Comparing Mobile Health (mHealth) and Clinic-Based Self-Management Interventions for Serious Mental Illness: Patient Engagement, Satisfaction, and Outcomes

Funding Source: Patient-Centered Outcomes Research Institute (PCORI)

Funding Period: 2014-2017

Principal Investigator: Dror Ben-Zeev, PhD 

Other Project Staff: Robert Drake, Elizabeth Carpenter-Song, Emily Scherer, Haiyi Xie, Nidhi Badiyani, Raymond Walker

Project Summary:  
The project will compare two illness self-management interventions for Serious Mental Illness (SMI): A widely used clinic-based treatment and a state-of-the-art mHealth intervention. Both interventions target similar outcomes, but differ in how treatment content  is delivered, and the burden placed on patients. The project aims are to: 1) Evaluate and compare the willingness and ability of individuals with SMI to enroll in the two interventions; 2) Examine and compare participant engagement and satisfaction with both treatments; and 3) Examine and compare patient outcomes following participation in the interventions.

Public Health Significance:  
The study is directly aligned with PCORI’s mission to help patients and stakeholders make informed decisions, and improve healthcare delivery and outcomes.  Our examination of which intervention patients are more willing and able to use in real-world conditions will directly inform stakeholders and patients about the utility and limitations of clinic-based vs. mHealth treatment delivery options. Evaluation of which intervention produces better outcomes will provide patients, systems of care, and funding agencies with the information needed to consider treatment options for illness self-management in SMI. 

September 26, 2014  

Opportunity for Innovation: Harnessing the Mobile Revolution to Improve Global Health

Alain B. Labrique, PhD, MHS, MS, MACE
Director, Johns Hopkins Global mHealth Initiative
Assistant Professor, Department of International Health /Epidemiology
Johns Hopkins Bloomberg School of Public

About the Presenter:

Dr. Alain Labrique is the founding director of the Johns Hopkins University Global mHealth Initiative, a multi-disciplinary consortium of mHealth research across the Johns Hopkins system. An infectious disease epidemiologist with over a decade of experience running large population-based research studies, Dr. Labrique serves on the faculty in the Global Disease Epidemiology and Control Program of the Department of International Health. He holds joint appointments in the Department of Epidemiology, Bloomberg School of Public Health and the Department of Community-Public Health in the School of Nursing of the Johns Hopkins University. His projects measure the impact of mHealth and other interventions on improving maternal, neonatal and infant outcomes, with a focus on mortality in resource-limited settings. Dr. Labrique was recognized as one of the Top 11 mHealth Innovators in 2011. Dr. Labrique also designs and validates appropriate diagnostic and public health technologies, and is the inventor of a number of devices. 

Computer-based Prescription Opioid Abuse Prevention for Adolescents

Funding Source: National Institute on Drug Abuse

Funding Period: 2014 - 2016

Principal Investigator: Lisa A. Marsch, PhD 

Other Project Staff: Sarah K. Moore, PhD (Project Co-Investigator; Site Principal Investigator, Capital Health Medical Center), Sarah Lord, PhD (Project Co-Investigator), Michael Grabinski (Lead Developer)

Project Summary: 
Recreational use of prescription opioids among adolescents is a significant and growing public health concern and has been referred to as an emerging epidemic in the U.S.   Although a number of science-based, interactive, drug-abuse prevention programs focus on preventing use of non-prescription drugs among youth, to our knowledge, no science-based, interactive program focused on the prevention of prescription opioid abuse among youth exists.   Given that adolescents' views about the recreational use of prescription opioids differ in systematic ways from use of illegal, non-prescription drugs, developing an effective prevention program for youth targeted specifically at prescription opioid abuse is critical.

In this project, we are developing an interactive, web-based program for youth ages 11-14 focused on the prevention of prescription opioid abuse.   This program will be grounded in a scientific understanding of risk factors for prescription opioid abuse among youth, employ informational technologies which are effective in promoting relevant knowledge and skills, and present program content using strategies which have been shown to be highly appealing to adolescents.   In our completed Phase 1 of this project, we developed and demonstrated the scientific, technical and commercial merit and feasibility of a prototype of a web-based, prescription opioid abuse prevention program for youth.  Phase I results demonstrated the high acceptability and potential utility of the prototype of this program to the target audience.   Participants’ rated the program very positively, and their knowledge related to prescription opioid abuse prevention markedly increased from low baseline levels to perfect or near perfect levels after completing the program prototype.   In this Phase 2 project, we will complete the development of all components of the multimedia, prescription opioid abuse prevention program and conduct a randomized, controlled trial with youth (ages 11-14 years) to evaluate the effectiveness of the web-based prevention intervention in increasing knowledge about key issues relevant to prescription opioid abuse among youth, skills acquisition relevant to preventing their misuse, negative attitudes about prescription opioid misuse, and perceived risk associated with their misuse.  We will also assess the program’s effectiveness in reducing intentions to misuse prescription opioids as well as actual rates of such use.  

This program will be developed as a mobile-friendly website which can be accessed via a variety of platforms online (e.g., desktop interface, mobile device) to enable flexible use in a variety of settings.  If this tool is shown to be effective in this project, we plan to embed it in a suite of science-based, technology-delivered tools focused on the prevention and treatment of substance use disorders that have been developed and deployed in a wide array of settings by our group. 

Public Health Significance: 
This program may provide an innovative, engaging, effective and potentially cost-effective tool for promoting the widespread delivery of science-based prevention of prescription opioid abuse among adolescents. 

Social Media Antismoking Intervention: Delivery, Tracking, and Engagement Systems on a Smartphone-Accessed Facebook Group

Funding Source: National Institute on Drug Abuse – Center for Technology and Behavioral Health Pilot Core

Project Period: October 2014 – September 2015

Principal Investigator: Sunny J. Kim, PhD

Other Project Staff: Lisa A. Marsch, PhD; Jesse Dallery, PhD; Jeffrey T. Hancock, PhD; Haiyi Xie, PhD; Benjamin S. Crosier, PhD


Project Summary:

Tobacco use is the primary cause of premature death in the U.S., responsible for more than 443,000 preventable deaths per year.  A total of approximately 8.4 billion dollars was spent in 2011 for marketing cigarettes, which was far greater than the $175 million that the Centers for Disease Control and Prevention and the states have invested in tobacco prevention and control programs. Media-based antismoking communication approaches are considered to be the most effective intervention strategy in countering this aggressive cigarette marketing while promoting quitting and preventing cigarette-smoking.


Social media, such as Facebook, provide promising interfaces that can substantially enhance the delivery system of targeted messages with high frequency, reach, and duration - which are three key factors for successful health campaigns. Facebook features, such as Facebook Groups, provide multi-directional, non-linear communication platforms connecting geographically distant audiences, and enhance users’ engagement with shared messages and interactions with other users. 


This study is designed to promote effective delivery, tracking, and engagement/interaction systems via a smartphone-accessed Facebook Group in order to facilitate antismoking attitudes and smoking reduction/cessation behavior. We will adopt existing antismoking ads and campaigns, and utilize the smartphone-accessed Facebook Group as a communication platform to deliver antismoking content. This pilot study has the following specific aims. First, we aim to evaluate the feasibility of delivering antismoking content via our smartphone-accessed Facebook Group as well as acceptability/usability of our antismoking intervention. Second, we aim to evaluate the feasibility of fostering engagement and interaction on the smartphone-accessed Facebook Group that can lead to positive intervention outcomes (e.g., antismoking attitudes and smoking reduction).


The project seeks to advance new knowledge about how the technology features afforded by social media can promote antismoking attitudes and behaviors through active engagement with the intervention and via interaction among group users.

WorkingWell: Developing a Mobile Employment Support Tool  for Individuals with Psychiatric Disabilities

Funding Source: National Institute on Disability and Rehabilitation Research (H133G140089)

Project Period: 2014 - 2017

Principal Investigator: Joanne Nicholson, Ph.D.

Other Project Staff: Sarah E. Lord, Ph.D. (Co-Investigator), Justin Tauscher, M.S., LADC, LCMHC

Project Summary: 

In this intervention development project we examine the feasibility and acceptability of WorkingWell, an innovative mobile employment support tool for individuals with severe psychiatric disabilities, who constitute a large and underserved population in need of vocational rehabilitation services. WorkingWell will be based on the Individual Placement and Support (IPS) model of supported employment. Despite strong evidence that IPS successfully connects individuals to competitive employment, studies suggest that individuals may benefit from additional follow-up support to sustain employment. Mobile communication devices and cloud computing may be the most effective, least expensive, and most non-stigmatizing way to provide follow-up support to the broadest group of individuals in the work place.

WorkingWell will target three key autonomy-supportive constructs derived from Self-Determination Theory and previous research to help people succeed in employment: engage (identifying personal motivation to work), manage (setting goals, assessing progress, and building self-efficacy), and connect (linking to social supports). The specific aims of the WorkingWell project include: (1) to develop the information architecture, functionality, technical specifications and general design for the WorkingWell prototype via iterative, user-centered design including focus groups of users and employment specialists, and expert review; (2) to develop the fully functional WorkingWell prototype using state-of-the-art processes informed by iterative, formative testing of the usability, accessibility and acceptability of prototype components; and (3) to test the acceptance and feasibility of WorkingWell through (a) a 6-month pretest-posttest demonstration field test with individuals receiving IPS, (b) usage metrics, and (b) post-implementation feedback interviews with a purposive sample of users and employment specialists. We hypothesize that use of the WorkingWell tool, by focusing on engaging, managing, and connecting in the workplace, will contribute to positive changes in motivation, self-efficacy, and social support, and will enhance job tenure.

WorkingWell will offer users an innovative, easy-to-access, self-directed and individualized employment support tool available where and when the user needs it, for as long as he or she needs it. Our goal is to create a validated application that can be easily installed onto a mobile phone, facilitating wide-scale and far-reaching dissemination of IPS and follow-up support for the target population of individuals with severe psychiatric disabilities.