User-centered design of a mobile health intervention to promote help-seeking and reduce duration of untreated illness among young adults with early psychosis

项目概要/摘要 在精神病的早期提供协调的专科护理（CSC）可以减少长期的 慢性和功能障碍与精神分裂症谱系障碍。然而，很少有年轻人 早期精神病（EP）参与了这些项目。患有EP的年轻人特别容易受到 关于精神病治疗的耻辱和消极信念，因此往往担心向病人提出， 个人护理。尽管他们不愿意寻求服务，但患有EP的年轻人经常参与心理健康 通过在线和移动的技术提供资源。已经开发了几种数字健康干预措施， 作为针对该人群的面对面服务的辅助手段，并已证明其可行性、可接受性和 初步疗效。然而，很少有为EP年轻人设计的数字健康工具 那些与亲自护理无关的人在没有这些工具的情况下，人们往往会转向社交媒体或 经常将污名化的信仰具体化或阻止寻求帮助的论坛。移动的健康干预出现了 考虑到移动的设备是主要的媒体源， 大多数年轻人，可以提供个性化，实时，真实的支持，向用户介绍 参与CSC的心理社会干预。然而，目前仍不清楚是否以及如何远程 提供的mHealth可用于增加EP年轻成人的治疗参与。 拟议的研究项目建议开发和测试一种移动健康干预措施， 通过心理教育、减少污名的内容、压力管理练习， 以及通过音频、视频和自动激励文本提供的本地相关治疗信息 交互作用，并通过生态瞬时评估（EMA）个性化。该项目将采取用户- 以参与和不参与治疗的个人为中心的设计方法，包括（1） 情境调查，以了解与mHealth和面对面相关的障碍，兴趣和偏好 治疗，（2）开发，改进和可用性测试，以及（3）试点随机对照试验 评估与主动控制移动健康干预相比的可行性、可接受性和初步疗效 只提供压力管理。 这个研究项目将提供候选人的整体培训计划的核心部分。K23 职业发展奖提供培训，以支持一个独立的研究计划， 干预措施，减少障碍，以照顾年轻的成年人与EP。这包括三个培训领域，包括 (1)移动的健康定位增加心理健康护理参与，（2）以用户为中心的设计，以及（3） 数字健康试验的先进纵向模型和定量方法。这些目标将通过 专家指导，教学培训，课程，并顺利完成研究项目。

PROJECT SUMMARY / ABSTRACT Coordinated specialty care (CSC) provided in the early course of psychosis can reduce the long-term chronicity and dysfunction associated with schizophrenia-spectrum disorders. However, few young adults with early psychosis (EP) are engaged with these programs. Young adults with EP are particularly susceptible to stigma and negative beliefs about psychiatric treatment, and thus are often apprehensive to present to in- person care. Despite their reluctance to seek services, young adults with EP often engage with mental health resources through online and mobile technologies. Several digital health interventions have been developed as adjuncts to in-person services for this population and have demonstrated feasibility, acceptability and preliminary efficacy. However, there are few available digital health tools designed for young adults with EP who are not connected to in-person care. In the absence of such tools, individuals often turn to social media or forums that often reify stigmatizing beliefs or discourage help seeking. Mobile health interventions appear particularly well suited to this population given the fact that mobile devices are the primary media source for most young adults and can provide individualized, real-time, real-place support to introduce users to psychosocial interventions involved in CSC. It remains unclear at present, however, whether and how remotely delivered mHealth can be leveraged to increase engagement in treatment for young adults with EP. The proposed research project proposes to develop and test an mHealth intervention designed to impact help-seeking beliefs through psychoeducation, stigma-reducing content, stress management exercises, and locally relevant treatment information delivered through audio, video, and automated motivational text interactions, and personalized through ecological momentary assessment (EMA). This project will take a user- centered design approach with individuals who are both engaged and unengaged in treatment, including (1) a contextual inquiry to understand barriers, interests and preferences related to mHealth and in-person treatment, (2) development, refinement and usability testing, and (3) a pilot randomized controlled trial assessing feasibility, acceptability and preliminary efficacy compared to an active control mHealth intervention providing only stress management. This research project will provide a central piece of the candidate's overall training plan. This K23 career development award provides training to support an independent research program developing interventions that reduce barriers to care for young adults with EP. This includes three training areas, including (1) mobile health targeting increasing mental health care engagement, (2) user-centered design, and (3) advanced longitudinal models and quantitative methods for digital health trials. These goals will be met through expert mentorship, didactic training, coursework, and the successful completion of the research project.