Low and Middle Income Countries

mHealth Washington is an initiative funded by the National Institute of Mental Health (Grant # R01MH116057) and is a collaboration between The University of Washington and Washington Health Care Authority.

 

The study evaluated two mHealth implementation strategies that leverage digital navigators to support deployment of a smartphone intervention for schizophrenia (FOCUS) in 23 community mental health programs. Both strategies were designed to engage community mental health center staff and patients in mHealth: External Facilitation (EF) – a hub-and-spoke model where digital navigators provide mHealth support to staff and patients at multiple agencies versus Internal Facilitation (IF) – where frontline staff at each agency serve as the local digital navigators.  Implementation outcomes of 3,816 patients with schizophrenia-spectrum disorders, included intervention reach, penetration, intake completion, and treatment initiation as well as practitioner ratings of intervention acceptability, appropriateness, and feasibility in their setting. Intervention outcomes of 274 enrolled patients included participant psychiatric hospitalization and emergency room admissions, clinical symptoms, and recovery (assessed at baseline, posttreatment, and six months).  

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Highlights

 

This hybrid type 3 effectiveness-implementation trial is one of the largest digital mental health studies conducted with people with schizophrenia, to date (23 community sites, 274 participants).

 

Both implementation strategies produced similar agency-level implementation outcomes.

 

FOCUS reduced the percentage of participants who experienced psychiatric emergency room admissions in EF, but not in IF. The smartphone intervention produced small positive effects on psychiatric symptom and recovery measures in both conditions, but the magnitudes of gains were greater in the EF condition. These findings suggest a clinical advantage to the EF implementation model.

 

Regional EF hubs can potentially provide support to community agencies implementing mHealth for schizophrenia.

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