Tatar Ovidiu, Abdel-Baki Amal, Tra Christophe, Mongeau-Pérusse Violaine, Arruda Nelson, Kaur Navdeep, Landry Vivianne, Coronado-Montoya Stephanie, Jutras-Aswad Didier
Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
JMIR Form Res. 2021 Apr 5;5(4):e26562. doi: 10.2196/26562.
The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability.
The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention.
A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers.
Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians).
This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis.
首次发作精神病（FEP）的年轻成年人中，大麻使用障碍（CUD）的持续存在与不良的临床和功能结局相关。面对面心理干预对治疗CUD有效。然而，由于存在包括工作量大、临床医生培训的异质性以及患者缺乏治疗动机等障碍，它们在精神病早期干预服务（EIS）中的应用并不一致。定制基于新技术的心理干预（TBPI）以克服这些障碍对于确保其最佳可接受性是必要的。
本研究的目的有两个：探索与治疗早期精神病患者的CUD相关的心理干预实践和干预目标，以及探索与技术辅助心理干预的开发和实施相关的因素。
2019年6月，共有10名在EIS中接受FEP和CUD治疗的患者参加了焦点小组。对在加拿大魁北克省首次发作诊所工作的10名临床医生进行了半结构化个人访谈。采用混合归纳 - 演绎方法分析数据。对于演绎分析，我们使用了文献中发现的促进策略类别，这些策略被证明可提高对物质使用的基于网络干预的依从性（即定制、提醒、交付策略、社会支持和激励）。对于归纳分析，我们通过两位独立评审员多次审查数据的迭代过程确定了新主题。
数据被综合为从数据收集中出现的五类因素，并对患者和临床医生观点之间的共性和差异进行了叙述性综合。这些类别包括与心理干预相关的态度和信念（如行为改变阶段）、心理干预策略（如动机访谈、认知行为疗法、心理教育、压力管理）、激励措施（如应急管理）、对TBPI的总体兴趣（如TBPI的促进因素和障碍）以及TBPI的定制（如应用需求和偏好、临床医生感兴趣的结局指标）。
本研究全面描绘了患者和临床医生与TBPI相关的多方面需求和偏好。我们的结果可为针对患有早期精神病的年轻成年人的CUD开发基于智能手机或网络的心理干预提供参考。
