MedActive: A Smartphone Intervention to Improve Adherence to Antipsychotic Medications
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      We propose to develop and pilot test the effect of a mobile smartphone intervention,
      MedActive, on improving antipsychotic adherence among individuals with schizophrenia.
    

Detailed description: 
      Up to 60% of individuals with schizophrenia do not take their antipsychotic medications as
      prescribed, which can lead to symptom relapse, decreased functioning, hospitalization, and
      increased healthcare costs. Recent studies of both patient- and pharmacy-based interventions
      utilizing behavioral tailoring, environmental supports, and medication monitoring have shown
      promise in improving antipsychotic adherence. However, there is continued need for effective
      adherence-enhancing interventions (AEIs) that are less resource intensive and more widely
      accessible by the broad range of individuals in need of assistance with medication
      management. Over the last decade, technological advances in internet and cellular
      communication, including the emergence of mobile 'smartphones', have revolutionized the way
      our society communicates. Whereas a variety of mobile phone-based applications have been
      shown to be effective for improving health outcomes such as medication adherence for a number
      of medical conditions, few such applications have been developed for individuals with
      schizophrenia. Therefore, in response to NIMH PAR-09-173, we propose to develop and pilot
      test the effect of a mobile smartphone intervention, MedActive, on improving antipsychotic
      adherence among this population. We used the Information-Motivation-Behavioral (IMB) Skills
      Model of adherence as the theoretical framework to inform the conceptualization of MedActive.
      The IMB Skills Model posits that individuals who are well-informed and motivated to adhere
      will enact adherence-related behavioral skills that lead to adherence behaviors and favorable
      health outcomes. MedActive will provide personalized reminders to patients to take their
      antipsychotic medications as prescribed and will query them about their intentions to take
      the medication, the occurrence of side effects, and the presence of positive psychotic
      symptoms. Summaries of these ecological momentary assessments of adherence, symptoms, and
      side effects will be made available to the individual on the phone and to their psychiatrist
      through a secure, online clinician interface. Using an iterative user-centered design
      approach, the specific aims of this proposal are to (1) collaborate with individuals with
      schizophrenia, psychiatrists and an expert advisory group to develop the initial version of
      MedActive; (2) conduct laboratory usability testing and a short-term field trial in 10
      individuals with schizophrenia and their psychiatrists to determine the preliminary
      acceptability and feasibility of MedActive in clinical practice; and (3) conduct a randomized
      pilot trial of MedActive compared to providing a smartphone alone in 40 individuals with
      schizophrenia and their psychiatrists to evaluate its effect on antipsychotic adherence. We
      will also explore whether psychiatric symptoms and neuropsychological impairments moderate
      the effect of MedActive on adherence. If shown to be effective, MedActive will introduce a
      paradigm shift in medication self-management by individuals with schizophrenia and in
      treatment monitoring by their clinicians.
    

Intervention name(s): MedActive; Smartphone
Intervention type(s): Behavioral; Device
Intervention description(s): Participants randomized to the MedActive condition will complete a 1-hour training session on MedActive, which will include ascertaining their antipsychotic administration schedule that will be pre-programmed into the application along with other personalized features. Each participate will be asked to use the medActive application over the following three months. All participants randomized to this condition will also have their antipsychotic medication adherence assessed over the 3-month period.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: Schizophrenia; antipsychotic medication adherence; mobile phones