Does Delivery Modality (Native Smart Phone App VS SMS) Affect Validity of Ambulatory Monitoring in Severe Mental Illness
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Abstract
BACKGROUND:
Ambulant, real-time self-report assessment using a native smart phone app has been shown to have validity when compared with the semi-structured interview scales for psychosis that are the gold standard approach to assessing psychotic and other symptoms. However, there are alternative delivery modalities available such as SMS text messages, and little is known about whether the delivery modality affects validity.
OBJECTIVES:
We report on two different delivery modalities of a monitoring system for the assessment of psychosis, a native smart phone app and SMS text messages. The primary aim was to assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis for both delivery modalities. It was also predicted that there would be correspondence between the validity of the two delivery modalities across the symptom dimensions being assessed.
METHODS:
A randomised repeated measures cross over design was employed. Participants, with currently-treated Diagnostic and Statistical Manual (Fourth Edition) schizophrenia or related disorders (n=24), were randomly allocated to completing six-days of assessment (four sets of questions per day) with a native smartphone application or the SMS text only implementation. There was then a one-week break before completing a further six days with the alternative delivery modality. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data.
RESULTS:
Of the 24 participants all of them completed 6 days with the native smart phone app, and 23 completed the 6 days with the SMS text only implementation. Three dimensions (delusions, depression and hopelessness) showed strong correlation using Spearman’s correlation (rho) for both delivery modalities. To two decimal places they were (app/SMS) hopelessness = 0.69/0.66 (p<.001/p=.001), delusions = 0.69/0.73 (p<.001/p<.001), depression = 0.56/0.56 (p=.005/p=.008). The dimensions anxiety and paranoia were strongly correlated for the native smart phone app only. To two decimal places they were (app/SMS) anxiety= 0.76/0.48 (p<.001/p=.028), paranoia = 0.72/0.54 (p<.001/p=.012). The dimensions of hallucinations and grandiosity were uncorrelated for both delivery modalities.
CONCLUSIONS:
The failure to observe the same degree of correlation across the five symptom dimensions in both implementations indicates that delivery mechanism may have a role to play in validity. There is strong correspondence in the hopelessness, depression and delusion, but not in paranoia and anxiety. Further evaluation is required over longer assessment periods, in clinical trials and service settings.
Ambulant, real-time self-report assessment using a native smart phone app has been shown to have validity when compared with the semi-structured interview scales for psychosis that are the gold standard approach to assessing psychotic and other symptoms. However, there are alternative delivery modalities available such as SMS text messages, and little is known about whether the delivery modality affects validity.
OBJECTIVES:
We report on two different delivery modalities of a monitoring system for the assessment of psychosis, a native smart phone app and SMS text messages. The primary aim was to assess validity through correlations of item responses with those on widely accepted interview assessments of psychosis for both delivery modalities. It was also predicted that there would be correspondence between the validity of the two delivery modalities across the symptom dimensions being assessed.
METHODS:
A randomised repeated measures cross over design was employed. Participants, with currently-treated Diagnostic and Statistical Manual (Fourth Edition) schizophrenia or related disorders (n=24), were randomly allocated to completing six-days of assessment (four sets of questions per day) with a native smartphone application or the SMS text only implementation. There was then a one-week break before completing a further six days with the alternative delivery modality. Face to face PANSS and CDS interviews were conducted before and after the assessment period blind to the ambulant data.
RESULTS:
Of the 24 participants all of them completed 6 days with the native smart phone app, and 23 completed the 6 days with the SMS text only implementation. Three dimensions (delusions, depression and hopelessness) showed strong correlation using Spearman’s correlation (rho) for both delivery modalities. To two decimal places they were (app/SMS) hopelessness = 0.69/0.66 (p<.001/p=.001), delusions = 0.69/0.73 (p<.001/p<.001), depression = 0.56/0.56 (p=.005/p=.008). The dimensions anxiety and paranoia were strongly correlated for the native smart phone app only. To two decimal places they were (app/SMS) anxiety= 0.76/0.48 (p<.001/p=.028), paranoia = 0.72/0.54 (p<.001/p=.012). The dimensions of hallucinations and grandiosity were uncorrelated for both delivery modalities.
CONCLUSIONS:
The failure to observe the same degree of correlation across the five symptom dimensions in both implementations indicates that delivery mechanism may have a role to play in validity. There is strong correspondence in the hopelessness, depression and delusion, but not in paranoia and anxiety. Further evaluation is required over longer assessment periods, in clinical trials and service settings.
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