(PS13-C69) Examining the Feasibility and Acceptability of a Mobile Health Intervention for Individuals with Psychosis

Background: Schizophrenia spectrum disorders (SSDs) are associated with high recurrent hospitalizations, resulting in frequent movement between facilities and levels of care. Patients often experience increased stress, suicidality, and difficulties with housing stability and treatment access during transitions from inpatient to outpatient care, rendering this a high risk period. Despite costs of rehospitalization, transitional services supporting patients’ return to the community are limited. To augment in-person services, mobile health (mHealth) assessment and intervention strategies show promise for use with this population. The Mobile After-Care Support (MACS) application uses ecological assessment and cognitive behavioral therapy for psychosis (CBTp) strategies to monitor symptoms and functioning and provides just-in-time interventions to support treatment adherence and foster healthy coping skills. Initial open trial data (n = 10) demonstrated that MACS was a feasible, acceptable, and potentially effective intervention for patients with SSDs. Therefore, the aim of the current study was to further examine feasibility and acceptability of MACS in a pilot randomized trial design. 

Methods: Hospitalized patients (n = 42) with SSDs were randomized to receive MACS or a psychoeducation (PE) app condition that contained ecological assessment and information alone. Participants were English-speaking adults diagnosed with a psychotic disorder or mood disorder with psychotic features based on a structured clinical interview (SCID-5). Both groups received 3 prompts during daytime hours assessing coping, substance use, symptoms, treatment adherence, behavioral activation, and quality of life. The PE group received psychoeducation content about their illness and the MACS group received individualized intervention skills. Acceptability and satisfaction was assessed at follow-up. 

Results: Participants were a majority male (61.9%), white (59.5%), and non-hispanic (69%), with an average age of 33.9 (PE n = 23, MACS n = 19). The MACS group was significantly more likely to have used the app (MACS: 74% vs. PE: 43%, 2=3.88, p = 0.04). MACS participants most frequently chose coping skills related to distressing thoughts and voices (46.8% of skills chosen). MACS participants rated high levels of helpfulness of individual skills. Both groups showed significant decreases in psychotic (BL: 16.9 + 5.8 vs. M4: 9.5 + 5.9, t = 5.96, p < .001), affective (BL: 19.9 + 6.2 vs. M4: 13.7 + 6.4, t = 4.09, p < .001), and disorganized symptoms (BL: 5.4 + 2.5 vs. M4: 4.0 + 1.8, t = 2.66, p = .013) on BPRS at follow up. Both groups reported similar levels of satisfaction with the app at 4-month follow-up (PE: 22.5 + 7.6 vs. MACS: 23.7 + 4.4, t = -0.44, n.s.). Both groups rated the app as “good” or a grade of B on the system usability scale.
Discussion: Consistent with open trial results, MACS usability and satisfaction were positive. This study provides further evidence for the feasibility and acceptability of MACS during transitions of care for those with SSDs and delivers lessons in addressing barriers to mHealth access. These findings support the use of mHealth in this severely ill population and aid in the development of a full scale RCT.