SMART: preliminary efficacy, feasibility and acceptability of a theory-informed digital intervention for metabolic health in people with schizophrenia and related disorders

BACKGROUND: People with schizophrenia spectrum disorders (SSD) experience high rates of type 2 diabetes (T2D), mainly due to antipsychotic medication side-effects and lifestyle factors (e.g. suboptimal nutrition and physical inactivity). Digital technologies may reduce T2D risk by complementing face-to-face and pharmacological treatments, through the provision of flexible and personalised psychoeducation and behavioural prompts tailored to end-users. AIMS: This study tested the preliminary efficacy of the Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART), a co-designed text message-facilitated intervention, designed to reduce the risk and/or improve self-management of T2D, along with its acceptability and feasibility. METHOD: Using an uncontrolled pre-post design, 29 out-patients of an endocrinology mental health clinic and two community-based rehabilitation mental health facilities used SMART for 12 weeks. The primary outcome was patient activation, measured using the Patient Activation Measure. Secondary outcomes were combined objective cardiometabolic and self-reported health and mental health indicators. Pre-post changes were analysed with a linear mixed model, accounting for within-participant variation. RESULTS: < 0.05) were detected in patient activation, confidence in diabetes self-management and general health management, health literacy and mental health recovery. High levels of acceptability and feasibility were confirmed, with recruitment, retention and adherence rates of 67.4, 92.9 and 93.0%, respectively. CONCLUSIONS: SMART is a world-first digital intervention aimed at improving metabolic health in individuals with SSD. This study provides evidence of its preliminary efficacy in self-management of metabolic health while confirming its high acceptability and feasibility, supporting expansion towards a sufficiently powered controlled trial to assess its clinical effectiveness.