Implementing mHealth for Schizophrenia in Community Mental Health Settings

项目总结 精神分裂症谱系障碍(SSD)是一个主要的公共卫生问题。循证疾病 管理干预可以延长恢复期并改善SSD患者的预后，但 社区精神卫生诊所(CMHC)很少提供这些服务，在那里，大多数患有 固态硬盘接受护理。广泛可用的移动技术可以帮助克服容量限制 CMHC，扩大循证精神卫生保健的覆盖范围，并提供急需的疾病 为拥有固态硬盘的人员提供管理技能和资源，无论他们身在何处。 Focus是一种移动健康(MHealth)疾病管理系统，专门为患有以下疾病的人设计 固态硬盘。对十个州的500多名患有SSD的参与者进行的一系列研究表明， 焦点是可行的、可用的、吸引人的和有效的。CMHC临床医生和管理人员强烈表示 有兴趣将Focus整合到他们的产品和工作流程中。虽然福克斯已经做好了部署的准备， 如何在现实世界的社区护理环境中最好地实施mHealth干预措施尚不清楚。 两种实践促进策略可能适用于在CMHC中实施Focus：外部 促进(EF)和内部促进(IF)方法。我们建议进行一种比较有效的 前瞻性整群随机混合3型试验，比较聚焦实施的EF和IF 对华盛顿州的20家儿童保健中心进行干预。具体地说，我们的目标是1.评估和比较 执行成果；2.审查主持人(即，变革准备情况、文化、城市与农村状况) 和实施效果的中介物(吸收能力)；以及3.评估和比较患者的结果， 包括干预作用机制的评价。我们将审查是否实施了 策略不同地影响患者参与度、精神症状严重程度和疾病管理 容量。该项目涉及NIMH的几个战略优先事项，并在其目标方面具有很高的创新性， 调查小组的组成、数据收集战略、干预和实施模式以及 研究设计。这项研究采用了NIMH实验疗法，并对建议的 实施和患者结果的行动机制。在微观层面上，这项研究将有所帮助 确定哪些策略可以促进、增强或阻碍焦点的吸收和临床效果。在一次 在宏观层面，研究结果将对成功实施移动健康产生更广泛的影响 未来几年的干预措施。与NIMH资助的多个mHealth和eHealth开发和临床 目前正在进行的试验，现在是审查执行战略的好时机，这将有助于为 这是现实世界接受出现的最有希望的数字干预的途径。

PROJECT SUMMARY Schizophrenia spectrum disorders (SSD) are a major public health concern. Evidence-based illness management interventions can extend the recovery periods and improve the outcomes of people with SSD but these are seldom available at community mental health clinics (CMHCs) where the majority of individuals with SSD receive care. Widely available mobile technologies can help overcome the capacity constraints of CMHCs, expand the reach of evidence-based mental healthcare, and provide much needed illness management skills and resources for people with SSD, wherever they may be. FOCUS is a Mobile Health (mHealth) illness-management system specifically designed for people with SSD. A series of studies conducted with over 500 participants with SSD across ten states has shown that FOCUS is feasible, usable, engaging, and effective. CMHC clinicians and administrators express a strong interest in integrating FOCUS into their offerings and workflow. While FOCUS is well-poised for deployment, how best to implement mHealth interventions in real-world community care settings is unclear. Two Practice Facilitation strategies may be suitable for implementation of FOCUS in CMHCs: External Facilitation (EF) and Internal Facilitation (IF) approaches. We propose to conduct a comparative effectiveness prospective cluster randomized hybrid type 3 trial to compare EF vs. IF implementation of the FOCUS intervention in 20 CMHCs in Washington State. Specifically, we aim to 1. Evaluate and compare implementation outcomes; 2. Examine moderators (i.e., readiness for change, culture, urban vs. rural status) and mediators (absorptive capacity) of implementation effects; and 3. Evaluate and compare patient outcomes, including evaluation of intervention mechanism of action. We will examine whether the implementation strategies differentially affect patient engagement, psychiatric symptom severity, and illness management capacity. The project addresses several NIMH strategic priorities and is highly innovative in its objectives, composition of the investigative team, data collection strategy, intervention and implementation models, and study design. The study adopts the NIMH experimental therapeutics approach and evaluates proposed mechanisms of action for both implementation and patient outcomes. At a micro-level, the study will help determine which strategies may facilitate, enhance, or hinder the uptake and clinical effects of FOCUS. At a macro-level, study findings will have broader implications for successful implementation of mHealth interventions in the years ahead. With multiple NIMH-funded mHealth and eHealth development and clinical trials currently underway, now is the opportune time to examine implementation strategies that will help pave the way for real-world uptake of the digital interventions that emerge as most promising.