Background Digital health interventions (DHIs) may enable low cost, scalable improvements in the quality of care for adults with schizophrenia. Given the fast-growing number of studies using these tools, this review aimed to assess the efficacy and feasibility of randomized controlled trials (RCTs) of DHIs among people with schizophrenia, focusing on human support. Design A systematic search of PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Cochrane databases was conducted in January 2024 to identify relevant RCTs. Random effects meta-analyses were undertaken to evaluate the effects on psychosis symptoms, cognition, and other health-related outcomes. Results Twenty-six RCTs (n = 2481 participants) were included. Pooled recruitment and retention rates were 57.4% and 87.6%, respectively. DHIs showed no statistically significant effect sizes across all examined outcomes, including psychosis symptoms, depression, quality of life, global and social cognition, global and social functioning, and medication adherence. A third (34.6%) of DHIs were developed using co-design while the majority (70%) personalized the intervention to its users and 69.2% were deemed to be at high risk of bias. There were trends toward effects in favor of DHIs with human support for social cognition and quality of life. Conclusions DHIs are feasible for people with schizophrenia and potentially useful for improving health outcomes, particularly when including human support. More high-quality studies are required to examine the benefits of human support within DHIs. Future research should examine the feasibility of sustained adherence and benefits from digital interventions, possibly incorporating human interaction complemented with artificial intelligence, in real-world clinical settings.

中文翻译：

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用户自我主导和人类支持的数字健康干预措施对精神分裂症患者的功效：系统评价和荟萃分析


背景数字健康干预措施（DHI）可以以低成本、可扩展的方式改善成人精神分裂症患者的护理质量。鉴于使用这些工具的研究数量快速增长，本综述旨在评估精神分裂症患者 DHI 随机对照试验 (RCT) 的有效性和可行性，重点关注人类支持。设计 2024 年 1 月对 PubMed、Embase、PsycINFO、CINAHL、Web of Science 和 Cochrane 数据库进行了系统检索，以确定相关的 RCT。进行随机效应荟萃分析来评估对精神病症状、认知和其他健康相关结果的影响。结果 纳入 26 项随机对照试验（n = 2481 名受试者）。合并招聘率和保留率分别为 57.4% 和 87.6%。 DHI 对所有检查结果（包括精神病症状、抑郁、生活质量、整体和社会认知、整体和社会功能以及药物依从性）没有显示出统计学上显着的影响大小。三分之一 (34.6%) 的 DHI 是使用协同设计开发的，而大多数 (70%) 则针对用户进行个性化干预，其中 69.2% 被认为存在高偏倚风险。随着人类对社会认知和生活质量的支持，DHI 产生了有利于 DHI 的效果的趋势。结论 DHI 对于精神分裂症患者来说是可行的，并且可能有助于改善健康结果，特别是在包括人力支持时。需要更多高质量的研究来检验 DHI 中人类支持的好处。未来的研究应该探讨在现实世界的临床环境中持续坚持的可行性以及数字干预措施的益处，可能将人际互动与人工智能相结合。