Gowarty Minda A, Aschbrenner Kelly A, Brunette Mary F
Departments of Internal and Family Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
Front Psychiatry. 2021 May 7;12:656538. doi: 10.3389/fpsyt.2021.656538. eCollection 2021.
Young adults with serious mental illness (SMI) are over twice as likely to smoke cigarettes than those in the general population, but little research has evaluated the efficacy of interventions for this group. While smartphone apps are a promising tool to address this need, their usability should be evaluated among young adults with psychotic disorders, whose symptoms and cognitive impairments may be a barrier to app use. We compared usability and acceptability of National Cancer Institute apps (QuitGuide and quitSTART) between young adult smokers with SMI psychotic disorders and other SMI diagnoses. We evaluated objective app usability at the initial study visit and following 2 weeks of independent use a video-recorded task-completion protocol. Perceptions of usability and acceptability were assessed with semi-structured interviews. Engagement was assessed with backend app use data. Participants had a mean age of 29 years old (SD = 4). Of the participants without psychotic disorders ( = 10), all were diagnosed with SMI post-traumatic stress disorder (SMI-PTSD). QuitGuide objective task completion rates were high and similar between diagnosis groups, whereas quitSTART task completion was initially lower among users with psychotic disorder compared to users with SMI-PTSD at Visit 1, and improved by Visit 2. Mean app interactions, mean days of use, and median completed notifications were dramatically higher among quitSTART users compared to QuitGuide users. Compared to quitSTART users with SMI-PTSD, quitSTART users with psychotic disorders had similar daily app interactions over the first week of use (mean 3.8 ± 2.4 interactions), and numerically lower mean daily app interactions during the second week (1.9 ± 1.5 vs. 3.4 ± 2.5), whereas completed notifications remained stable among quitSTART users in both diagnosis groups over time. Qualitative comments indicated general acceptability of both apps among both diagnosis groups. Both QuitGuide and quitSTART were usable and appealing among young adult smokers with psychotic disorders and SMI-PTSD, although quitSTART engendered a dramatically greater level of engagement compared to QuitGuide. Initial coaching to support initiation and app notifications to promote prolonged engagement may be important for young adult smokers with psychotic disorders. Replication and efficacy testing for quitSTART is warranted.
患有严重精神疾病（SMI）的年轻人吸烟的可能性是普通人群的两倍多，但针对这一群体的干预措施效果的研究却很少。虽然智能手机应用程序是满足这一需求的有前景的工具，但它们在患有精神疾病的年轻人中的可用性应该得到评估，因为他们的症状和认知障碍可能会成为使用应用程序的障碍。我们比较了患有SMI精神疾病的年轻成年吸烟者与其他SMI诊断患者在使用美国国立癌症研究所应用程序（QuitGuide和quitSTART）时的可用性和可接受性。我们在初次研究访视时以及独立使用2周后，通过视频记录的任务完成协议评估了应用程序的客观可用性。通过半结构化访谈评估了对可用性和可接受性的看法。通过应用程序后端使用数据评估参与度。参与者的平均年龄为29岁（标准差 = 4）。在没有精神疾病的参与者（n = 10）中，所有人都被诊断患有SMI创伤后应激障碍（SMI-PTSD）。QuitGuide的客观任务完成率很高，且在不同诊断组之间相似，而quitSTART的任务完成率在第1次访视时，与患有SMI-PTSD的用户相比，患有精神疾病的用户最初较低，但在第2次访视时有所改善。与QuitGuide用户相比，quitSTART用户的平均应用程序交互次数、平均使用天数和完成通知的中位数显著更高。与患有SMI-PTSD的quitSTART用户相比，患有精神疾病的quitSTART用户在使用的第一周每天的应用程序交互次数相似（平均3.8 ± 2.4次交互），在第二周的平均每日应用程序交互次数在数值上较低（1.9 ± 1.5次对3.4 ± 2.5次），而随着时间的推移，两个诊断组的quitSTART用户完成通知的数量保持稳定。定性评论表明两个诊断组对这两个应用程序的总体接受度。QuitGuide和quitSTART在患有精神疾病和SMI-PTSD的年轻成年吸烟者中都是可用且有吸引力的，尽管与QuitGuide相比，quitSTART产生了更高的参与度。对于患有精神疾病的年轻成年吸烟者来说，支持启动的初始指导和促进长期参与的应用程序通知可能很重要。有必要对quitSTART进行复制和疗效测试。
