Individuals with schizophrenia often demonstrate poor engagement in treatment and challenges with illness self-management. App4independence (A4i) is a digital health platform that was developed with the purpose of addressing the aforementioned challenges. While digital interventions can support patient care, there is a paucity of research on implementing such interventions in clinical settings. To describe the contextual factors that impacted the implementation of and engagement with A4i across three different clinical implementation sites, a descriptive approach, guided by implementation science frameworks, was employed to understand how people, culture, process, and technology impacted the implementation of A4i. Descriptive statistics were used to present user engagement data across each site implementation. Additionally, the lessons learned from each implementation were described narratively. 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.
Keywords: behavioral health; consumer health; digital health; digital navigators; implementation science; mobile health; schizophrenia spectrum disorders.
Digital health tools like, App4Indepence (A4i), have the potential to support people with schizophrenia spectrum disorders in self-managing and engaging in their care. Although it is known that digital tools can support mental health care, there is a lack of knowledge on how best to implement these digital tools into clinical care. Given this, the following brief report aims to describe factors that affected the implementation of A4i across three different clinical settings. An implementation science framework was used to compare and contrast the implementation of A4i across the various clinical settings. Specifically, the impact of people, culture, process, and technology on each implementation was described. Overall, it was found that there were differing rates of engagement with the A4i app across each clinical setting. Higher engagement was found when peer support workers or clinicians were involved in the use of A4i with their clients. In each setting, having a clear implementation plan, creating personalized educational materials, and providing timely and appropriate technical support, facilitated the implementation of the A4i digital platform.
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