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      Measuring Users’ Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study

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          Abstract

          Background

          Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice.

          Objective

          The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST).

          Methods

          Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework.

          Results

          A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution.

          Conclusions

          Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact.

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          Most cited references34

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          The positive and negative syndrome scale (PANSS) for schizophrenia.

          The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
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            Mobile Assessment and Treatment for Schizophrenia (MATS): a pilot trial of an interactive text-messaging intervention for medication adherence, socialization, and auditory hallucinations.

            Mobile Assessment and Treatment for Schizophrenia (MATS) employs ambulatory monitoring methods and cognitive behavioral therapy interventions to assess and improve outcomes in consumers with schizophrenia through mobile phone text messaging. Three MATS interventions were developed to target medication adherence, socialization, and auditory hallucinations. Participants received up to 840 text messages over a 12-week intervention period. Fifty-five consumers with schizophrenia or schizoaffective disorder were enrolled, but 13 consumers with more severe negative symptoms, lower functioning, and lower premorbid IQ did not complete the intervention, despite repeated prompting and training. For completers, the average valid response rate for 216 outcome assessment questions over the 12-week period was 86%, and 86% of phones were returned undamaged. Medication adherence improved significantly, but only for individuals who were living independently. Number of social interactions increased significantly and a significant reduction in severity of hallucinations was found. In addition, the probability of endorsing attitudes that could interfere with improvement in these outcomes was also significantly reduced in MATS. Lab-based assessments of more general symptoms and functioning did not change significantly. This pilot study demonstrated that low-intensity text-messaging interventions like MATS are feasible and effective interventions to improve several important outcomes, especially for higher functioning consumers with schizophrenia.
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              • Article: not found

              Emerging mHealth and eHealth interventions for serious mental illness: a review of the literature.

              Serious mental illness (SMI) is one of the leading causes of disability worldwide. Emerging mobile health (mHealth) and eHealth interventions may afford opportunities for reaching this at-risk group.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                Jul-Sep 2016
                28 September 2016
                : 4
                : 3
                : e112
                Affiliations
                [1] 1Parc Sanitari Sant Joan de Déu, CIBERSAM G11 BarcelonaSpain
                [2] 2Sheba Medical Center Tel AvivIsrael
                [3] 3Department of Psychiatry and Psychotherapy, Semmelweis University BudapestHungary
                [4] 4Hospital de la Santa Creu i Sant Pau, CIBERSAM G21 BarcelonaSpain
                [5] 5Fundació TicSalut BarcelonaSpain
                [6] 6Center for Life Course Health Research, University of Oulu OuluFinland
                Author notes
                Corresponding Author: Elena Huerta-Ramos mehuerta@ 123456pssjd.org
                Author information
                http://orcid.org/0000-0003-4134-0637
                http://orcid.org/0000-0003-1150-5875
                http://orcid.org/0000-0003-2875-4456
                http://orcid.org/0000-0003-0103-5064
                http://orcid.org/0000-0003-1100-7489
                http://orcid.org/0000-0001-6367-4502
                http://orcid.org/0000-0001-5760-7389
                http://orcid.org/0000-0002-5845-5636
                http://orcid.org/0000-0003-1205-6557
                http://orcid.org/0000-0002-9464-4709
                http://orcid.org/0000-0002-5955-9920
                http://orcid.org/0000-0002-8752-2041
                http://orcid.org/0000-0001-6792-1080
                http://orcid.org/0000-0002-3229-1637
                http://orcid.org/0000-0003-2562-711X
                http://orcid.org/0000-0002-1746-7737
                Article
                v4i3e112
                10.2196/mhealth.5716
                5062002
                27682896
                6bd4f97e-61c1-4518-b951-a1307f8cbc7b
                ©Elena Huerta-Ramos, Maria Soledad Escobar-Villegas, Katya Rubinstein, Zsolt Szabolcs Unoka, Eva Grasa, Margarita Hospedales, Erika Jääskeläinen, Elena Rubio-Abadal, Asaf Caspi, István Bitter, Jesus Berdun, Jussi Seppälä, Susana Ochoa, Kata Fazekas, M-RESIST Group, Iluminada Corripio, Judith Usall. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 28.09.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 4 March 2016
                : 27 June 2016
                : 29 July 2016
                : 21 August 2016
                Categories
                Original Paper
                Original Paper

                mhealth solution,treatment-resistant schizophrenia,intervention model,qualitative research,needs assessment

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