Kathlene Smith

Telenursing intervention increases psychiatric medication adherence in schizophrenia outpatients.

BACKGROUND: Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors. OBJECTIVES: This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems. STUDY DESIGN : The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months. STUDY RESULTS : Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298. CONCLUSIONS: Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk. J Am Psychiatr Nurses Assoc, 2008; 14(3), 217–224. DOI: 10.1177/1078390308318750

Feasibility of the Walk, Address, Learn and Cue (WALC) Intervention for Schizophrenia Spectrum Disorders

The WALC intervention was designed to motivate exercise in the elderly. Persons with schizophrenia spectrum disorders (SSDs) face similar exercise barriers. We described theoritical underpinnings of the WALC intervention and how we adapted it for SSDs. We conducted a feasibility study of the adapted intervention in 17 persons with SSDs. The adapted intervention incorporated low intensity stretches, exercise education and exercise cues. The intervention was feasible and acceptable to participants; approximately two-thirds of all groups were attended and nearly half of participants attended at least 75% of groups. Follow up studies should examine the effect of the intervention upon future exercise behavior, with the goal of identifying evidence based interventions to increase exercise in this group.

A Pilot Study Describing Physical Activity in Persons with Schizophrenia Spectrum Disorders (SSDS) after an Exercise Program

Despite the well known mental and physical health benefits of exercise, persons with schizophrenia spectrum disorders remain sedentary. While the exercise barriers (i.e., lack of motivation, poor concentration, sedative effects of medication, poverty, and lack of access to exercise education/programs) of persons with SSDs are numerous, lack of motivation is considered foremost among them. Exercise interventions have been shown to improve exercise behavior, but there is a need for longitudinal documentation of physical activity after interventions conclude. This pilot study describes the physical activity level of 22 persons with SSDs 14 to 34 (mean 22) months after the conclusion of an exercise intervention provided in a randomized controlled trial (RCT). Eighteen months after the RCT, 22 participants wore pedometers daily for one week without altering their activity. Experimental participants walked more steps and covered more distance on average than control participants on six of the seven days. This pilot study is among the first to document the physical activity level of persons with SSDs after exercise intervention. While our findings confirm the low activity level of persons with SSDs reported by others, experimental participants demonstrated higher activity levels than controls on most days. Future studies should increase the sample size and recruit participants from multiple sites to enhance power and generalizability.

Effect of a Motivational Group Intervention on Exercise Self-Efficacy and Outcome Expectations for Exercise in Schizophrenia Spectrum Disorders

BACKGROUND Persons with schizophrenia spectrum disorders (SSDs) contend with multiple barriers to exercise. Interventions are needed to enhance attitudes theoretically linked to exercise behavior. OBJECTIVE To examine the effect of Walk, Address Sensations, Learn About Exercise, Cue Exercise for SSDs (WALC-S) intervention on exercise self-efficacy (SEE) and outcome expectations (OEES) in 97 outpatients with SSDs. DESIGN Experimental, pre- and posttest. Randomization to experimental (WALC-S) or time-and-attention control (TAC) after baseline SEE and OEES measures. Measures repeated after WALC-S or TAC. RESULTS N = 97, 46% female, 43% African American, average age 46.9 years (SD = 2.0). Mean SEE scores were significantly higher in WALC-S participants after intervention, F(1, 95) = 5.92, p = .0168, however, mean OEES scores were significantly higher in control participants after intervention, F(1, 95) = 5.76, p = .0183. CONCLUSION This is the first study to examine SEE and OEES in SSDs. Interventions to enhance exercise attitudes are a critical first step toward the ultimate goal of increasing exercise participation.BACKGROUND: Persons with schizophrenia spectrum disorders (SSDs) contend with multiple barriers to exercise. Interventions are needed to enhance attitudes theoretically linked to exercise behavior. OBJECTIVE: To examine the effect of Walk, Address Sensations, Learn About Exercise, Cue Exercise for SSDs (WALC-S) intervention on exercise self-efficacy (SEE) and outcome expectations (OEES) in 97 outpatients with SSDs. DESIGN: Experimental, pre- and posttest. Randomization to experimental (WALC-S) or time-and-attention control (TAC) after baseline SEE and OEES measures. Measures repeated after WALC-S or TAC. RESULTS: N = 97, 46% female, 43% African American, average age 46.9 years (SD = 2.0). Mean SEE scores were significantly higher in WALC-S participants after intervention, F(1, 95) = 5.92, p = .0168, however, mean OEES scores were significantly higher in control participants after intervention, F(1, 95) = 5.76, p = .0183. CONCLUSION: This is the first study to examine SEE and OEES in SSDs. Interventions to enhance exercise attitudes are a critical first step toward the ultimate goal of increasing exercise participation.

Motivating Persons with Schizophrenia Spectrum Disorders to Exercise: Rationale and Design.

Persons with schizophrenia spectrum disorders (SSDs) are not only at risk because of disabling disease symptoms but because necessary medications create health risks associated with high rates of obesity. Despite the well-known benefits of exercise, persons with SSDs rarely adhere to such regimens; few interventions to motivate exercise behavior have been tested in this group.The purpose of this study is to examine effects of the Walk, Address sensations, Learn about exercise, Cue exercise behavior for persons with SSDs (WALC-S) motivational intervention upon exercise behavior. We will recruit a total of eighty outpatients 18-68 years, meeting these criteria: 1) chart diagnosis of schizophrenia, any subtype, schizoaffective disorder or schizophreniform disorder, according to the criteria described in the Diagnostic and Statistical Manual for Mental Disorders, 2) English speaking, 3) Stable medication regimen (defined as no medication changes within the last month), and 4) medical clearance for moderate exercise in writing from primary care provider. Participants will be randomly assigned to the experimental (4-week WALC-S motivational intervention), or the control group (4-week time and attention control). After the first 4 weeks, all participants will attend a 16-week walking group.The primary measures of the effectiveness of the WALC-S are attendance, persistence and compliance to the 16-week walking group. The study will be completed in approximately January 2010. In addition to hypothesis testing, this study will provide information to estimate effect sizes to calculate power and determine appropriate sample sizes for future inquiries. This paper describes the rationale and design of the study.

Keeping in Touch: Cell Phone Use in People with Schizophrenia Spectrum Disorders

There is limited research exploring telephone intervention for psychiatric clients; no studies specific to cell phone use have been conducted. This pilot study examined the feasibility and acceptability of cell phone use in individuals with schizophrenia spectrum disorders (SSDs). Ten outpatients with SSDs were provided with previously activated cell phones for 5 months; trained nurses contacted participants weekly. Seven participants completed the 5-month follow-up period. A minority of participants reported difficulty retrieving messages and answering or charging their phone. These preliminary findings indicate the majority of individuals with SSDs are willing to use this method of communication and are able to do so with few problems. Possible barriers to the use of cell phones with this group include lifestyle factors and poor decision making. Future investigations should examine the use of cell phone access to foster personal safety, gain a sense of connectedness to others, and enhance quality of life.

A Comparison of Telephone and Texting Interventions for Persons with Schizophrenia Spectrum Disorders

Problem-solving interventions are not routinely offered to persons with schizophrenia spectrum disorders (SSDs). Telephone calls and text messages are potential avenues to offer problem solving support. This study compared the effect of telephone calls only, text messages only, and both telephone calls and text messages on individuals’ symptoms and medication adherence. Thirty outpatient participants with SSDs were randomly assigned to weekly telephone calls, daily text messages, or both for three months. Participants received monthly in-home pill counts and symptom assessments. Repeated measures ANOVA was significant (F (4,26) = 4.2, p = 0.005) for symptom scores. Further work with larger, more diverse, samples is needed.

Informed consent to research in persons with schizophrenia spectrum disorders

This manuscript describes the responses and correlates of outpatients with schizophrenia spectrum disorders to a tool designed to measure comprehension before obtaining informed consent for research participation. We used the Evaluation to Sign Consent form to document comprehension in 100 outpatients as part of their consent to participate in an ongoing study of an exercise intervention. The findings suggest that using this form is a feasible and acceptable approach to documenting comprehension of research procedures prior to obtaining informed consent. Age 49 years and older and the receipt of intramuscular antipsychotic medication predicted the need for additional assistance to complete the Evaluation to Sign Consent form successfully (χ2 = 8.29, P = 0.016). Nurse researchers should consider documenting comprehension with this tool owing to its availability, time efficiency and utility.

Examining Informed Consent in Persons with Schizophrenia

This descriptive study examined the responses of outpatients with schizophrenia to a tool designed to measure comprehension before obtaining informed consent to participate in a research study. We used the Evaluation to Sign Consent (ESC) form to document comprehension in 29 schizophrenia outpatients. Participants living in supervised housing were significantly more likely to require prompts than those living alone (χ2 = 9.4, p = 0.024). Participants prescribed two antipsychotic medications were significantly more likely to require a prompt than those prescribed only one antipsychotic (χ2 = 5.12, p = 0.023). Nurse researchers should consider documenting comprehension with the ESC due to its availability, time efficiency, and utility.

Effect of a Telephone Intervention Upon Self-Reported Medication Adherence and Self-Efficacy in Outpatients With Schizophrenia Spectrum Disorders (SSDs).

We conducted a randomized controlled trial to determine the effect of weekly telephone intervention upon self-reported medication adherence, medication adherence self efficacy, and symptom levels in 140 stable outpatients with SSDs for three months. To our knowledge, this is the first study examining medication adherence self efficacy in persons with SSDs. Study measures were administered in a private office by trained study staff immediately following the granting of informed consent, and again after three months. Participants ranged in age from 19–71 years with an average age of 46.1 years (SD 12.9). A majority were males (n = 80, 57.1%) with schizoaffective disorder (n = 94, 67.1%). Symptoms were lower and self-reported medication adherence was higher in experimental participant after three months, but differences were not statistically significant. Medication adherence self efficacy was essentially unchanged over the three month follow up period. This study extends the literature on adherence in SSDs by describing a clinic-based sample of stable outpatients, and is the first investigation to measure medication adherence self efficacy in this group. Our next project will examine the effectiveness of TIPS upon objectively measured medication adherence in this group over 6 months of follow up.