title: mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge.
abstract: BACKGROUND
  mHealth 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.
  
  
  OBJECTIVE
  Our 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)?
  
  
  METHODS
  We 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.
  
  
  RESULTS
  On 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.
  
  
  CONCLUSIONS
  The 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 during high-risk periods.
authors.affiliation: Dartmouth College, Hanover, NH, United States. Dror.Ben-Zeev@Dartmouth.edu.
authors.forename: Dror
authors.identifier: http://orcid.org/0000-0001-6597-2407
authors.initials: D
authors.lastname: Ben-Zeev
authors.forename: Emily A
authors.identifier: http://orcid.org/0000-0002-6166-4455
authors.initials: EA
authors.lastname: Scherer
authors.forename: Jennifer D
authors.identifier: http://orcid.org/0000-0001-8435-3839
authors.initials: JD
authors.lastname: Gottlieb
authors.forename: Armando J
authors.identifier: http://orcid.org/0000-0002-7529-6753
authors.initials: AJ
authors.lastname: Rotondi
authors.forename: Mary F
authors.identifier: http://orcid.org/0000-0002-0713-8745
authors.initials: MF
authors.lastname: Brunette
authors.forename: Eric D
authors.identifier: http://orcid.org/0000-0001-8939-1535
authors.initials: ED
authors.lastname: Achtyes
authors.forename: Kim T
authors.identifier: http://orcid.org/0000-0002-1482-8314
authors.initials: KT
authors.lastname: Mueser
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0001-7323-4615
authors.initials: S
authors.lastname: Gingerich
authors.forename: Christopher J
authors.identifier: http://orcid.org/0000-0002-1550-651X
authors.initials: CJ
authors.lastname: Brenner
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0002-3598-4498
authors.initials: M
authors.lastname: Begale
authors.forename: David C
authors.identifier: http://orcid.org/0000-0002-5443-7596
authors.initials: DC
authors.lastname: Mohr
authors.forename: Nina
authors.identifier: http://orcid.org/0000-0003-3610-9393
authors.initials: N
authors.lastname: Schooler
authors.forename: Patricia
authors.identifier: http://orcid.org/0000-0002-9428-1231
authors.initials: P
authors.lastname: Marcy
authors.forename: Delbert G
authors.identifier: http://orcid.org/0000-0001-6606-4507
authors.initials: DG
authors.lastname: Robinson
authors.forename: John M
authors.identifier: http://orcid.org/0000-0002-2628-9442
authors.initials: JM
authors.lastname: Kane
keywords: adherence; engagement; illness management; mHealth; relapse; schizophrenia; smartphone; symptoms; technology