MedActive: A Smartphone Intervention to Improve Adherence to Antipsychotic Medications

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.

Inclusion Criteria:

- Decisional capacity to provide informed consent

- Chart diagnosis of schizophrenia or schizoaffective disorder

- Currently prescribed at least one oral antipsychotic medication

- Self administers at least one oral antipsychotic medication

- 18-64 years of age

- English Speaking

- Be able to read English

Exclusion Criteria:

- Has visual, hearing, voice, or motor impairment that would prevent completion of
study procedures or use of mobile phone