The App for Independence (A4i) is a digital platform co-designed with individuals with schizophrenia, families, and service providers. A single-blinded randomized trial in Toronto, Canada, with 91 participants, assessed the feasibility of A4i over six months. Feasibility metrics included recruitment, engagement, retention, and secondary clinical outcomes. COVID-19 disrupted recruitment and engagement targets were not met, but user satisfaction and qualitative feedback were positive. The study highlights the interest in digital health for severe mental illness but underscores the need for improved implementation strategies and research methods.

The current study outlines the results from a qualitative co-design project that engaged 6 lived experts and 8 clinical experts in a series of focus groups and interviews to adapt an existing intervention for use in OUD. Focus groups and interviews were recorded and transcribed before undergoing thematic analysis. This co-design process is the first stage of a larger project that will lead to the development of a novel digital health intervention for OUD populations. Lived experts and clinicians strongly supported integrating digital tools into OUD care. Ongoing work is needed to better understand the role of technology in existing OUD structures as well as the implementation of key features such as digital peer support and creating effective and safe social connections. This study also validates co-design as an essential step in digital health development.

Overall, 53 patients were onboarded to A4i in Context 1, 8 in Context 2, and 65 within Context 3, with retention rates over 90 days of 100%, 100%, and 96%, respectively. The adoption, engagement, and sustained use of the A4i platform varied across each implementation site and were affected by implementation strategies within the sociotechnical domains of people, culture, process, and technology. Despite differences in implementation processes, engagement with A4i remained consistently high. Customized educational materials, digital navigators, and technical support served as facilitators in the adoption of A4i.

The results suggest that individual smartphone digital intervention engagement is heterogeneous, and symptom-specific baseline data may be predictive of increased engagement and positive qualitative impressions of digital intervention in patients with psychosis. Taken together, interrogating individual response to and engagement with digital-based intervention with machine learning provides increased insight to otherwise ignored nuances of treatment response.

Feasibility metrics in this single-blind, randomized trial include study recruitment and retention, rate of technology use, safety, and utility in clinical interactions. Other outcome metrics include symptomatology, treatment adherence, patient-provider alliance, and quality of life. In this trial, 160 study participants with schizophrenia spectrum diagnoses will be randomized to either treatment or control conditions, with pretest-posttest outcomes measured over a 6-month period.

Among the 38 individuals with a primary psychosis who participated, there was no research attrition and classic retention on the app was 52.5%. Significant improvement was observed in some psychiatric symptom domains with small-medium effects. Significant change in recovery engagement and medication adherence were not observed after controlling for multiple comparisons. Those who interacted with the app more frequently were more depressed and had higher hostility and interpersonal sensitivity at baseline. Satisfaction with the app was high and qualitative feedback provided insights regarding feature enhancements.