The FOCUS mobile application (app) allows users to track symptoms and receive targeted interventions based on responses to daily assessments.
FOCUS was designed based on recommendations for digital resources for people with serious mental illness and with feedback from people with schizophrenia or other psychotic disorders. Users can select domains to focus on including medication adherence, mood regulation, sleep, social functioning, and coping with auditory hallucinations. Users are prompted once a day to complete an assessment of target domains and receive targeted text interventions based on responses. Users can also initiate interventions from any domain without completing an assessment. Users can opt to transmit their data to servers for processing to display on a web-based dashboard and can grant dashboard access to their clinicians to support collaborative treatment.
Cognitive Behavioral Therapy
Young Adults (18-30)
Development and usability testing of FOCUS: A smartphone system for self-management of schizophrenia.
Summary: Researchers conducted a survey with 904 people with schizophrenia or schizoaffective disorder about use of mobile technology, payment for mobile phone services, and acceptability of mobile interventions. Most participants (63%) reported owning a mobile device. Some participants were interested in a mobile intervention for medication or appointment reminders (44%), practitioner check-ins (38%), and psychoeducation and resource information (31%). Researchers also conducted a survey and focus group among 8 practitioners about the feasibility of delivering a mobile intervention to the target population. Practitioners believed that target users would able to learn how to use a mobile device, would respond to treatment prompts throughout the day, and could benefit from a mobile intervention. Researchers conducted two waves of usability testing of FOCUS with 12 people with schizophrenia or schizoaffective disorder. Participants also completed a survey about app usability and were asked to rate possible names for the as-of-yet unnamed app. First-wave participants used a web-based version of FOCUS and reported that text needed to be simplified, fonts needed to be larger, and touch screen “buttons” needed to be less sensitive and further apart. Participants in the second wave evaluated a mobile version of FOCUS modified with first-wave feedback. All participants reported that they were able to use FOCUS. Most participants (83%) found FOCUS easy to use and helpful.
Take Away: FOCUS is a feasible and acceptable intervention for people with schizophrenia and schizoaffective disorder.
Summary: In this pilot study, researchers recruited 33 people with schizophrenia or schizoaffective disorder from community treatment programs to use FOCUS for 1 month. All participants were assigned medication adherence as a focus area and chose two additional focus domains with the help of a clinician. Participants completed baseline and 1-month assessments of schizophrenia symptomology (positive, negative, general), depressive symptomology, sleep, and medication-related concerns. The follow-up assessment also included assessments of acceptability and usability. Participants were provided smartphones with unlimited data plans for the study and were compensated for completing each assessment. One participant dropped out after 1 week and data from 2 participants were lost. Participants experienced significant improvements in schizophrenia symptomology overall and in positive and general symptoms specifically. Results also indicated that schizophrenia and depressive symptomology significantly improved. Change in depressive symptoms was related the percentage of days participants used FOCUS; using the system less often was related to a greater reduction in depressive symptoms. Participants used FOCUS on 86.5% of days they had the phone, with use declining between week 1 (average: 6.7 days) and week 4 (average: 5.9 days). Most participants found FOCUS easy to use (87.5%), were satisfied with FOCUS (90.6%), and would recommend FOCUS to a friend (87.5%).
Take Away: FOCUS shows evidence of being acceptable, usable, and effective at helping people with schizophrenia manage schizophrenia symptoms, but FOCUS may be better in moderation for depressive symptoms.
Video-based mobile health interventions for people with schizophrenia: Bringing the “pocket therapist” to life.
Summary: For FOCUS-AV, researchers adapted the written information in FOCUS to video, so users could choose between written or video-delivered information. Researchers recruited 10 individuals with schizophrenia or schizoaffective disorder by referral from staff at a community mental health agency. Participants were provided a smartphone with a data plan for one month. A post-intervention assessment measured preference for written or video-delivered information, usability, acceptability, satisfaction, and negative consequences of FOCUS-AV. Researchers also collected FOCUS-AV usage information about system-prompted and self-initiated use, rates of response to prompts, and use of video-delivered information. Finally, participants were interviewed about their experiences with FOCUS-AV. Participants used FOCUS-AV an average of 5.9 days per week, with average use declining from week 1 (6.4 days) to week 4 (5.8 days). Participants responded to 66.8% of prompts and self-initiated 52% of use. Participants selected video-delivered information for 22.2% of system-prompted use and 66.7% of self-initiated use. Participants found videos more personal, engaging, and helpful than written information. Video-delivered and written information were rated similarly easy to use and understand, motivating, and positive. Participants found written content less effortful and better for letting users go at their own pace than video-delivered information. Participants were more willing to view video-delivered information in private (100%) or in public using headphones (100%) than in public without headphones (11%). Less than a quarter of participants felt upset (22%) or concerned about privacy (22%) after using FOCUS-AV. One participant dropped out after a message about a mobile phone update made them anxious.
Take away: Video-delivered information through FOCUS-AV shows some advantages over written information, but may be most appropriate for viewing privately.
mHealth for schizophrenia: Patient engagement with a mobile phone intervention following hospital discharge.
Summary: As a part of a larger implementation trial evaluating technology-assisted relapse prevention for people with psychotic disorders, participants were offered FOCUS for 6 months. Participants in the larger study had been discharged from psychiatric hospitalization within the past 60 days. Participants were offered a smartphone installed with FOCUS. Consenting participants chose three focus domains with help from an assigned case manager, who also provided technical support during the study. Researchers analyzed FOCUS usage data (days used, days responding to system prompts, days of self-initiated use, frequency of self-initiated use per day) from 342 individuals with psychotic disorders who agreed to use FOCUS. Participants used FOCUS for 82% of weeks they had a study phone, accessing FOCUS an average of 3.5 days per week. On average, participants responded to system prompts 2.9 days per week, self-initiated use 1.8 days per week, and self-initiated use 1.2 times per day. Average weekly use declined between week 1 (3.9 days) and week 24 (1.9 days). Participants who used FOCUS more and those with fewer than 7 psychiatric hospitalizations were less likely to discontinue FOCUS than less engaged participants or those with more hospitalizations. Participants with 7 or more psychiatric hospitalizations also used FOCUS fewer days per week but there were no differences between participants with 7 or more hospitalizations and participants with fewer hospitalizations in other usage metrics.
Take Away: FOCUS may be more appropriate for individuals with fewer past hospitalizations, who may be more inclined to use and continue using FOCUS.