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Kabukye JK, Namagembe R, Nakku J, Kiberu V, Sjölinder M, Nilsson S, Wamala-Larsson C. Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach. JMIR Hum Factors 2024; 11:e53976. [PMID: 38843515 PMCID: PMC11190627 DOI: 10.2196/53976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/01/2024] [Accepted: 05/01/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. OBJECTIVE This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. METHODS This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. RESULTS Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. CONCLUSIONS This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption.
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Affiliation(s)
- Johnblack K Kabukye
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
- Uganda Cancer Institute, Kampala, Uganda
| | - Rosemary Namagembe
- Hutchinson Centre Research Institute of Uganda, Uganda Cancer Institute, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral and Teaching Mental Hospital, Kampala, Uganda
| | - Vincent Kiberu
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Susanne Nilsson
- Unit for Integrated Product Development and Design, Department of Machine Design, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Caroline Wamala-Larsson
- SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
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Flower KB, Gutierrez-Wu JC, McBride JP, Sylvester F, Díaz-González de Ferris ME. Spanish-Speaking Parents' Experiences Accessing Care: Evolving Challenges and Promising Approaches. Acad Pediatr 2024; 24:391-393. [PMID: 38253176 DOI: 10.1016/j.acap.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/22/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC.
| | - Jennifer C Gutierrez-Wu
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research (JC Gutierrez-Wu), University of North Carolina, Chapel Hill, NC
| | - Jennifer Pilotos McBride
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology (F Sylvester), Department of Pediatrics, University of North Carolina at Chapel Hill
| | - Maria E Díaz-González de Ferris
- Division of General Pediatrics and Adolescent Medicine (KB Flower, JC Gutierrez-Wu, JP McBride, and ME Díaz-González de Ferris), Department of Pediatrics, University of North Carolina School of Medicine, University of North Carolina, Chapel Hill, NC
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Koh LM, Iradukunda F, Martínez AD, Caetano Schulz KC, Bielitz I, Walker RK. A remotely accessible plant-based culinary intervention for Latina/o/x adults at risk for diabetes: lessons learned. Front Nutr 2024; 11:1298755. [PMID: 38414490 PMCID: PMC10896850 DOI: 10.3389/fnut.2024.1298755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/25/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Little research has examined how community-engaged and -participatory dietary interventions adapted to remotely-accessible settings during the COVID-19 pandemic. Objectives To identify lessons learned in design, implementation, and evaluation of a remotely-accessible, community-based, nurse-led approach of a culturally-tailored whole food plant-based culinary intervention for Latina/o/x adults to reduce type 2 diabetes risk, delivered during a pandemic. Methods A mixed methods quasi-experimental design consisting of a pre-post evaluation comprised of questionnaires, culinary classes, biometrics, and focus groups. Lessons learned Community partnerships are essential for successful recruitment/retention. To optimally deliver a remotely-accessible intervention, community leadership and study volunteers should be included in every decision (e.g., timeframes, goals). Recommendations include managing recruitment and supply chain disruption of intervention supplies. Conclusion Future research should focus on increasing accessibility and engagement in minoritized and/or underserved communities, supply chain including quality assurance and delivery of services/goods, study design for sustainable, remotely-accessible interventions, and health promotion.
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Affiliation(s)
- Linda M Koh
- Stanford Prevention Research Center, Department of Medicine, School of Medicine, Stanford University, Palo Alto, CA, United States
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Favorite Iradukunda
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
| | - Airín D Martínez
- School of Public Health & Health Sciences, University of Massachusetts Amherst, Amherst, MA, United States
| | | | - Irene Bielitz
- Independent Researcher, Loma Linda, CA, United States
| | - Rae K Walker
- Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States
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Zysset AE, Schwärzler P, Dratva J. Seeking Health in a Digital World: Exploring Immigrant Parents' Quest for Child Health Information-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6804. [PMID: 37835074 PMCID: PMC10572919 DOI: 10.3390/ijerph20196804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 09/16/2023] [Indexed: 10/15/2023]
Abstract
During pregnancy and early parenthood, parents' strong interest in pediatric health information presents a valuable opportunity to positively impact long-term health-seeking behavior and overall child health. In line with the increasing prevalence of digital transformation, a scoping review was conducted to explore two key aspects: (1) information seeking and use of digital health information among immigrant parents, and (2) associated reasons and factors. The literature search covered the period until July 2022, using Web of Science, MEDLINE, and CINAHL Complete databases. Out of 625 articles, 12 were included, comprising six qualitative, five quantitative studies, and one review. The majority of studies focused on immigrants in North America, primarily from Latin America and Asia. The studies varied in topics and methodologies, making it challenging to draw general conclusions. Nevertheless, while most immigrant parents rely on digital information on child health, they often prefer human sources such as family, friends, or healthcare providers. Trustworthiness and accessibility emerged as critical criteria for health resources. Two focus group discussions, derived from the results of the review, confirmed these findings for migrant mothers in Switzerland.
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Affiliation(s)
- Annina E. Zysset
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
| | - Patricia Schwärzler
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
| | - Julia Dratva
- Departement of Health, Institute of Public Health, ZHAW Zürich University of Applied Sciences, 8401 Winterthur, Switzerland; (A.E.Z.); (P.S.)
- Medical Faculty, University of Basel, 4056 Basel, Switzerland
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Creating an Inclusive Urology Practice. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:131-138. [PMID: 36817083 PMCID: PMC9925931 DOI: 10.1007/s11884-023-00694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 02/16/2023]
Abstract
Purpose of Review Patients seeking urologic care come from diverse backgrounds. Therefore, clinics should strive for inclusivity to make all patients feel comfortable seeing a urologist. This review aims to outline and analyze literature relevant to the care of LGTBQIA+ (lesbian, gay, transgender/transexual, queer/questioning, intersex, asexual/allies, nonbinary/genderqueer +), racial and ethnic minorities, those who have disabilities, and those with a high body mass index (BMI). Although this review article presents the care of diverse communities separately, there is an overlap of the various social axes influencing healthcare outcomes. Healthcare workers should be open-minded to learning about evolving community needs. Recent Findings Creating a safe space for LGTBQIA+ requires understanding terminology, awareness of community-specific challenges and health risks, and changing heteronormative behaviors built into medicine. Specific clinical care delivery structural processes and patient-physician-centered practices can make a clinic welcoming for patients from underrepresented backgrounds and with disabilities. BMI surgical requirements may pose barriers to care, and if implemented, there should be assistance to reach specified weight goals. Summary Creating an inclusive urology clinical practice takes time, but it can be achieved by building a collaborative team. Treating patients with consideration of their personal identities and social determinants of health will lead to better patient-center care and health outcomes.
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Ornelas IJ, Perez G, Maurer S, Gonzalez S, Childs V, Price C, Nelson AK, Perez Solorio SA, Tran A, Rao D. Amigas Latinas Motivando el Alma: In-Person and Online Delivery of an Intervention to Promote Mental Health Among Latina Immigrant Women. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:821-829. [PMID: 35723668 PMCID: PMC9595613 DOI: 10.1089/jicm.2022.0491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Objective: A few mindfulness-based interventions have been developed for Latina immigrant populations. We describe the feasibility and acceptability of Amigas Latinas Motivando el Alma (ALMA), a culturally grounded intervention developed to prevent and reduce depression and anxiety among Latina immigrants. We also compare participation in the intervention in-person with an online adaptation developed in response to the COVID-19 pandemic. Methods: ALMA was developed through several years of formative research in collaboration with community organizations serving Latino immigrants. The curriculum integrates mindfulness-based approaches with Latino cultural strengths to reduce stress, enhance coping strategies, and increase social support. Latina immigrant women who spoke Spanish were recruited from Latino serving organizations to participate in an intervention trial. The program consisted of eight sessions offered weekly in person to groups of ∼20 Latina immigrants. After the onset of the pandemic, the program was adapted to be delivered online via zoom. Attendance and fidelity were monitored by intervention staff, and a satisfaction survey was given to participants post-intervention. Results: We enrolled 226 Latina immigrant women with an average age of 40 years and an average of 15.0 years living in the United States. The majority of participants were monolingual Spanish speakers (59%) with a high school degree (66%), although almost half were living on less than $2,200 per month (48%). One hundred and seven (47%) attended the program in-person, and 119 (53%) participated online. Program attendance was similar across modalities, with an average of 58% sessions completed among in-person and 60% among online participants. Participant satisfaction and perceived efficacy of the intervention were high in both in-person and online groups. Discussion: Our findings indicate that the ALMA intervention is acceptable and feasible in this population. Future research should assess the efficacy of mindfulness-based interventions in Latina immigrant populations, including both in-person and online modalities. CTR# NCT03749278.
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Affiliation(s)
- India J. Ornelas
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Georgina Perez
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Serena Maurer
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | | | - Veronica Childs
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Cynthia Price
- University of Washington School of Nursing, Seattle, WA, USA
| | - Adrianne Katrina Nelson
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - S. Adriana Perez Solorio
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Anh Tran
- Department of Family Medicine and Community Health, Duke School of Medicine, Durham, NC, USA
| | - Deepa Rao
- Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
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