Development of the First Episode Digital Monitoring mHealth Intervention for People With Early Psychosis: Qualitative Interview Study With Clinicians

Abstract

Background Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes. Objective This qualitative study sought clinicians’ input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM. Methods Following the app’s initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app’s design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications‐Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions. Results The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers’ clinical judgment (eg, need for clinically relevant information), and organizations’ mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention’s scope, concerns regarding dilution of the intervention’s core components, and concerns about increasing patient burden while using the app. Conclusions FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients—the enhancement of SDM and improvement of therapeutic relationships. This study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care. Trial Registration ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6

Communicating diagnoses to individuals with a first episode psychosis: A qualitative study of individuals perspectives

“…Furthermore, they argue that joint reflection by the clinician and patient should be used to address SDM-related risks ( 40 ). Also (online/mobile) health interventions are developed to improve SDM ( 41 ).…”

Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study

“…Congruent with other trends in the literature [ 23 ], patient feedback and higher rates of fidelity and feasibility in the modular version of the DMHI suggest that a structured approach may maximize acceptability, adoption, appropriateness, fidelity, and feasibility. In addition, findings from a recent qualitative study gathering clinician feedback on another DMHI suggested that adaptable DMHIs may work to improve implementation outcomes such as feasibility, appropriateness, adoption, and penetration [ 24 ]. Prior research using smartphone apps in the care of patients with early psychosis has also shown feasibility [ 9 , 25 ], which is similar to our results; however, the use of digital navigators in this study is novel.…”