Implementation strategies for digital relapse prevention in schizophrenia identified during a randomized controlled trial

Digital mental health technologies hold promise, yet their integration into routine care remains challenging. This study reports findings from an implementation workshop conducted midway through an ongoing multi-site randomized controlled trial (RCT) evaluating a smartphone-based relapse prevention app for patients with schizophrenia and schizoaffective disorder. Sixteen stakeholders, including developers, researchers, and clinicians, discussed experiences and barriers using a semi-structured agenda, incorporating prior feedback from three focus groups with people with lived experience, and analyzed the discussions using an adopted R(E)-AIM framework (Reach, Adoption, Implementation, and Maintenance). Findings highlight the need for structural, technical, and personnel adjustments to support sustainable implementation. Key recommendations include integrating digital tools into discharge planning, enhancing interdisciplinary collaboration, delegating digital responsibilities, and streamlining technical workflows to facilitate seamless adoption. These insights inform feasibility considerations and strategic requirements for digital interventions in severe mental illness, offering guidance for future RCTs and practice-oriented integration of digital therapeutics in psychiatric care.