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abstract
Objective: Mobile health (mHealth) approaches have the potential to transform prevention, wellness, and illness management for people with dual diagnosis consisting of co-occurring mental illness and substance use disorders by providing timely and cost-effective interventions in clients' natural environments. However, little is known about how clients interact with mHealth interventions to manage their illness. This qualitative study explored the content of mobile phone text messages between clients with dual diagnosis and a clinician who engaged them in daily assessment and intervention text exchanges. Methods: Seventeen participants with psychotic disorders and substance use were enrolled in a 12-week single-arm trial of an mHealth intervention focusing on illness management. The clinician (i.e., mobile interventionist) sent daily text messages to participants' privately owned mobile phones to assess their medication adherence and clinical status. The clinician provided other illness management and wellness suggestions flexibly, in response to participants' needs and preferences. In this qualitative study we conducted a thematic analysis of the client–clinician text exchanges that occurred over the course of the intervention. Results: Seven major content themes in client–clinician text message exchanges were identified: mental health symptoms; mental health coping strategies; mental health treatment and management; lifestyle behaviors; social relationships and leisure activities; motivation and personal goal setting; and independent living. Participants were interested in discussing strategies for coping with mental health symptoms (e.g., cognitive restructuring, social support) and health behavior change (e.g., increased physical activity, dietary changes). Conclusions: Our findings suggest that client-centered text messaging has the potential to be an important component of illness management for people with dual diagnosis. This approach is able to offer coping strategies that are tailored to clients' needs and preferences in real time when help is needed.
Disclosures
The authors report no conflict of interest as it relates to the subject of this manuscript. Dr. Ben-Zeev has an intervention content licensing agreement with Pear Therapeutics, a digital intervention company.
Funding
This study was funded by an intramural grant from the Department of Psychiatry at Dartmouth's Geisel School of Medicine and a grant from the National Institute of Mental Health (R34 MH100195, PI: Ben-Zeev). Additional support was received from the United States Centers for Disease Control and Prevention Health Promotion and Disease Prevention Research Center (Cooperative Agreement Number U48DP005018). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.