Feasibility and outcomes of a multi-function mobile health approach for the schizophrenia spectrum: App4Independence (A4i)

Relative to the large investments in mobile health (mHealth) strategies for mental illnesses such as anxiety and depression, the development of technology to facilitate illness self-management for people with schizophrenia spectrum illnesses is limited. This situation falls out of step with the opportunity mHealth represents for providing inexpensive and accessible self-care resources and the routine use of mobile technologies by people with schizophrenia. Accordingly, the focus of this study was upon the feasibility of a schizophrenia-focused mobile application: App4Independence (A4i). A4i is a multi-feature app that uses feed, scheduling, and text-based functions co-designed with service users to enhance illness self-management. This study was completed in a large urban Canadian centre and employed pre-post assessments over a 1-month period that examined medication adherence, personal recovery, and psychiatric symptomatology. App use metrics were assessed as was qualitative feedback through semi-structured interview. Findings are reported in line with the World Health Organization mHealth Evidence and Assessment (mERA) checklist. Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements. This research suggested that A4i is feasible in terms of outcome and process indicators and is a technology that is ready to move on to clinical trial and validation testing. This study contributes to the small but emergent body of work investigating digital health approaches in severe mental illness populations.相较于针对焦虑、抑郁等精神疾病的移动健康（mHealth）策略所投入的巨额资金，针对精神分裂症谱系障碍患者的疾病自我管理辅助技术开发仍相对滞后。这一现状与移动健康所能提供的低成本、可及性自我照护资源，以及精神分裂症患者日常使用移动技术的需求并不匹配。据此，本研究的核心聚焦于一款针对精神分裂症的移动应用——App4Independence（简称A4i）的可行性。A4i是一款多功能应用，整合了动态信息流、日程管理与文本交互功能，由服务使用者共同参与设计，旨在提升疾病自我管理能力。本研究在加拿大某大型城市中心开展，采用为期1个月的前后测评估方案，对受试者的服药依从性、个人康复状况与精神症状表现进行了测评。研究同时评估了应用使用数据，并通过半结构化访谈收集了质性反馈。本研究的结果报告严格遵循世界卫生组织移动健康证据与评估（mHealth Evidence and Assessment, mERA）清单规范。共有38名首发精神病患者参与研究，无受试者脱落，应用的经典留存率为52.5%。部分精神症状维度出现了具有统计学意义的改善，效应量为中小水平。在校正多重比较后，未观察到康复参与度与服药依从性出现显著变化。基线时使用应用频率更高的受试者，抑郁程度更高，敌意与人际敏感性得分也更高。受试者对应用的满意度较高，质性反馈也为功能优化提供了宝贵思路。本研究表明，A4i在结局指标与流程指标层面均具备可行性，可进一步开展临床试验与验证性测试。本研究为针对重症精神疾病群体的数字健康干预研究这一新兴且规模尚小的领域补充了实证依据。