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BACKGROUND Mobile health (mHealth) technologies have been used extensively in psychosis research. In contrast, their integration into clinical care has been sparse, despite substantial increase in the availability of smartphone-based apps targeting mental health care. One potential reason is that few of these apps have been developed with input from stakeholders (e.g., clinicians), the primary users of data from such applications, making their integration into routine clinical care challenging. OBJECTIVE This qualitative study sought clinicians’ input to inform the adaptation of FREEDoM, an app-based mHealth intervention designed to enhance treatment of patients with first-episode psychosis (FEP). METHODS The FREEDoM app was developed to enhance the quality, quantity, and timeliness of clinical and functional data available to clinicians and patients in order to enhance their therapeutic relationship and increase shared decision-making. Following the app’s initial development, semi-structured qualitative interviews were conducted with 11 FEP treatment providers at three sites to elicit input on the app. We then conducted summary template and matrix analysis to systematically categorize suggested adaptations using dimension of the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) and documented the rationale for adopting/rejecting suggestions. RESULTS The clinicians provided 31 suggestions (18 adopted, 13 rejected). Suggestions to add/refine content were most common (e.g., adding questions within the app). Adaptations to context were most often related to plans for implementing the intervention, how reported data were displayed to clinicians, and with whom reports were shared. Reasons for suggestions primarily included factors related to clients’ health narratives/priorities (e.g., symptom’s functional impact vs. their frequency/severity), providers’ clinical judgment (e.g., need for clinically relevant information), and organizations’ mission/culture. Reasons for rejecting suggestions included need for resources beyond intervention scope, concerns regarding dilution of the intervention core components, and increasing patient burden. CONCLUSIONS This study describes the development of the FREEDoM app, an innovative stakeholder-informed intervention designed to enhance treatment for individuals with FEP. Our study illustrates a pragmatic application of the FRAME and provides methods and tools for rapid analysis to track adaptations and related decision-making processes, potentially contributing to its acceptance and use in clinical care. CLINICALTRIAL Trial registration: ClinicalTrials.gov #NCT04248517, registered Jan. 30, 2020 https://clinicaltrials.gov/ct2/show/NCT04248517?term=using+mhealth&draw=2&rank=4

Tobacco use is decreasing among the general population, but persistent use among individuals in treatment for first-episode psychosis (FEP) remains a problem. This study aimed to measure the prevalence and course of tobacco use and explore the associations between tobacco use and clinical outcomes in a FEP sample located in New York State (NYS).Participants (N = 870) were from the OnTrackNY system of coordinated specialty care clinics in NYS. Participant data were collected at admission to the program and at every 3 months of follow-up using standardized forms based on reports from clients, client families and chart review. Course of tobacco use was categorized into four groups: no-use, cessation, persistent and initiation over 1 year of follow-up.The prevalence of tobacco use was 12.8% at baseline and 19.9% at 1-year follow-up. Only 3.8% of tobacco users stopped by 1 year follow-up, and 4.9% initiated use. Urbanicity of clinic location (p .001); age at admission (p = .044); gender (p = .015); ethnoracial group (p = .007); baseline education/employment status (p = .004); and baseline use of any non-tobacco substances (p .001), including alcohol (p .001) and cannabis (p .001), were associated with tobacco course. Findings suggest an association between tobacco use and reduced improvement in symptoms.Despite a lower prevalence of tobacco use among OnTrack participants than in other comparable samples, tobacco cessation was minimal and more individuals initiated tobacco use than ceased over the course of follow-up. Efforts to implement tobacco cessation interventions in coordinated specialty care are warranted, since tobacco use is associated with poor health outcomes.