FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study (Preprint)

Abstract

BACKGROUND Veterans with serious mental illnesses (SMI) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with serious mental illness in community mental health settings. mHealth for SMI has not been tested within the VA. OBJECTIVE The present study examined the feasibility, acceptability and preliminary effectiveness of an mHealth intervention for serious mental illness in the context of VA outpatient care. METHODS Seventeen (n = 17) veterans with serious mental illnesses enrolled in a one-month pilot trial of FOCUS, a smartphone-based self-management intervention for serious mental illness. At baseline and post-test they completed measures examining symptoms and functional recovery. Participants provided qualitative feedback related to the usability and acceptability of the intervention. RESULTS Veterans completed on average 85.00 (SD = 96.11) interactions with FOCUS over the one-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all (n = 16, 94.1%) participants reporting that they would recommend the intervention to a fellow veteran. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (e.g. combat veterans) as well as specific delivery modalities (e.g. groups). In the one-month period, participants experienced small improvements in self-assessed recovery, auditory hallucinations and quality of life. CONCLUSIONS The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population.

Mobile applications may be the future of veteran mental health support but do veterans know yet? A survey of app knowledge and use.

“…mHealth support specialists are human support personnel embedded within clinical settings that help users interact with mHealth technologies, and could help socialize patients to mental health apps. Models have been tested with nonclinical personnel who are trained specifically to perform the role of support of specialist (e.g., Buck et al, under review; Graham et al, 2020), as well as licenced mental health clinicians who perform this role in addition to other clinical duties (Mohr et al, 2019; Possemato et al, 2016). Researchers have begun examining the mHealth support specialist model in real-world clinical settings, and have found that its implementation results in significant improvement in symptoms of depression and anxiety compared to treatment as usual in a primary care setting (Graham et al, 2020; Possemato et al, 2016), as well as increased app use compared to a control of only providing information about the app (Possemato et al, 2016).…”