JMIR Publications

ABSTRACT

Background:

Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into clinical care has been sparse, despite substantial increase in the availability of smartphone-based apps targeting mental health care. One potential reason is that few of these apps have been developed with input from stakeholders (e.g., clinicians), the primary users of data from such applications, making their integration into routine clinical care challenging.

Objective:

This qualitative study sought clinicians’ input to inform the adaptation of FREEDoM, an app-based mHealth intervention designed to enhance treatment of patients with first-episode psychosis (FEP).

Methods:

The FREEDoM app was developed to enhance the quality, quantity, and timeliness of clinical and functional data available to clinicians and patients in order to enhance their therapeutic relationship and increase shared decision-making. Following the app’s initial development, semi-structured qualitative interviews were conducted with 11 FEP treatment providers at three sites to elicit input on the app. We then conducted summary template and matrix analysis to systematically categorize suggested adaptations using dimension of the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) and documented the rationale for adopting/rejecting suggestions.

Results:

The clinicians provided 31 suggestions (18 adopted, 13 rejected). Suggestions to add/refine content were most common (e.g., adding questions within the app). Adaptations to context were most often related to plans for implementing the intervention, how reported data were displayed to clinicians, and with whom reports were shared. Reasons for suggestions primarily included factors related to clients’ health narratives/priorities (e.g., symptom’s functional impact vs. their frequency/severity), providers’ clinical judgment (e.g., need for clinically relevant information), and organizations’ mission/culture. Reasons for rejecting suggestions included need for resources beyond intervention scope, concerns regarding dilution of the intervention core components, and increasing patient burden.

Conclusions:

This study describes the development of the FREEDoM app, an innovative stakeholder-informed intervention designed to enhance treatment for individuals with FEP. Our study illustrates a pragmatic application of the FRAME and provides methods and tools for rapid analysis to track adaptations and related decision-making processes, potentially contributing to its acceptance and use in clinical care. Clinical Trial: Trial registration: ClinicalTrials.gov #NCT04248517, registered Jan. 30, 2020 https://clinicaltrials.gov/ct2/show/NCT04248517?term=using+mhealth&draw=2&rank=4