Background: Ecological momentary assessment (EMA) tools appear to be useful interventions for collecting real-time data on patients’ behavior and functioning. However, concerns have been voiced regarding the acceptability of EMA among patients with schizophrenia and the factors influencing EMA acceptability. Objective: The aim of this study was to investigate the acceptability of a passive smartphone-based EMA app, evidence-based behavior (eB2), among patients with schizophrenia spectrum disorders and the putative variables underlying their acceptance. Methods: The participants in this study were from an ongoing randomized controlled trial (RCT) of metacognitive training, consisting of outpatients with schizophrenia spectrum disorders (F20-29 of 10th revision of the International Statistical Classification of Diseases and Related Health Problems), aged 18-64 years, none of whom received any financial compensation. Those who consented to installation of the eB2 app (users) were compared with those who did not (nonusers) in sociodemographic, clinical, premorbid adjustment, neurocognitive, psychopathological, insight, and metacognitive variables. A multivariable binary logistic regression tested the influence of the above (independent) variables on “being user versus nonuser” (acceptability), which was the main outcome measure. Results: Out of the 77 RCT participants, 24 (31%) consented to installing eB2, which remained installed till the end of the study (median follow-up 14.50 weeks) in 14 participants (70%). Users were younger and had a higher education level, better premorbid adjustment, better executive function (according to the Trail Making Test), and higher cognitive insight levels (measured with the Beck Cognitive Insight Scale) than nonusers (univariate analyses) although only age (OR 0.93, 95% CI 0.86-0.99; P=.048) and early adolescence premorbid adjustment (OR 0.75, 95% CI 0.61-0.93; P=.01) survived the multivariable regression model, thus predicting eB2 acceptability. Conclusions: Acceptability of a passive smartphone-based EMA app among participants with schizophrenia spectrum disorders in this RCT where no participant received financial compensation was, as expected, relatively low, and linked with being young and good premorbid adjustment. Further research should examine how to increase EMA acceptability in patients with schizophrenia spectrum disorders, in particular, older participants and those with poor premorbid adjustment. Trial Registration: ClinicalTrials.gov NCT04104347; https://clinicaltrials.gov/ct2/show/NCT04104347

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中文翻译：

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精神分裂症患者通过基于智能手机的被动应用程序 (eB2) 使用生态瞬时评估：可接受性研究

背景：生态瞬时评估 (EMA) 工具似乎是收集患者行为和功能实时数据的有用干预措施。然而，人们对精神分裂症患者对 EMA 的可接受性以及影响 EMA 可接受性的因素表示担忧。目的：本研究的目的是调查基于被动智能手机的 EMA 应用程序、基于证据的行为 (eB2) 在精神分裂症谱系障碍患者中的​​可接受性以及他们接受的潜在变量。方法：本研究的参与者来自正在进行的元认知训练的随机对照试验 (RCT)，包括精神分裂症谱系障碍的门诊患者（国际疾病和相关健康问题统计分类第 10 版的 F20-29），年龄在 18-64 岁之间，均未获得任何经济补偿。同意安装 eB2 应用程序的人（用户）与不同意安装 eB2 应用程序的人（非用户）在社会人口学、临床、病前调整、神经认知、精神病理学、洞察力和元认知变量方面进行了比较。多变量二元逻辑回归测试了上述（独立）变量对“用户与非用户”（可接受性）的影响，这是主要的结果衡量标准。结果：在 77 名 RCT 参与者中，24 人 (31%) 同意安装 eB2，在 14 名参与者 (70%) 中一直安装到研究结束（中位随访 14.50 周）。用户更年轻，受教育程度更高，病前适应能力更好，执行功能更好（根据 Trail Making Test），尽管只有年龄（OR 0.93，95% CI 0.86-0.99；P=.048）和青春期早期病前调整（OR 0.75，95%），但认知洞察力水平（用贝克认知洞察量表测量）高于非使用者（单变量分析） CI 0.61-0.93；P=.01) 在多变量回归模型中幸存下来，从而预测 eB2 的可接受性。结论：在这项 RCT 中，没有参与者获得经济补偿的精神分裂症谱系障碍参与者对基于智能手机的被动 EMA 应用程序的可接受性相对较低，正如预期的那样，并且与年轻和良好的病前调整有关。进一步的研究应该检查如何提高精神分裂症谱系障碍患者的 EMA 可接受性，特别是老年参与者和病前调整较差的参与者。试验注册：ClinicalTrials.gov NCT04104347；

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