Using Innovation-Corps (I-Corps™) Methods to Adapt a Mobile Health (mHealth) Obesity Treatment for Community Mental Health Settings

Abstract

BackgroundWe employed Innovation Corps (I-Corps™) methods to adaptation of a mobile health (mHealth) short-message-system (SMS) -based interactive obesity treatment approach (iOTA) for adults with severe mentall illness receiving care in community settings.MethodsWe hypothesized “jobs to be done” in three broad stakeholder groups: “decision makers” (DM = state and community clinic administrators), “clinician consumers” (CC = case managers, peer supports, nurses, prescribers) and “service consumers” (SC = patients, peers and family members). Semistructured interviews (N = 29) were recorded and transcribed ver batim and coded based on pragmatic-variant grounded theory methods.ResultsFour themes emerged across groups: education, inertia, resources and ownership. Sub-themes in education and ownership differed between DM and CC groups on implementation ownership, intersecting with professional development, suggesting the importance of training and supervision in scalability. Sub-themes in resources and intertia differed between CC and SC groups, suggesting illness severity and access to healthy food as major barriers to engagement, whereas the SC group identified the need for enhanced emotional support, in addition to pragmatic skills like menu planning and cooking, to promote health behavior change. Although SMS was percieved as a viable education and support tool, CC and DM groups had limited familiarity with use in clinical care delivery.ConclusionsBased on customer discovery, the characteristics of a minimum viable iOTA for implementation, scalability and sustainability include population- and context-specific adaptations to treatment content, interventionist training and delivery mechanism. Successful implementation of an SMS-based intervention will likely require micro-adaptations to fit specific clinical settings.

Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Protocol for a Mixed Methods Implementation and Pilot Randomized Controlled Trial

“…The individual-level iOTA intervention for adults with an SMI [ 20 , 38 ] is based on assessment of individual behavior risks, collaborative goal setting with a health coach, and use of an interactive SMS text messaging system that prompts participants to report their weight and their progress on achieving their goals with a “check-in” day each week, and sends immediate, tailored feedback about their progress. Weekly and monthly health tip messages are customized to the participant’s selected health goals.…”

Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria

“…Individuals ages 16 to 75 years who were actively engaged in outpatient community mental health clinic or clubhouse programming in the St. Louis and surrounding urban, suburban, and rural areas [ 44 - 46 ] were eligible for participation. Clubhouses are community-based programs that provide structured daytime programming for psychosocial rehabilitation through supported educational, vocational, and social activities, referring to participants as members rather than clients or patients [ 47 ].…”

“…Subsequent visits followed the same format, with the 30-minute discussion including session-specific content (session 2: meal planning and nutrition, session 3: physical activity, and session 4: skills for long-term health behavior change). The order of the content delivered in the sessions was determined based on prior behavioral weight loss treatment development experience in youth and adults with SMI treated in community settings, where qualitative efforts identified the greatest health behavior knowledge and skill deficits in this population were understanding nutrition and healthy meal planning [ 46 , 53 ].…”

Engaging Patients and Other Stakeholders in “Designing for Dissemination” of Record Linkage Methods and Tools

“…We used UX design principles and methods to iteratively develop and refine prototypes. 15,36,37 In UX design, designers apply both what they have learned (e.g., from patient engagement, customer discovery, and value proposition design)…”

“…We used UX design principles and methods to iteratively develop and refine prototypes. 15,36,37 In UX design, designers apply both what they have learned (e.g., from patient engagement, customer discovery, and value proposition design) and the identified associated specifications to create sketches, mockups, and product prototypes. 29 The design phase typically requires multiple iterations before producing a high-fidelity product.…”