Table 3 Emergent themes, sub-themes, and illustrative quotes from focus group discussions

1. Versatile functionality of the LSR and smartphone facilitated use

▪ Enhanced ability to contact and be contacted (by care providers and family/friends) was important

▪ “…good way for me to…keep in contact with [my]social worker so we could send…messages…in between appointments”

▪ Tracking and appointment reminders were valuable functions

▪ “…keeps me on track…to actually stay on my meds”

▪ Applications associated with the smartphone (e.g., music, internet browsing, social media), made it an appealing tool to integrate into daily life

▪ “Definitely I’ve been happier just because I can like actually listen to my music…and watch it…before I could only listen to it, now I can watch it”

2. Aspects of the technologies as barriers to use

▪ Lack of knowledge about technology and data plans prevented use

▪ “I just don’t understand plans, so I just don’t get it. Like the minutes and the data, I don’t get that”

▪ An onerous login process and the requirement to remember a password for the LSR was challenging

▪ “… it was…frustrating to have to…log in at every single point… and…wait for the loading process…”

▪ The LSR was too slow

▪ Prompts and reminders did not always occur as programmed

▪ “I find it sometimes hard to keep track of all the password (sic)I have now”

▪ Small font and button size on the smartphone was difficult to see/use

▪ “I put it in for a reminder and it emails at the beginning of the day. Well that doesn’t help remind…to take my bedtime meds”

▪ Smartphone battery life was insufficient

▪ “the text messages are a little too small”

▪ “the iPhone keyboard is terrible……a real deterrent to using the iPhone”

▪ “…the battery only lasted a couple hours”

3. Use of the MHEN technologies resulted in perceived positive outcomes

▪ Enhanced feelings of safety, security, independence, and confidence

▪ “I’ve added emergency contacts”

▪ “I feel more secure because it has all these records and all these things on it, and if I get too depressed I know I can grab my phone for help”

▪ Increased connection with family/friends and care providers

▪ Increased tracking of symptoms and moods

▪ “I’ve enjoyed the instant connection to people”

▪ Positive effects on mood

▪ “it’s very nice to go back and look at what you’ve written before and also sort of monitor your mood that way”

▪ Positive feelings towards the MHEN technologies increased over time

▪ “I’m more aware of how my moods are, since that I’ve been keeping track of it”

▪ “I find it really helpful and it is really good to have it in my hand because then I don’t have to go and log on the computer and wait for it to boot up”

4. Future enhancement of the LSR and intervention is recommended

▪ The appearance and functionality of the LSR should be improved

▪ “I would make it [look] less clinical”

▪ “could be nicer if gives forwarding messages to my email then I [would] get to see it directly”

▪ Alerts should be sent directly to the smartphone when messages or changes are made to the LSR

▪ “there’s so much on the SMART record that I don’t even know what to do with it”

▪ Additional training should be provided on the use of the LSR