Examining a Digital Health Approach for Advancing Schizophrenia Illness Self-management and Provider Engagement

Number of individuals successfully recruited into the trial with a target of 91.

Number of participants retained in the study through to post-intervention evaluation. The target is retaining 85% of participants recruited.

Number of interactions with the app will be collected including information on the combined time and frequency of use for each participant.

Safety/tolerability will be assessed through information gathered via all study-related interactions with significant safety concerns operationalized as one or more critical incidents occurring in which there is evidence of an association between the incident and App use.

Total number of posts liked for each participant will be collected.

General symptomatology will be assessed using the 53-item, 5-point likert scale Brief Symptom Inventory. Range 0-212. Lower values are better.

Medication adherence will be measured using the 4-item Brief Adherence Rating Scale with responses obtained by both providers and participants to assess medication adherence. There are two indicators, both are pre-post changes, "days not taken" and "days taken less", and both are not scored as a percentage.

The change scores for taking medication less (days taken less) and medication not taken (days not taken) were calculated as the difference from their 6 month score minus their baseline score. An value of "better" was assigned when the change score is > 0, value of "no change" was assigned when the change score is = 0, and a value of "worse" value was assigned when the change score is < 0.

Provider-Patient Clinical Alliance will be assessed with Scale to Assess the Therapeutic Relationship - Patient to measure patient perspective of provider-patient relationship. This 12-item measure employing a 5-point likert scale has been used extensively in studies of outpatient care for severe mental illness. This measure supports patient and provider versions. Higher values are better. Range 0-48.

The Heinrichs-Carpenter Quality of Life Scale, has 21 items, is well validated for schizophrenia, and captures sense of purpose, motivation, emotional and social interaction, role functioning, and engagement in regular activities. Higher values are better. Range 0-126.

Pre-post change scores were calculated by subtracting the pre-score from the post score (= post - pre).

Schizophrenia-specific symptomatology will be assessed with the Positive and Negative Syndrome Scale. Lower values are better. Range 30-210.

Pre-post change scores were calculated by subtracting the pre-score from the post score (= post - pre).

Global Appraisal of Individual Needs- Short Screener (GAIN-SS) - Instrument used for screening possible internalizing or externalizing psychiatric disorders, substance use disorders, or crime and violence problems. Lower values are better. Range 0-20.

Pre-post change scores were calculated by subtracting the pre-score from the post score (= post - pre).

The 5-item, 6-point likert scale Medical Outcomes Study general adherence scale to capture broader adherence to treatment recommendations (again triangulated with provider responses). Higher values are better. Range 5-26.

Pre-post change scores were calculated by subtracting the pre-score from the post score (= post - pre).

The average rate of scheduled appointments attended through EMR audit at CAMH or provider report at non-CAMH sites. No show vs. attending rates for both arms do not add up to 100% since an additional measure of cancelled rates was measured in the RCT. However, this variable was excluded from analysis since in the client's medical records it is unclear whether the clinician or client cancelled the appointment.

Provider-Patient Clinical Alliance will be assessed with Scale to Assess the Therapeutic Relationship - Patient to measure patient perspective of provider-patient relationship. This 12-item measure employing a 5-point likert scale has been used extensively in studies of outpatient care for severe mental illness. This measure supports patient and provider versions. Higher values are better. Range 0-48.

Pre-post change scores were calculated by subtracting the pre-score from the post score (= post - pre).

Service Use History measure to assess past month service use history. Number of visits due to physical health issues (in the past 6 months) included the sum of: family doctor, ER, walk-in clinic, and other services Number of visits due to mental health issues (in the past 6 months) included the sum of: sum of family doctor, outpatient, psychologist, social worker, community service There is no limit on the scale range since it is based on the number of visits to various services in the past 6 months.

Service Use History measure to assess past month service use history of patient participant.

Number of visits due to physical health issues (in the past 6 months) included the sum of: family doctor, ER, walk-in clinic, and other services for the patient participant Number of visits due to mental health issues (in the past 6 months) included the sum of: sum of family doctor, outpatient, psychologist, social worker, community service for the patient participant There is no limit on the scale range since it is based on the number of visits to various services in the past 6 months.