , New Hampshire , USA.|d Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Aschbrenner
authors.affiliation: a Health Promotion Research Center at Dartmouth , Lebanon , New Hampshire , USA.|b The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College , Lebanon , New Hampshire , USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Naslund
authors.affiliation: a Health Promotion Research Center at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Lydia E
authors.initials: LE
authors.lastname: Gill
authors.affiliation: a Health Promotion Research Center at Dartmouth , Lebanon , New Hampshire , USA.|b The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College , Lebanon , New Hampshire , USA.|d Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Bartels
authors.affiliation: c mHealth for Mental Health Program, Dartmouth Psychiatric Research Center , Lebanon , New Hampshire , USA.|d Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA.
authors.forename: Dror
authors.initials: D
authors.lastname: Ben-Zeev
mesh_terms: D000223:Adaptation, Psychological; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D008019:Life Style; D009042:Motivation; D010349:Patient Compliance; D018802:Patient-Centered Care / Q000379:methods*; D010817:Physician-Patient Relations; D011618:Psychotic Disorders / Q000150:complications / Q000628:therapy*; D036301:Qualitative Research; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D060145:Text Messaging
keywords: Mobile health (mHealth); dual diagnosis; health promotion; illness management; mobile phones
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