Lay health supporters aided by a mobile text messaging intervention led to improvements in medication adherence, relapses and rehospitalizations among people with schizophrenia in a resource-poor community in rural China, according to a PLOS Medicine study.
Dong Roman Xu, PhD, MPP, of Sun Yat-sen University Global Health Institute, China, and colleagues created LEAN, an intervention that involved the recruitment of lay health supporters (eg, family members of the patients or community volunteers); an electronic platform with medication reminders, health education and monitoring via text; awarding token gifts for positive behavioral improvement; and integrating texting into the health system.
“In [low- and middle-income countries (LMICs)], with limited mental health facilities and the health care workforce concentrated in large urban centers, the scarcity, inequity and inefficiency of mental health resources present challenges,” the researchers wrote. “The LEAN intervention was intended ... to have broad applicability for resource-poor settings in LMICs.”
In this two-arm randomized controlled trial, patients with schizophreniav in both the intervention and the control groups received a nationwide community-based mental health program that provided free antipsychotic medications. The intervention group also received LEAN. Xu and colleagues evaluated patients’ medication adherence, symptoms, functioning, relapses and rehospitalizations.
In total, 271 patients had 6-month follow-up data.
Xu and colleagues found that LEAN demonstrated a 27% improvement in antipsychotic adherence among patients with schizophrenia. Those in the intervention group had better medication adherence than those in the control group (0.61 vs. 0.48; adjusted mean difference, 0.12 [95% CI, 0.03-0.22]).
In addition, the intervention group had substantial reductions in risk for relapse (21.7% of intervention participants vs. 34.2% controls; RR = 0.63 [95% CI, 0.42-0.97]) and rehospitalizations (7.3% vs. 20.5%; RR = 0.36; 95% CI, 0.17-0.73).
“The program was also found to be generally well accepted by the patients and their families, was relatively easy to implement and use, and added little marginal cost,” the researchers wrote.
Although Xu and colleagues observed less loss of functioning in those who received the intervention than in those in the control group, the difference was not statistically significant.
“Our study points to several future directions for research,” they wrote. “Smartphones, with their sensor technologies and apps, may have considerable potential for improving the health of people with schizophrenia. The role of smartphones needs to be further explored in trials.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.