背景:移动健康(mHealth)技术已广泛用于精神病研究。相比之下,尽管针对精神健康护理的基于智能手机的应用程序广泛可用,但它们与现实世界临床护理的整合受到限制。大多数为治疗精神病患者而开发的应用程序主要集中在通过练习在面对面临床会话中学习的认知行为技术来鼓励患者的自我管理技能(例如,挑战功能失调的思想和放松练习),从事健康促进活动的提醒(例如,锻炼,睡觉,和社交),或症状监测。相比之下,很少有应用程序试图增强临床接触本身,以改善与临床医生的共享决策(SDM)和治疗关系,这与积极的临床结果有关。
目的:这项定性研究寻求临床医生的投入,以开发第一集数字监测(FREEDoM),基于应用程序的mHealth干预。FREEDOM旨在提高质量,数量,以及临床医生可获得的临床和功能数据的及时性,以治疗患有首发精神病(FEP)的患者,以增强他们的治疗关系并增加SDM。
方法:在应用程序的初始开发之后,在3个协调的专科护理诊所对11个FEP治疗提供者进行了半结构化定性访谈,以引起对应用程序设计的输入,临床医生的数据报告,和计划的使用程序。然后,我们生成了摘要模板,并进行了矩阵分析,以使用报告适应和修改增强框架(FRAME)的维度对基于证据的干预措施的建议适应进行系统分类,并记录了采用或拒绝建议的理由。
结果:临床医生提供了31条建议(18条被采纳,13条被拒绝)。添加或完善内容的建议是最常见的(例如,在应用程序中添加问题)。适应环境通常与实施干预措施的计划有关,报告的数据是如何显示给临床医生的,与谁分享了报告。建议的原因主要包括与患者的健康叙述和优先事项相关的因素(例如,关注症状的功能影响及其严重程度),提供者临床判断(例如,需要临床相关信息),和组织的使命和文化。拒绝建议的原因包括超出干预范围的数据和程序请求,对干预核心组成部分稀释的担忧,以及在使用该应用程序时增加患者负担的担忧。
结论:FREEDoM专注于在FEP患者治疗中部署mHealth技术的新目标-增强SDM和改善治疗关系。这项研究说明了框架的使用,以及快速定性分析的方法和工具,作为其开发过程的一部分,系统地跟踪对应用程序的适应。这种适应可能有助于提高临床医生对干预的接受度,并提高整合到临床护理中的可能性。
背景:ClinicalTrials.govNCT04248517;https://tinyurl.com/tjuyxvv6.
BACKGROUND: Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into real-world clinical care has been limited despite the broad availability of smartphone-based apps targeting mental health care. Most apps developed for treatment of individuals with psychosis have focused primarily on encouraging self-management skills of patients via practicing cognitive behavioral techniques learned during face-to-face clinical sessions (eg, challenging dysfunctional thoughts and relaxation exercises), reminders to engage in health-promoting activities (eg, exercising, sleeping, and socializing), or symptom monitoring. In contrast, few apps have sought to enhance the clinical encounter itself to improve shared decision-making (SDM) and therapeutic relationships with clinicians, which have been linked to positive clinical outcomes.
OBJECTIVE: This qualitative
study sought clinicians\' input to develop First Episode Digital Monitoring (FREEDoM), an app-based mHealth intervention. FREEDoM was designed to improve the quality, quantity, and timeliness of clinical and functional data available to clinicians treating patients experiencing first-episode psychosis (FEP) to enhance their therapeutic relationship and increase SDM.
METHODS: Following the app\'s initial development, semistructured qualitative interviews were conducted with 11 FEP treatment providers at 3 coordinated specialty care clinics to elicit input on the app\'s design, the data report for clinicians, and planned usage procedures. We then generated a summary template and conducted matrix analysis to systematically categorize suggested adaptations to the evidence-based intervention using dimensions of the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and documented the rationale for adopting or rejecting suggestions.
RESULTS: The clinicians provided 31 suggestions (18 adopted and 13 rejected). Suggestions to add or refine the content were most common (eg, adding questions in the app). Adaptations to context were most often related to plans for implementing the intervention, how the reported data were displayed to clinicians, and with whom the reports were shared. Reasons for suggestions primarily included factors related to health narratives and priorities of the patients (eg, focus on the functional impact of symptoms vs their severity), providers\' clinical judgment (eg, need for clinically relevant information), and organizations\' mission and culture. Reasons for rejecting suggestions included requests for data and procedures beyond the intervention\'s scope, concerns regarding dilution of the intervention\'s core components, and concerns about increasing patient burden while using the app.
CONCLUSIONS: FREEDoM focuses on a novel target for the deployment of mHealth technologies in the treatment of FEP patients-the enhancement of SDM and improvement of therapeutic relationships. This
study illustrates the use of the FRAME, along with methods and tools for rapid qualitative analysis, to systematically track adaptations to the app as part of its development process. Such adaptations may contribute to enhanced acceptance of the intervention by clinicians and a higher likelihood of integration into clinical care.
BACKGROUND: ClinicalTrials.gov NCT04248517; https://tinyurl.com/tjuyxvv6.