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Development of FOCUS: A Smartphone System for Serious Mental Illness

The FOCUS smartphone intervention provides automated real-time/real-place illness-management support to individuals with SMI. The system was specifically designed to be usable by people with psychotic disorders who may have cognitive impairment, psychotic symptoms, negative symptoms, and/or low reading levels. FOCUS offers users both pre-scheduled and on-demand resources to facilitate symptom management, mood regulation, medication adherence, social functioning, and improved sleep. FOCUS was developed in collaboration with individuals with schizophrenia and psychosocial rehabilitation practitioners at a community-based rehabilitation agency.

In stage 1 of the study, 904 individuals with schizophrenia or schizoaffective disorder completed a survey reporting on their current use of mobile devices and interest in receiving mHealth services.

In stage 2 Practitioners representing a range of psychosocial programs completed surveys examining their attitudes and expectations from an mHealth intervention, and identified needs and potential obstacles. Our multidisciplinary team incorporated patient and practitioner input, and employed design principles for the development of electronic resources for people with cognitive impairment, to produce a suitable mobile intervention.

In stage 3, patients participated in laboratory-based usability sessions and were observed performing a series of tasks involved in operating the new system, and provided running “think aloud” commentary and post-session usability ratings.

In stage 4, patients used FOCUS in their own environments.

Findings: Participants were able to learn how to use the intervention independently without difficulty. Patients used the system on 86.5% of days they had the device, an average of 5.2 times a day. Approximately 62% of use of the FOCUS intervention was initiated by the participants, and 38% of use was in response to automated prompts. Baseline levels of cognitive functioning, negative symptoms, persecutory ideation, and reading level, were not related to participants’ use of the intervention. Approximately 90% of participants rated the intervention as highly acceptable and usable. Statistical analyses found significant reductions in psychotic symptoms, depression, and general psychopathology, after FOCUS use. This study demonstrated the feasibility, acceptability, and preliminary efficacy of the FOCUS intervention for schizophrenia, and introduces a new treatment model which has promise for extending the reach of evidence-based care using widely available technologies.

Funded by: The National Institute of Mental Health

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