Feasibility and acceptability of remotely accessed cognitive remediation for schizophrenia in public health settings. (July 2021)

• Record Type: Journal Article
• Authors: Medalia, Alice; Saperstein, Alice M.; Stefancic, Ana; Meyler, Shanique; Styke, Sarah; Qian, Min; Liu, Jun; Cabassa, Leopoldo J.
• Is Part Of: Psychiatry research. Volume 301(2021)
• Publication Date: 2021-07
• Subjects: Schizophrenia -- Cognitive remediation -- Telepsychiatry -- Mixed methods; Psychiatry -- Periodicals; Psychiatry -- periodicals; Psychiatrie -- Périodiques; 616.89
• DOI: 10.1016/j.psychres.2021.113956
• Languages: English
• ISSNs: 0165-1781

Abstract

Highlights: Public health (PH) settings may face challenges providing care remotely on web connected devices. This trial assessed the feasibility of remote cognitive remediation (CR) in a PH setting. Client access to and competency with devices were significant barriers to remotely delivered CR. Clinician support was considered integral to a positive experience with remote and in- person CR. The study highlights disparities in access to the technology needed to access CR remotely. Abstract: Cognitive remediation (CR) is an evidence-based therapy used to improve cognition in people with schizophrenia. However, it often requires multiple in-person clinic sessions per week, which can limit scalability. This mixed methods study considered the feasibility and acceptability of a hybrid approach, which allowed for half the sessions to be conducted remotely as homework, without the clinician present. Individuals with schizophrenia were randomized to either all in-clinic or hybrid conditions and completed questionnaires and individual interviews about their experience. CR clinicians provided feedback in complement. Because of limited access to technology, most Hybrid CR participants had to come to clinic to access computers and often sought clinician support to do their homework. Participants in the two conditions were equally satisfied per the Client Satisfaction Questionnaire, and the majority reported perceived benefit and enjoyment. Both CR participants and clinicians identified access to technology as a barrier to program feasibility, while availability of clinician support positively impacted acceptability. Suggestions to improve CR highlighted adopting a flexible approach to providing CR that accounts for participant access to technology, potential benefit from peer interaction, and need for clinician support.