Smartphone and Internet Access and Utilization by People With Schizophrenia in South Australia: Quantitative Survey Study

Abstract

Background Web-based information and interventions for mental illness are increasingly being provided. There is an expectation that citizens have access to the internet and are competent in using technology. People with schizophrenia are often excluded from social engagement, have cognitive impairment, and have very limited income, all of which may reduce their use of technology. Objective This study aimed to investigate technology access, use of digital technology, and confidence in using technology among people with schizophrenia living in the community. Methods Face-to-face structured interviews with 50 people with schizophrenia (aged 18-65 years) living in the northern suburbs of Adelaide, South Australia, were conducted using an instrument designed to assess technology access and utilization. Results Most participants (42/50, 84%) owned a mobile phone, but only 58% (29/50) owned a smartphone. Two-thirds of participants (33/50, 66%) had access to the internet at home, using a smartphone or computer. Moreover, 40% (20/50) of participants used the internet at least daily, but 30% (15/50) of participants had never accessed the internet from any device. Approximately half of the participants (24/50, 48%) had never used Facebook. Participants rarely used community facilities (eg, libraries and cafes) to access the internet. There were no significant differences (P values ranged from .14 to .70) between younger participants (aged 18-34 years) and older participants (aged 35-64 years) in internet or smartphone access or confidence in using technology. Conclusions Although the sample size of this study is small, it shows limited technology access, use of digital technology, and confidence in using technology among the participants. This could be a barrier to the online delivery of information and interventions for people with schizophrenia. To better understand the impacts of such technological disadvantage and potential disparities in access and use of online resources, prospective studies should recruit a larger sample size and include control subjects matched for socioeconomic disadvantage.

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“…Twelve (71%) declined the offer or gave the phone away. A recent study of patients in our region showed limited access and confidence in using technology among people with schizophrenia, which could be a barrier to online interventions (Wong et al, 2020). There is also the potential for additional clinical risks when using telepsychiatry in an already high-risk population, especially for those presenting in crisis (Cowan et al, 2019).…”

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“…PSSDs were as confident during data entry as PADs and had the impression they could understand and answer questionnaires equally well. This is a very promising result, as previous investigations have demonstrated that PSSDs, in particular older patients, lack confidence in using a computer or a smartphone (Too et al, 2020;Wong et al, 2020). It should be considered that we asked for the patients' self-evaluation after they entered data with the tablet.…”

“…Concerns exist about the user engagement (Ben-Zeev et al, 2016; Daker-White & Rogers, 2013; Surmann et al, 2017) and that cognitive impairment may complicate the use of assistive technologies (Surmann & Lencer, 2017; Treisman et al, 2016). As a consequence patients find themselves digitally excluded with less use of computers, mobile phones and the internet (Greer et al, 2019; Wong et al, 2020). This led Firth and Torous (2015) to state that PSSDs face a double stigma based on the nature of their condition on the one hand, and attitudes toward their abilities to handle digital media on the other.…”

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“…Physical examination cannot be conducted as usual and there may be challenges in comprehensively assessing physical appearance and functioning in virtual psychiatric assessments. Virtual care may impose additional barriers to assessment for patients presenting with certain symptoms, such as paranoid ideation, 7,8 although a recent study on the use of telepsychiatry for first-episode psychosis suggests that 50% of patients reported telepsychiatry as a favourable modality for follow-up. 9,10 Patients experience differential access to virtual platforms and technology, based on socioeconomic and other factors.…”