JMIR Publications

ABSTRACT

Background:

Despite growing interest in the adoption of smartphone technologies to monitor patient outcomes, only a limited number of studies have investigated the long-term use of smartphone applications in patients with psychosis. This means we have limited understanding of facilitators and barriers to sustained user engagement with these technologies in this population.

Objective:

To examine the impacts of demographic and clinical characteristics on Ecological Momentary Assessment (EMA) completion rates in a large sample of people who experienced a First Episode of Psychosis (FEP); to assess acceptability, barriers and motivators that influence long-term engagement; to understand how to improve users’ experience in future smartphone-based research; to better understand participants’ general attitude toward the use of digital technologies in clinical settings.

Methods:

This study employed a convergent mixed methods design. Linear regression models were used to assess the association between demographics and clinical variables and completion rates. Semi-structured interviews were conducted and analyzed using a hybrid deductive and inductive thematic approach.

Results:

Quantitative

Results:

A total of 274 participants were recruited. The average EMA completion rate was 14.5% (53/365). No statistically significant associations were found between demographic characteristics and EMA completion rates, whilst there was a positive association with baseline level of functioning. PANSS general subscales and depression were negatively associated with completion rates. Qualitative

Results:

20 participants completed the qualitative sub-study. Participants acknowledged the ease of downloading and using the app and the user-friendly interface. They also valued the consistency of the assessments and felt this encouraged self-reflection. However, daily EMA felt time-consuming and repetitive over time, and some participants found it challenging to remain engaged over a long period of time due to competing life priorities. While some participants felt the app lacked tangible benefits, others reported indirect benefits from tracking their daily experiences and wellbeing. The opportunity to contribute to research was highly valued, as well as the importance of human connection with the researchers in sustaining long-term engagement. Participants made a number of suggestions for future studies: reducing EMA frequency to 1-2 per week, integrating passive and active monitoring tools and incorporating individualized features. Finally, most participants supported using an app as part of their routine clinical care, provided data security and privacy were adequately addressed.

Conclusions:

Overall, our study suggests that smartphone-based technologies are both feasible and acceptable monitoring tool for FEP patients, particularly with a frequency of 1-2 assessments per week. Although participants are interested in using smartphone apps as a clinical tool, this must complement, rather than replace, the therapeutic relationship with clinicians. Clinical Trial: IRAS project ID: 278399, REC reference 20/L0/0331