# Assessing Usage and Usability of a Narrative-Based Psychoeducational Digital Intervention to Improve Medication Adherence Among Individuals With Schizophrenia in a Stable Phase: Mixed Methods Study

## TL;DR

A digital psychoeducation app improved medication adherence and attitudes in people with schizophrenia, showing promise as a cost-effective rehabilitation tool.

## Contribution

The study introduces a culturally relevant, narrative-based digital intervention that shows improved medication adherence and user engagement in schizophrenia patients.

## Key findings

- The intervention group showed significantly higher medication adherence and more positive drug attitudes compared to controls.
- Qualitative feedback highlighted the app's cultural relevance and engagement, though some users faced challenges with pacing and feedback tone.
- Participants suggested personalization and reminders could improve future versions of the app.

## Abstract

Nonadherence to antipsychotic medication remains one of the most substantial challenges in the management of schizophrenia, contributing to relapse, rehospitalization, and functional decline. Although psychoeducational interventions are a key intervention for relapse prevention, traditional formats often lack interactivity and cultural resonance, thereby limiting engagement and sustained impact. Digital health innovations offer an opportunity to improve both treatment adherence and user experience, but evidence in schizophrenia populations remains limited.

This study aimed to evaluate the usage patterns, usability, and effectiveness of a narrative-based psychoeducational digital intervention designed to enhance medication adherence among individuals with schizophrenia in the maintenance phase. By employing a mixed methods design, the study integrated quantitative measures of adherence and functioning with qualitative insights into participants’ experiences and perceptions.

A 6-month parallel mixed methods randomized controlled trial was conducted in community mental health settings in Shanghai. Seventy individuals with schizophrenia in a stable phase were randomly assigned (1:1) to the intervention group, which received the digital narrative-based psychoeducation application (Healing Town) in addition to routine community care, or to the control group, which received routine community rehabilitation only. Quantitative evaluation focused on medication adherence, drug attitude, social functioning, and psychiatric symptoms. In parallel, qualitative data were collected through semistructured interviews with patients, caregivers, and clinicians to examine intervention usage, usability, engagement, and perceived impact.

Seventy participants (mean age 44.2, SD 8.057 y; 61% male) were enrolled, and 69 (98.6%) completed the 6-month trial, with one dropout during the intervention period. At 6 months, the intervention group showed significantly higher medication adherence (mean difference 1.27, 95% CI 0.30‐2.24; P=.02) and more positive drug attitudes (mean difference 3.41, 95% CI 1.18‐5.65; P=.002) compared with controls. Improvements in social functioning were significant within the intervention group (P=.03) but not between groups. No significant group differences were observed in psychiatric symptoms. Qualitative findings identified three overarching themes: (1) adherence and usability—patients reported enhanced treatment knowledge, confidence, and motivation, though some described challenges with feedback tone and pacing; (2) experiences and attitudes—users valued cultural relevance, immersive narratives, and gamified elements but noted occasional overstimulation; and (3) expectations and recommendations—participants expressed demand for personalized features, reminders, and dynamic content to sustain engagement.

This mixed methods study provides preliminary evidence that a narrative-based digital psychoeducational intervention may enhance medication adherence and attitudes toward medication among individuals with schizophrenia in the maintenance phase, while being perceived as engaging, usable, and culturally relevant. Furthermore, the qualitative findings suggest that supportive feedback, adaptive difficulty, and personalized features may enhance user motivation and optimize future scalability. Overall, this narrative-based digital psychoeducation represents a promising and potentially cost-effective approach to supporting community-based psychiatric rehabilitation, meriting further longitudinal and multisite investigation.