Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Dec 16, 2020
Date Accepted: May 13, 2021
Can we use Ecological Momentary Assessment for real-world patients with schizophrenia? A study of acceptability of the passive smartphone-based app Evidence-Based Behavior (eB2).
ABSTRACT
Background:
Ecological momentary assessment (EMA) tools collect real-time data on patients’ behaviour and functioning and may be useful interventions. However, concerns have been voiced regarding acceptability of EMA among patients with schizophrenia and what may underlie this remains poorly understood.
Objective:
To investigate acceptability of a passive smartphone-based EMA app, the Evidence-Based Behavior (eB2), among patients with schizophrenia spectrum disorders and putative variables underlying this.
Methods:
Participants came from an ongoing randomised controlled trial (RCT) of metacognitive training - outpatients with schizophrenia spectrum disorders (SSD) (F20-29-ICD10 codes), age 18-64 - none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (non-users) in sociodemographic, clinical, premorbid adjustment (Premorbid Adjustment Scale -PAS-), neurocognitive, psychopathological, insight and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on ‘being user vs. non-user’ (acceptability), which was the main outcome measure.
Results:
Out of N=77 RCT participants, n=24 subjects (31%) consented to eB2, which remained installed at the end of the study (median follow-up=14.50 weeks) in n=14 subjects (70%). Users were younger and had a high education level, better premorbid adjustment, better executive function (according to the Trail Making Test) and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than non-users (univariate analyses), although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence PAS (OR 0.75, 95% CI 0.61-0.93; P=.010) survived the multivariable regression model, thus predicting eB2 acceptability.
Conclusions:
Acceptability of a passive smartphone-based EMA app among SSD participants in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability to SSD patients, particularly older participants and those with poor premorbid adjustment. Clinical Trial: This stusy is part of a randmised controlled trial which has been registered at ClinicalTrials.gov (NCT04104347) since the 26/09/2019. URL of registry https://clinicaltrials.gov/ct2/show/NCT04104347
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