Table 1:

Studies using digital technology to manage SMDs in LMICs

Authors	Country	Study Aim	Design	Participants	Findings
Chen et al (2007)[29]	China	Comparative study of relapse prevention in schizophrenia by network	Randomized control trial with one year follow up. Online psychoeducation for relapse prevention combined with drug treatment for non-acute schizophrenia; compared with general rehabilitation control group	71 patients with schizophrenia	Intervention group showed a significant decrease in positive and negative symptoms and relapse incidence compared with control group (p<0.01) Intervention group had better medication adherence and social function than the control group (p<0.01).
Fang et al. (2011)[28]	China	Effects of daily short message reminder for preventing schizophrenia recrudescence	Randomized control trial with a two year follow up. Mobile SMS text-messages sent daily as reminders for medication adherence combined with antipsychotic treatment and telephone follow-up; compared with control group with antipsychotic treatment and telephone follow-up only	91 patients with clinically stable schizophrenia	At two-year follow-up, relapse rates were 36% in the intervention group compared with 61% in the control group (p=0.03). Daily SMS text-message reminders appear effective for reducing relapse in schizophrenia.
Maiga et al (2011)[25]	Niger	Impact of mobile technology on follow up visit attendance among patients with psychosis	Randomized control trial with a two year follow up. Reminder SMS text-messages and phone calls two days before monthly follow-up appointments; compared with control without appointment reminders	100 participants with psychosis	The intervention group attended significantly more monthly follow-up visits than the control group (p<0.05)
Ozkan et al.[30] (2013)	Turkey	Effect of psychoeducation and telepsychiatric follow up given to the caregiver of the schizophrenic patient on family burden, depression and expression of emotion	Randomized-controlled experimental study	62 participants with schizophrenia and their caregivers assigned to experiment (n=32) and control (n=30) groups	Mean scores of caregivers in the experiment group with regards to family burden, emotional expression and depression decreased after education and after telephone follow-up. The difference was significant (p<0.001).
Sibeko et al.[26] (2017)	South Africa	Improving adherence in mental health service users with severe mental illness in South Africa	A pilot randomized controlled trial of a treatment partner and text message intervention vs treatment as usual (TAU). Intervention pairs underwent treatment-partner contracting, psychoeducation and received monthly text message reminders of clinic appointments.	77 participants were recruited from a psychiatric hospital in Cape Town. 42 randomized to receive the intervention and 35 to TAU.	Formative work by the researchers found support for text message reminders. Yet, during the trial, a range of challenges were encountered Both participants and fieldworkers reported loss of handsets and fieldworkers faced software-related challenges. The text message component was deemed acceptable but not feasible in its current form. Factoring in contextual socio-economic factors and minimizing the complexity of software used is key to boosting the utility of text message prompts in this setting.
Thomas et al.[24] (2017)	Nigeria	Effect of short message service reminders on clinic attendance among outpatients with psychosis at a psychiatric hospital in Nigeria	Patients seeking treatment for a psychotic episode for the first time were randomly assigned to a control group or intervention group. Both groups received appointment dates on appointment cards, and the intervention group also received SMS text reminders of their appointments.	A total of 192 patients were included in a per-protocol analysis	Participants who received the SMS reminders were almost twice as likely to attend their appointment compared with the control group. The analysis showed that receiving an SMS reminder independently reduced the risk of a missed next appointment by 50%.
Xu et al.[27] (2019)	China	Lay health supporters aided by mobile text messaging to improve adherence, symptoms, and functioning among schizophrenia patients in a resource-poor community in rural China (LEAN)	The control group received a free antipsychotic medication under the public ‘686 Program’ (also known as the National Continuing Management and Intervention Program for Psychoses), while the intervention group received the 686 Program plus LEAN.	There were 278 participants in total and 271 out of 278 were successfully followed up for outcome assessment. All participants were community-dwelling villagers from 9 townships of Hunan, China.	Significant improvement in medication adherence (27% improvement in adherence in the intervention group) Substantial reduction in risk of relapse in the intervention group (21.7%) versus the control (34.7%) Substantial reduction in rehospitalization in the intervention group (7.3%) versus the control (20.5%) Texting effectively addressed the low adherence at marginal cost.