Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study

Javier-David Lopez-Morinigo, María Luisa Barrigón, Alejandro Porras-Segovia, Verónica González Ruiz-Ruano, Adela Sánchez Escribano Martínez, P. -J. Escobedo-Aedo, S. Sánchez-Alonso, L. Mata-Iturralde, Laura Muñoz Lorenzo, Antonio Artés-Rodríguez, Anthony S David, Enrique Baca-García: Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study. En: J Med Internet Res, vol. 23, no. 7, pp. e26548, 2021, ISSN: 1438-8871.

Resumen

Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients' behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on ``being user versus nonuser'' (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. Trial Registration: ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347

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@article{info:doi/10.2196/26548,
title = {Use of Ecological Momentary Assessment Through a Passive Smartphone-Based App (eB2) by Patients With Schizophrenia: Acceptability Study},
author = {Javier-David Lopez-Morinigo and Mar\'{i}a Luisa Barrig\'{o}n and Alejandro Porras-Segovia and Ver\'{o}nica Gonz\'{a}lez Ruiz-Ruano and Adela S\'{a}nchez Escribano Mart\'{i}nez and P. -J. Escobedo-Aedo and S. S\'{a}nchez-Alonso and L. Mata-Iturralde and Laura Mu\~{n}oz Lorenzo and Antonio Art\'{e}s-Rodr\'{i}guez and Anthony S David and Enrique Baca-Garc\'{i}a},
url = {http://www.ncbi.nlm.nih.gov/pubmed/34309576},
doi = {10.2196/26548},
issn = {1438-8871},
year  = {2021},
date = {2021-07-26},
urldate = {2021-07-26},
journal = {J Med Internet Res},
volume = {23},
number = {7},
pages = {e26548},
abstract = {Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients' behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on ``being user versus nonuser'' (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. Trial Registration: ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347},
keywords = {ecological momentary assessment; acceptability; schizophrenia spectrum disorders; eB2; digital tools; mental health; schizophrenia; real-time data; patients; digital health; internet; mobile apps},
pubstate = {published},
tppubtype = {article}
}