Lay health supporters aided by mobile text messaging to improve adherence, symptoms, and functioning among people with schizophrenia in a resource-poor community in rural China (LEAN): A randomized controlled trial

Abstract

Background Schizophrenia is a leading cause of disability, and a shift from facility- to community-based care has been proposed to meet the resource challenges of mental healthcare in low- and middle-income countries. We hypothesized that the addition of mobile texting would improve schizophrenia care in a resource-poor community setting compared with a community-based free-medicine program alone. Methods and findings In this 2-arm randomized controlled trial, 278 community-dwelling villagers (patient participants) were randomly selected from people with schizophrenia from 9 townships of Hunan, China, and were randomized 1:1 into 2 groups. The program participants were recruited between May 1, 2015, and August 31, 2015, and the intervention and follow-up took place between December 15, 2015, and July 1, 2016. Baseline characteristics of the 2 groups were similar. The patients were on average 46 years of age, had 7 years of education, had a duration of schizophrenia of 18 years with minimal to mild symptoms and nearly one-fifth loss of functioning, and were mostly living with family (95%) and had low incomes. Both the intervention and the control groups received a nationwide community-based mental health program that provided free antipsychotic medications. The patient participants in the intervention group also received LEAN (Lay health supporters, E-platform, Award, and iNtegration), a program that featured recruitment of a lay health supporter and text messages for medication reminders, health education, monitoring of early signs of relapses, and facilitated linkage to primary healthcare. The primary outcome was medication adherence (proportion of dosages taken) assessed by 2 unannounced home-based pill counts 30 days apart at the 6-month endpoint. The secondary and other outcomes included patient symptoms, functioning, relapses, re-hospitalizations, death for any reason, wandering away without notifying anyone, violence against others, damaging goods, and suicide. Intent-to-treat analysis was used. Missing data were handled with multiple imputations. In total, 271 out of 278 patient participants were successfully followed up for outcome assessment. Medication adherence was 0.48 in the control group and 0.61 in the intervention group (adjusted mean difference [AMD] 0.12 [95% CI 0.03 to 0.22]; p = 0.013; effect size 0.38). Among secondary and other outcomes we noted substantial reduction in the risk of relapse (26 [21.7%] of 120 interventional participants versus 40 [34.2%] of 117 controls; relative risk 0.63 [95% CI 0.42 to 0.97]; number needed to treat [NNT] 8.0) and re-hospitalization (9 [7.3%] of 123 interventional participants versus 25 [20.5%] of 122 controls; relative risk 0.36 [95% CI 0.17 to 0.73]; NNT 7.6). The program showed no statistical difference in all other outcomes. During the course of the program, 2 participants in the intervention group and 1 in the control group died. The limitations of the study include its lack of...

The association between a free medicine program and functioning in people with schizophrenia: a cross-sectional study in Liuyang, China

“…In this aspect, the wide use of smartphones and mobile health may help. Indeed, our trial has shown that mobile texting significantly improved patient adherence to antipsychotics in Liuyang (Xu et al, 2019).…”

“…However, better refill adherence alone was not associated with better functional outcomes in this study. Comprehensive approaches may be needed to address patient preferences, unwanted side effects, suboptimal treatments and other rehabilitative needs (Xu et al, 2016(Xu et al, , 2019. Local support and implementation are vital to complement the national program.…”

Pencegahan Kekambuhan Klien Skizofrenia Berbasis Mobile Apps dan Mobile Web: Systematic Review

“…No Penulis/negara Metode Kondisi N Nama aplikasi/web Fitur aplikasi/web dan program intervensi 1 Xu D et al (19) Cina Fitur data demografi klien Fitur randomisasi responden berdasarkan data demografi, hasil randomisasi akan dikirimkan via email ke responden Fitur pengisian kuesioner Early Warning Sign (EWS) melalui telepon genggam klien dan keluarga Apabila hasil kuesioner menunjukkan adanya keparahan gejala maka email secara otomatis akan terkirim ke petugas yang merawat Klien dianjurkan mengunjungi pelayanan kesehatan dan akan diberikan tambahan terapi 3 Gottlieb JD et al (21) USA Fitur pengkajian early warning sign pada kekambuhan untuk menilai kekambuhan pada klien yang mendapatkan intervensi 1 tahun pengurangan dosis terapi antipsikotik 9 Kidd SA et al (27) Kanada (31) Cina…”

“…Aplikasi ini melakukan pemantauan secara berkala tanda-tanda awal kekambuhan dan efek samping obat dengan cara mengirimkan ceklist tanda dana gejala kekambuhan kepada klien dan LHS. (19,31) Evaluasi penting dilakukan secara berkala terhadap tanda dan gejala kekambuhan agar dapat ditentukan sesegera mungkin intervensi yang tepat seandainya muncul tanda-tanda kekambuhan.…”

“…Dokter setempat selanjutnya akan melakukan asesmen tingkat keparahan gejala kemudian klien akan dirujuk ke rumah sakit untuk mendapatkan penanganan selanjutnya. (19,31) Fitur integrasi yang disediakan oleh aplikasi App4Independence hampir sama dengan LEAN dimana data kondisi kesehatan mental klien terintegrasi secara langsung dengan sistem informasi kesehatan sehingga petugas kesehatan dapat memantau keadaan klien dari jarak jauh. (27) M-Resist menggunakan web based platform sebagai alat untuk mengumpulkan data klien, dan melakukan komunikasi dan koordinasi dengan klien dan petugas kesehatan lainnya.…”