TechCare – Mobile Assessment and Therapy for Psychosis: Feasibility Study of an Intervention for Clients within the Early Intervention Service

Background: Mobile digital health technologies, mHealth, is a growing field globally with a potential to improve mental health. Technological advances have shown promise across healthcare and particularly when delivering interventions for mental health problems such as psychosis. The use of mobile devices provides greater autonomy to service users who would otherwise be seen as a ‘hard to reach group’, with complex relationships between psychotic experiences, trust and engagement with services. A non-stigmatising approach is implicit within technological developments, as many service users experience mental health stigma, which can compound problematic engagement, treatment adherence and outcomes. This study was an original piece of work and has created new insights into mHealth technologies for individuals experiencing psychosis. Aim: The aim of the project was to develop and conduct a feasibility study of the mobile phone application (App) ‘TechCare’ for individuals with psychosis in the North West of England. Methods/Design: The feasibility study followed the National Institute of Health Research (NIHR) guidance on feasibility study design and consisted of both qualitative and quantitative components. The study was conducted across three strands as follows: 1) Qualitative work & Systematic review; 2) Test-run and Intervention refinement (developing the TechCare App); 3) Feasibility trial. The TechCare App assessed participants’ symptoms and responses and provided for a personalised guided self-help based psychological intervention, with the aim of reducing participants’ symptoms. In Strand 1 of the study, 16 service users and 16 health professionals from Lancashire Care NHS Foundation Trust, Early Intervention Service (EIS) were recruited to explore their experience of psychosis and give their opinions on the existing evidence based treatment (Cognitive Behavioural Therapy (CBT)) and how the mobile App could be developed (service users and staff). In Strand 2, a test-run with a small number (n= 4) of participating service users, was conducted to refine the mobile intervention (TechCare). Finally, in Strand 3 the TechCare App was examined in a feasibility study with a total of 12 service users. The study was also registered on ClinicalTrials.gov Identifier: NCT02439619. Results: The systematic review, found 7 studies which met the inclusion criteria, from a total of 5690 records. The included studies describing the feasibility of using mHealth technologies for psychosis, functionality and access to mHealth interventions and study outcomes. Overall, the systematic review results suggested that mHealth for psychosis is acceptable and feasible in the target population. Furthermore, the TechCare App had been developed, working alongside service users who consulted on the development of the App. The qualitative result of the study showed that the TechCare App was found to be an acceptable means of receiving interventions for the service users, with key themes around, the participant’s experience of using the App, the further development and refinement of the intervention and the usability of the intervention. In addition, the Strand 3 feasibility study, results showed that out of the 12 participants, a total of 83.33% of participants completed the 6 week intervention. Overall participants responded to the App notifications on average 2.95 time per day (Range: 0-11), with a reduction in average scores on the TechCare App, from baseline to week 6 for the depression scale questions (Week 1, M=29.13 (SD=18.29); Week 6 was M=17.50 (SD=11.92)) and paranoia scale questions (Week 1 M=38.00, SD=28.27; Week 6, M=33.92, SD=27.88). Discussion: The results of the study show promise in the feasibility and acceptability of the TechCare App. Based on these results I can now take the research forward as part of a future clinical and cost effectiveness trial. It has been suggested that there is a need, for a rapid increase in the evidence base for the clinical effectiveness of digital technologies, considering mHealth research can potentially be helpful in addressing the demand on mental health services in the UK and mental health inequalities