Original ArticlesDeveloping Texting for Relapse Prevention: A Scalable mHealth Program for People With Schizophrenia and Schizoaffective DisorderYbarra, Michele L. MPH, PhD∗; Rodriguez, Katrina MA†; Madison, Hannah BA∗; Mojtabai, Ramin MD†; Cullen, Bernadette A. MB BCh‡ Author Information ∗Center for Innovative Public Health Research, San Clemente, California †Department of Mental Health, Johns Hopkins Bloomberg School of Public Health ‡Department of Psychiatry and Behavioral Sciences Johns Hopkins Hospital, Baltimore, Maryland. Send reprint requests to Michele L. Ybarra, MPH, PhD, Center for Innovative Public Health Research, 555 N El Camino Real #A347, San Clemente, CA. E-mail: [email protected]. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonmd.com). The Journal of Nervous and Mental Disease: October 2019 - Volume 207 - Issue 10 - p 854-862 doi: 10.1097/NMD.0000000000001037 Buy SDC Metrics Abstract Symptom relapse in people with schizophrenia and schizoaffective disorder is common and has a negative impact on the course of illness. Here, we describe the development of Texting for Relapse Prevention, a scalable, cost-effective text messaging relapse prevention program that queries patients' “early warning signs” daily. Results of development focus groups and content advisory teams with 25 patients and 19 providers suggest that patients were enthusiastic about the program and thought that receiving daily messages about their symptoms would help them feel supported. Providers also were positive about the idea but worried that the program might interfere with patient-provider communication if patients thought that the messages were coming from providers. Patients found the content positive and actionable. The program was improved to address this feedback. This iterative development process that included multiple stakeholders ensured that the program is feasible and acceptable to both patients and providers. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.