A Novel Digital Intervention to Facilitate Diabetes Self-Management Among People with Schizophrenia and Related Disorders: Development and Acceptability Testing of SMART

doi:10.2147/NDT.S513272

. 2025 Jun 26:21:1289-1305.

doi: 10.2147/NDT.S513272. eCollection 2025.

A Novel Digital Intervention to Facilitate Diabetes Self-Management Among People with Schizophrenia and Related Disorders: Development and Acceptability Testing of SMART

Urska Arnautovska^{1

2

3}, Gabrielle Ritchie^{1

2

3}, Rebecca Soole^{1

3}, Anish Menon^{1

4}, Nicole Korman², Alyssa Milton^{5

6}, Marlien Varnfield⁷, Jaimon T Kelly⁴, Pieter M Jansen⁸, Andrea Baker³, Derek Ireland⁷, Anthony W Russell^{4

9

10}, Justin Chapman², Kathleen Mulligan^{11

12}, Shashivadan P Hirani¹¹, Kathryn Jemimah Vitangcol¹, Gemma McKeon^{3

13

14}, Dan Siskind^{1

2

3}

Affiliations

¹ Faculty of Health, Medicine, and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia.
² Metro South Addiction and Mental Health Services, Queensland Health, Brisbane, Queensland, Australia.
³ Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
⁴ Centre for Online Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
⁵ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ ARC Centre of Excellence for Children and Families Over the Life Course, Indooroopilly, Queensland, Australia.
⁷ The Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia.
⁸ The Princess Alexandra Hospital, Department of Diabetes and Endocrinology, Brisbane, Queensland, Australia.
⁹ The Alfred Hospital, Melbourne, Victoria, Australia.
¹⁰ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ School of Health and Medical Sciences, Department of Health Services Research and Management, City St George's University of London, London, UK.
¹² East London NHS Foundation Trust, London, UK.
¹³ University of Queensland, Child Health Research Centre, Brisbane, Queensland, Australia.
¹⁴ West Moreton Health Psychology, Ipswich, Queensland, Australia.

PMID: 40589585
PMCID: PMC12208133
DOI: 10.2147/NDT.S513272

A Novel Digital Intervention to Facilitate Diabetes Self-Management Among People with Schizophrenia and Related Disorders: Development and Acceptability Testing of SMART

Urska Arnautovska et al. Neuropsychiatr Dis Treat. 2025.

. 2025 Jun 26:21:1289-1305.

doi: 10.2147/NDT.S513272. eCollection 2025.

Authors

Affiliations

¹ Faculty of Health, Medicine, and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia.
² Metro South Addiction and Mental Health Services, Queensland Health, Brisbane, Queensland, Australia.
³ Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
⁴ Centre for Online Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
⁵ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
⁶ ARC Centre of Excellence for Children and Families Over the Life Course, Indooroopilly, Queensland, Australia.
⁷ The Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Brisbane, Queensland, Australia.
⁸ The Princess Alexandra Hospital, Department of Diabetes and Endocrinology, Brisbane, Queensland, Australia.
⁹ The Alfred Hospital, Melbourne, Victoria, Australia.
¹⁰ School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
¹¹ School of Health and Medical Sciences, Department of Health Services Research and Management, City St George's University of London, London, UK.
¹² East London NHS Foundation Trust, London, UK.
¹³ University of Queensland, Child Health Research Centre, Brisbane, Queensland, Australia.
¹⁴ West Moreton Health Psychology, Ipswich, Queensland, Australia.

PMID: 40589585
PMCID: PMC12208133
DOI: 10.2147/NDT.S513272

Abstract

Introduction: Compared with the general population, people with schizophrenia and schizophrenia-related disorders (SSD) have a higher prevalence of type 2 diabetes (T2D) and T2D risk factors such as poor diet and sedentary lifestyle. Antipsychotic drugs significantly contribute to this risk through metabolic adverse effects, including weight gain and insulin resistance. Prevention and self-management of T2D is challenging in this population due to inherent motivational and cognitive challenges associated with schizophrenia. The objective of this study was to describe the co-design and test the feasibility, acceptability, and usability of a novel digital health intervention, Schizophrenia and diabetes Mobile-Assisted Remote Trainer (SMART), for prevention and self-management of T2D in people with SSD.

Methods: SMART was developed through an iterative process including review of relevant literature (eg, disease-specific guidelines), stakeholder involvement, and user testing. A pre-post mixed-methods design was used to assess the acceptability and feasibility of SMART over 4 weeks among five outpatients with schizophrenia/schizoaffective disorder and pre-diabetes/T2D.

Results: The co-design process resulted in a digital intervention, which consisted of personalised, interactive text messages, providing psychoeducation and strengthening motivation for self-care behaviours that promote effective diabetes self-management (ie, nutrition, physical activity, weight management, and stress coping). The pilot study demonstrated good acceptability of SMART (response rates 75-95%). Trends towards improved clinical outcomes were observed in well-being, depression, anxiety, and mental health recovery. Barriers to usability included lack of mobile/internet data, precluding the ability to reply to text messages, and a preference for more hyperlinks and additional interactive features.

Conclusion: The comprehensive co-design process resulted in the development of a novel digital intervention for prevention and self-management of T2D tailored to unique needs and preferences of people with SSD. The pilot study findings indicate that SMART is acceptable and potentially usable for this population. Results will inform further adaptation and a future feasibility study to examine preliminary effectiveness of SMART.

Keywords: SMS; diabetes; eHealth; mHealth; mental health interventions; metabolic syndrome; mobile phone; psychosis; self-management.

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Conflict of interest statement

The authors have no conflicts of interest to declare in this work.

Figures

**Figure 1**
Stages of SMART Development and pilot testing.

**Figure 2**
An example of a text message with a reply option “No” and an automatic response of the SMART intervention.

**Figure 3**
SMART Pilot stages of change (n = 5).

See this image and copyright information in PMC

References

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[1] Ward M, Druss B. The epidemiology of diabetes in psychotic disorders. Lancet Psychiatry. 2015;2(5):431–451. doi: 10.1016/S2215-0366(15)00007-3 - DOI - PubMed

[2] Ward M, Druss B. The epidemiology of diabetes in psychotic disorders. Lancet Psychiatry. 2015;2(5):431–451. doi: 10.1016/S2215-0366(15)00007-3 - DOI - PubMed

[3] Afzal M, Siddiqi N, Ahmad B, et al. Prevalence of overweight and obesity in people with severe mental illness: systematic review and meta-analysis. Front Endocrinol. 2021;12:769309. - PMC - PubMed

[4] Afzal M, Siddiqi N, Ahmad B, et al. Prevalence of overweight and obesity in people with severe mental illness: systematic review and meta-analysis. Front Endocrinol. 2021;12:769309. - PMC - PubMed

[5] Vancampfort D, Firth J, Schuch FB, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta‐analysis. World Psychiatry. 2017;16(3):308–315. doi: 10.1002/wps.20458 - DOI - PMC - PubMed

[6] Vancampfort D, Firth J, Schuch FB, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta‐analysis. World Psychiatry. 2017;16(3):308–315. doi: 10.1002/wps.20458 - DOI - PMC - PubMed

[7] Pendlebury J, Holt R. Managing diabetes in people with severe mental illness. J Diabet Nurs. 2010;14:328–339.

[8] Pendlebury J, Holt R. Managing diabetes in people with severe mental illness. J Diabet Nurs. 2010;14:328–339.

[9] Firth J, Siddiqi N, Koyanagi A, et al. The lancet psychiatry commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry. 2019;6(8):675–712. doi: 10.1016/S2215-0366(19)30132-4 - DOI - PubMed

[10] Firth J, Siddiqi N, Koyanagi A, et al. The lancet psychiatry commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry. 2019;6(8):675–712. doi: 10.1016/S2215-0366(19)30132-4 - DOI - PubMed

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A Novel Digital Intervention to Facilitate Diabetes Self-Management Among People with Schizophrenia and Related Disorders: Development and Acceptability Testing of SMART

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A Novel Digital Intervention to Facilitate Diabetes Self-Management Among People with Schizophrenia and Related Disorders: Development and Acceptability Testing of SMART

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Abstract

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