Exploring user perspectives on SMART: qualitative study of novel digital intervention targeting metabolic care in schizophrenia and related disorders.

BACKGROUND: Effective implementation of novel digital technologies to improve health outcomes requires an in-depth understanding of end-users' perspectives and experiences. AIMS: We sought the perspectives of people with schizophrenia and schizophrenia-related disorders (SSD) on the acceptability of a novel short text message-delivered intervention targeting metabolic health, called Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART). METHOD: Twenty-nine participants with SSD and either at risk of type 2 diabetes (T2D) or with T2D, were recruited from 3 mental health sites in Brisbane, Australia. They were provided, for 12 weeks, with SMART text messages that embedded psychoeducation and behaviour change techniques to facilitate lifestyle behaviours crucial for metabolic health. Interviews explored participants' experiences of SMART, barriers to its use and suggestions for improvement. The qualitative data were collected by three mental health researchers and analysed using thematic analysis. RESULTS: Three themes were generated: acceptability and user experience, feasibility and implementation considerations, and mechanisms supporting change. SMART was found to be highly accessible and engaging, and participants reported positive lifestyle changes, including healthier eating, increased physical activity, weight loss and smoking cessation. The messages reinforced learning and supported participants' readiness for change. CONCLUSIONS: SMART is a world-first digital intervention aimed at improving metabolic health and diabetes self-management in individuals with SSD. High levels of acceptability of SMART highlight its strong potential as a digital innovation that can support its users in protecting their metabolic health while limiting the detrimental side effects of antipsychotic medications.