Mobile-Based SMS Intervention to Encourage Compliance in People with Serious Mental Disorders – Developing User-Friendly Intervention (SMS) and a Multi-Centre Randomised Controlled Design
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Abstract
Background
Non-adherence is the single most important predictor of relapse and readmission among patients with serious mental disorders affecting more costs to the society and disturbing everyday lives of patients and their families. Schizophrenia is associated with long-term illness with relapses and poor compliance. People, especially young, do not like to need long term treatment; often there is lack of insight or people forget to keep their appointments. It is therefore important to find easy and effective methods to encourage patient’s medication intake and attendance at follow-up at out-patient care. As the use of mobile technology has become increasingly widespread in societies globally, the significance of such new technologies for persons with serious mental disorders should be developed and tailored to satisfy users’ needs.
Objective
To describe establishment of tailored mobile telephone text messages intervention to encourage compliance with medication and a planning process of trial to follow up with people with psychosis at 12 months.
Methods
The study was rolled out of a consumer-designed simple intervention in the context of an evaluative study desig. First, a series of focus groups for service users (N = 5) and health care personnel (N = 5) were organised and run to ensure that semi-automated SMS text-based intervention is acceptable for patients and health care staff. Second, by working with service user and health care organization we worked to plan how to encourage people to accept a new intervention and its design to evaluating the effects of SMS messages. Thus, instead of running a complex intervention in isolation of daily reality, a special effort was put into collaboration with patients and hospital staff to ensure that the design is simple and widely acceptable widely in Finnish psychiatric services.
Results
First, based on a systematic development process, a consumer-designed simple intervention using mobile tehnology was planned. The content of messages was developed together with patients and their careers. Second, a randomized controlled trial with two arms was designed. All hospitals with psychiatric beds in Finland were invited in the trial study. Patients aged 18-65 years, either sex, with antipsychotic medication on discharge from psychiatric hospital, who have a mobile phone, are able to use Finnish language and to give written informed consent were invited to participate. So far 502 patients in 26 different hospital organizations have been randomized since September 2011; only 5 patients have requested to stop the messages. The outcomes will be based mainly on the data of Finnish national health registers.
Conclusions
This ongoing study has already shown that it is possible and necessary to modernize mental health services by using mobile technology. Our pragmatic and service-user designed study can create evidence-based knowledge of good practices in mental health care and helps to avoid imposing unevaluated intrusion into the lives of people with serious mental illnesses.
Non-adherence is the single most important predictor of relapse and readmission among patients with serious mental disorders affecting more costs to the society and disturbing everyday lives of patients and their families. Schizophrenia is associated with long-term illness with relapses and poor compliance. People, especially young, do not like to need long term treatment; often there is lack of insight or people forget to keep their appointments. It is therefore important to find easy and effective methods to encourage patient’s medication intake and attendance at follow-up at out-patient care. As the use of mobile technology has become increasingly widespread in societies globally, the significance of such new technologies for persons with serious mental disorders should be developed and tailored to satisfy users’ needs.
Objective
To describe establishment of tailored mobile telephone text messages intervention to encourage compliance with medication and a planning process of trial to follow up with people with psychosis at 12 months.
Methods
The study was rolled out of a consumer-designed simple intervention in the context of an evaluative study desig. First, a series of focus groups for service users (N = 5) and health care personnel (N = 5) were organised and run to ensure that semi-automated SMS text-based intervention is acceptable for patients and health care staff. Second, by working with service user and health care organization we worked to plan how to encourage people to accept a new intervention and its design to evaluating the effects of SMS messages. Thus, instead of running a complex intervention in isolation of daily reality, a special effort was put into collaboration with patients and hospital staff to ensure that the design is simple and widely acceptable widely in Finnish psychiatric services.
Results
First, based on a systematic development process, a consumer-designed simple intervention using mobile tehnology was planned. The content of messages was developed together with patients and their careers. Second, a randomized controlled trial with two arms was designed. All hospitals with psychiatric beds in Finland were invited in the trial study. Patients aged 18-65 years, either sex, with antipsychotic medication on discharge from psychiatric hospital, who have a mobile phone, are able to use Finnish language and to give written informed consent were invited to participate. So far 502 patients in 26 different hospital organizations have been randomized since September 2011; only 5 patients have requested to stop the messages. The outcomes will be based mainly on the data of Finnish national health registers.
Conclusions
This ongoing study has already shown that it is possible and necessary to modernize mental health services by using mobile technology. Our pragmatic and service-user designed study can create evidence-based knowledge of good practices in mental health care and helps to avoid imposing unevaluated intrusion into the lives of people with serious mental illnesses.
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