mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge.
mHealth for Schizophrenia: Patient Engagement With a Mobile Phone Intervention Following Hospital Discharge.
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DOI：
10.2196/mental.6348
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发表时间：
2016-07-27
影响因子：
5.2
通讯作者：
Kane JM
中科院分区：
文献类型：
--
作者：
Ben-Zeev D;Scherer EA;Gottlieb JD;Rotondi AJ;Brunette MF;Achtyes ED;Mueser KT;Gingerich S;Brenner CJ;Begale M;Mohr DC;Schooler N;Marcy P;Robinson DG;Kane JM
使用移动电话作为疾病管理工具的移动医疗干预措施越来越受欢迎。针对精神病患者的基于手机的移动健康项目的研究表明，这些方法是可行的、可接受的，并且在临床上很有前景。然而，大多数涉及精神分裂症患者的移动健康计划的时间跨度从几天到几周不等，并且通常涉及临床稳定的参与者。我们的目的是评估扩展移动健康干预精神分裂症谱系障碍患者出院后的可行性。具体来说，我们着手研究以下内容：(1)在这个高风险时期，个人是否可以参与手机干预计划？(2)随着时间的推移，年龄、性别、种族背景或住院史是否与他们参与或坚持使用手机干预有关？(3)参与是否因移动医疗干预本身的特点而不同（即，预编程功能与按需功能）？我们检查了342名精神分裂症谱系障碍患者的移动健康干预使用情况以及参与的人口统计学和临床预测因素，这些患者在住院后6个月的高风险期间接受了FOCUS手机干预，作为技术辅助复发预防计划的一部分。平均而言，参与者在使用手机的时间里，有82%的时间参与FOCUS。经常使用FOCUS的人持续使用的时间更长：44%的人使用了5-6个月，平均每周4.3天。性别、种族、年龄和过去精神病住院次数与参与有关。女性每周使用FOCUS的天数比男性平均多0.4天。白人参与者比非裔美国人平均每周多参与0.7天，比西班牙裔参与者每周多回应0.7天。年轻的参与者（18-29岁）每周按需使用的天数比30-45岁的人少0.4天，比年龄较大的参与者（46-60岁）每周少0.5天。过去住院次数较少（1-6次）的参与者每周平均比住院次数超过7次的参与者多0.2天。移动健康项目的功能与参与度有关。参与者对提示的反应比他们自己启动的按需工具更频繁，但FOCUS功能都是定期使用的。两种干预措施的使用都随着时间的推移而下降（按需使用的下降幅度更大）。尽管移动健康的使用有所下降，但大多数人在参与过程中定期使用按需和系统提示的功能。因此，这两个函数都不是多余的。研究结果表明，患有精神分裂症谱系障碍的个体可以在出院后6个月内积极参与临床支持的移动电话干预。移动医疗可能有助于接触到在高风险时期通常难以接触到的临床人群。
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. 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)? 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. 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. 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.