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Table 1 Routine care, timelines and corresponding study activities

From: 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

Stage in MHSU care MHSU care activity Corresponding research activity
Routine care Treatment as usual = routine care PLUS Intervention = treatment as usual PLUS
In pre-discharge ward The MHSU receives standard pre-discharge care. This includes
Clinical review
Finalizing of treatment plan
Psychosocial rehabilitation programmes
Individual and group psychoeducation
Discharge planning by the clinical team, encompassing identification of which CHC the MHSU will be discharged to and when, as well as arrangement of post-discharge psychosocial support for the MHSU
1. We obtained informed consent from eligible patients
2. We conducted recruitment activities including diagnostic and baseline measures as described in the text
3. We randomized recruited participants to receive either treatment as usual or the intervention
4. We informed participants which group they had been randomized to
5. Participants who had been randomized to receive the intervention selected a treatment partner as described in the text
6. These selected treatment partners were contacted telephonically, consented and a date was set for the psychoeducation and contracting session
7. The psychoeducation and contracting session was conducted at Valkenberg Hospital for the participant and treatment partner pair
On day of discharge The MHSU discharged from inpatient care with referral letter detailing course of admission, diagnosis, treatment plan, review CHC and date 8. Participants were enrolled onto the text message platform 9. The first text message was sent to the participant/ treatment partner pair containing details of first clinic appointment as per discharge treatment plan
10. Fieldworker handsets received updated participant review schedules
1 week before first clinic appointment No activity No activity 11. A text message reminder was sent to the participant/treatment partner pair containing same details as first message
At first clinic appointment The MHSU is reviewed by the mental health nurse or psychiatry registrar at the psychiatry clinic of CHC
Medication is renewed or modified
A follow up appointment is issued
The MHSU’s CHC clinical record clinical record updated to indicate
Attendance for review
Clinical status
Medication review and prescription
Next scheduled appointment date
The MHSU collects his or her medication and leaves the CHC
No additional activity 12. On arrival, mental health nurse checks the participant as present
13. The mental health nurse asks the participant how many days of medication have been missed since discharge from hospital and enters this information on the fieldworker handset
14. The mental health nurse enters the next scheduled clinic review appointment date onto the text message platform via the fieldworker handset
15. The participant/treatment partner pair immediately received a text message notification indicating the next appointment date with the name of the CHC as in the initial text message
After the first clinic appointment The MHSU is reviewed on the scheduled review date and the process described above at first clinic appointment is repeated for subsequent visits No additional activity 16. The participant/treatment partner pair receives a text message reminder of the next appointment date one week before that appointment
17. The process described at steps 12-16 above is repeated for three visits in total
3 months after discharge Routine clinical care is continued 18. All participants, accompanied by their caregivers for the TAU group or treatment partners for the intervention group, returned at 3 months after discharge for clinical and review and qualitative interviews as described in the text
9 months after discharge 19. Any readmissions were noted for all participants were noted via Clinicom