In response to the COVID-19 public health crisis in 2020, PCORI launched an initiative to enhance existing research projects so that they could offer findings related to COVID-19. The initiative funded this study and others.
People with serious mental illnesses (SMI), including schizophrenia, bipolar disorder, and depression, often have multiple health problems that place them at a disproportionate risk for COVID-19 infection. Other circumstances, such as being homeless or staying in group homes, may also increase the risk of infection and negatively affect access to care. Education on COVID-19 prevention could help reduce the risk of infection among this population.
To evaluate the effectiveness of an educational and skills training intervention for people with SMI in increasing knowledge of COVID-19 prevention, symptoms, and transmission and behaviors to prevent COVID-19
|Randomized study embedded in an ongoing RCT comparing two programs to help people with SMI manage comorbid health problems such as heart disease or diabetes
|162 adults ages 18 and older with SMI receiving care from community mental health centers in Tennessee and Kentucky
Primary: knowledge of COVID-19 prevention, symptoms, and transmission and how to respond to COVID-19; attitudes about COVID-19-related prevention behaviors; COVID-19-related behaviors to prevent contracting and spreading COVID-19, such as handwashing, physical distancing, and masking
Secondary: use of healthcare services for COVID-19-related concerns, loneliness and social connectedness, COVID-19 vaccination rates
|Data Collection Timeframe
|November 2020–April 2022
This study, embedded in an ongoing randomized controlled trial (RCT), evaluated an intervention to increase knowledge about COVID-19 prevention, symptoms, and transmission and behaviors related to COVID-19 prevention for people with SMI. The ongoing RCT is comparing two programs to help people with SMI manage physical health problems: the Chronic Disease Self-Management Program (CDSMP) and the Integrated Illness Management and Recovery (IIMR) program.
Participants randomly assigned to the IIMR program received the COVID-19 intervention while those assigned to the CDSMP program did not. The COVID-19 intervention included three 60-minute, individual telehealth sessions on Zoom with a trained clinical staff member over three to six weeks at the end of the IIMR program. The sessions provided education and skills training about COVID-19 transmission, prevention, and symptoms; coping skills; and social connectedness. If participants did not own a smartphone that could reliably run Zoom, researchers provided one. Before the sessions, participants received handouts about COVID-19. Participants in the CDSMP program had telehealth sessions focused on usual care.
The study included 162 adults with SMI receiving care from community mental health centers in Tennessee and Kentucky. Of these adults, 54% were White, 35% were Black or African American, 1% were American Indian or Alaska Native, and 9% were more than one race; 4% were Hispanic. The average age was 49, and 70% were female.
At baseline and 6 and 12 weeks later, participants completed surveys about knowledge, use of safety measures, and secondary outcomes.
Adults with SMI, family members of adults with SMI, and clinicians provided input throughout the study.
After 12 weeks, compared with participants who did not receive the COVID-19 intervention, participants who received it had improved knowledge of how to respond to symptoms (p<0.01). Patients who did and did not receive the COVID-19 intervention did not differ significantly in COVID-19 prevention knowledge, knowledge of symptoms or transmission, attitudes about COVID-19-related behaviors, COVID-19 prevention behaviors, use of healthcare services, social connectedness and loneliness, or COVID-19 vaccination rates.
Recommendations about COVID-19-related prevention behaviors evolved throughout the pandemic by location and in response to surges and variants. For example, vaccination rates varied by state. Kentucky had a larger increase in vaccination rates in the intervention group than Tennessee, which may have affected the results.
Conclusions and Relevance
In this study, compared with participants who did not receive the training intervention, participants who received it knew more about how to respond to COVID-19 symptoms