Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia
Feasibility of PRIME: A Cognitive Neuroscience-Informed Mobile App Intervention to Enhance Motivated Behavior and Improve Quality of Life in Recent Onset Schizophrenia
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DOI：
10.2196/resprot.5450
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发表时间：
2016-04-01
影响因子：
1.7
通讯作者：
Vinogradov, Sophia
中科院分区：
文献类型：
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作者：
Schlosser, Danielle;Campellone, Timothy;Vinogradov, Sophia
背景：尽管精神病的治疗方法有所改进，但精神分裂症仍然是一种慢性、使人衰弱的疾病，影响着大约 1% 的美国人口，在大部分生命周期中给社会造成的损失比抑郁症、痴呆和其他疾病还要严重。在病程早期改善功能可能对精神分裂症患者的长期结果产生重大影响。然而，目前的黄金标准治疗并没有带来临床上有意义的结果改善，部分原因是治疗患有严重认知和动机障碍的人群所面临的固有挑战。技术的兴起为开发新的治疗方法提供了机会，可以规避精神分裂症中观察到的动机和认知挑战。 目的：本研究的目的有两个：(1) 评估实施个性化实时动机增强干预 (PRIME) 的可行性和可接受性，这是一种移动应用程序干预措施，旨在针对奖励处理障碍，增强动机，从而改善新近发病的精神分裂症患者的生活质量，(2) 评估实证效益使用迭代的、以用户为中心的设计 (UCD) 流程。方法：我们与 15 个主要利益相关者举办了两次设计研讨会，随后与设计和创新公司 IDEO 合作进行了一系列深入访谈。 UCD 方法最终产生了 PRIME 的第一次迭代，由 10 名 RO 参与者进行了评估。第一阶段参与者的结果被用来指导目前正在进行的随机对照试验中正在评估的下一次迭代。鼓励两个阶段的参与者在 12 周内每天使用该应用程序，频率至少为每周 1 次。 结果：UCD 流程实现了以下功能集：(1) 由训练有素的治疗师提供基于短信（短信服务，SMS）的激励辅导，(2) 在预后重要的社会心理领域设定个性化目标，(3) 通过直接点对点消息传递进行社交网络，以及 (4) 社区“时刻馈送”以捕获和强化奖励经验和目标成就。用户更喜欢强调自决理论的几个原则的体验，包括对未来有更多控制的愿望（自主性和能力）以及帮助他们改善现有关系（相关性）的方法。 IDEO还推荐了一种随意、友好、无污名化的方式，这符合精神病的康复模式。使用 PRIME 12 周后，参与者平均每隔一天使用该应用程序，每次登录时都会积极使用其各种功能，并且保留率和满意度很高（20/20，100% 保留率，高满意度）。迭代设计过程使平台的几乎每个方面的参与度从第一阶段到第二阶段增加了 2 到 3 倍。结论：这些结果表明，基于神经科学的移动应用程序 PRIME 对于患有精神分裂症的年轻人来说是一种可行且可接受的干预措施。
Background: Despite improvements in treating psychosis, schizophrenia remains a chronic and debilitating disorder that affects approximately 1% of the US population and costs society more than depression, dementia, and other medical illnesses across most of the lifespan. Improving functioning early in the course of illness could have significant implications for long-term outcome of individuals with schizophrenia. Yet, current gold-standard treatments do not lead to clinically meaningful improvements in outcome, partly due to the inherent challenges of treating a population with significant cognitive and motivational impairments. The rise of technology presents an opportunity to develop novel treatments that may circumvent the motivational and cognitive challenges observed in schizophrenia.Objective: The purpose of this study was two-fold: (1) to evaluate the feasibility and acceptability of implementing a Personalized Real-Time Intervention for Motivation Enhancement (PRIME), a mobile app intervention designed to target reward-processing impairments, enhance motivation, and thereby improve quality of life in recent onset schizophrenia, and (2) evaluate the empirical benefits of using an iterative, user-centered design (UCD) process.Methods: We conducted two design workshops with 15 key stakeholders, followed by a series of in-depth interviews in collaboration with IDEO, a design and innovation firm. The UCD approach ultimately resulted in the first iteration of PRIME, which was evaluated by 10 RO participants. Results from the Stage 1 participants were then used to guide the next iteration that is currently being evaluated in an ongoing RCT. Participants in both phases were encouraged to use the app daily with a minimum frequency of 1/week over a 12-week period.Results: The UCD process resulted in the following feature set: (1) delivery of text message (short message service, SMS)-based motivational coaching from trained therapists, (2) individualized goal setting in prognostically important psychosocial domains, (3) social networking via direct peer-to-peer messaging, and (4) community "moments feed" to capture and reinforce rewarding experiences and goal achievements. Users preferred an experience that highlighted several of the principles of self-determination theory, including the desire for more control of their future (autonomy and competence) and an approach that helps them improve existing relationships (relatedness). IDEO, also recommended an approach that was casual, friendly, and nonstigmatizing, which is in line with the recovery model of psychosis. After 12-weeks of using PRIME, participants used the app, on average, every other day, were actively engaged with its various features each time they logged in and retention and satisfaction was high (20/20, 100% retention, high satisfaction ratings). The iterative design process lead to a 2- to 3-fold increase in engagement from Stage 1 to Stage 2 in almost each aspect of the platform.Conclusions: These results indicate that the neuroscience-informed mobile app, PRIME, is a feasible and acceptable intervention for young people with schizophrenia.