Abstract
BackgroundIndividuals experiencing psychosis are at a disproportionate risk for premature disengagement from clinical treatment. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services. Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. However, little is known about the efficacy of SMS text messaging in psychosis.ObjectiveThis review aimed to address this gap, providing insights into the relationship between SMS text messaging and clinical engagement in the treatment of psychosis.MethodsStudies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Included studies were published from the year 2000 onward in the English language, with no methodological restrictions, and were identified using 3 core databases and gray literature sources.ResultsOf the 233 studies extracted, 15 were eligible for inclusion. Most studies demonstrated the positive effects of SMS text messaging on dimensions of engagement such as medication adherence, clinic attendance, and therapeutic alliance. Studies examining the feasibility of SMS text messaging interventions found that they are safe, easy to use, and positively received.ConclusionsOverall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, although efficacy may vary by symptomology and personal characteristics. Cost-effectiveness and safety considerations were not adequately examined in the studies included. Future studies should consider personalizing SMS text messaging interventions and include cost and safety analyses to appraise readiness for implementation.
Highlights
Psychosis and EngagementThe major psychoses are recognized as a leading cause of disability worldwide [1] and are associated with poverty [2], premature mortality [3], impaired cognitive function [4], loss of education and employment [5], and increased global economic burden [6]
This review focused on treatment-seeking individuals with psychosis to isolate the effect of SMS text messaging on clinical engagement
Search terms and keywords related to psychosis and SMS text messaging that were used to search gray literature included the following: (1) SMS OR Short Message Service OR SMS-Survey OR Texting OR Text Message OR SMS Based System OR SMS Reminder OR Text Message Reminder and (2) Psychosis OR Schizophrenia OR Bipolar OR Schizoaffective OR Schizophrenia Spectrum OR
Summary
Psychosis and EngagementThe major psychoses (ie, schizophrenia spectrum and bipolar I disorder) are recognized as a leading cause of disability worldwide [1] and are associated with poverty [2], premature mortality [3], impaired cognitive function [4], loss of education and employment [5], and increased global economic burden [6]. Barriers to clinical engagement typically result from funding constraints causing limited access to and flexibility in services Digital strategies, such as SMS text messaging, offer a low-cost alternative to potentially improve engagement. Methods: Studies examining SMS text messaging as an engagement strategy in the treatment of psychosis were reviewed. Conclusions: Overall, SMS text messaging is a low-cost, practical method of improving engagement in the treatment of psychosis, efficacy may vary by symptomology and personal characteristics. Cycles of relapse and rehospitalization create a unique conundrum for this population as evidence suggests that with each period of disengagement and relapse, positive symptoms become more severe and more difficult to treat [19] This group is less likely to fully recover or hold employment [18]. As such, understanding and improving engagement in this population is a priority
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