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Mirabolfathi V, Choobin MH, Moradi AR, Sanambari F, Naeini S, Mahdavi M, Hitchcock C. Improving access to psychological intervention in low-middle income settings: Results from a waitlist-controlled, proof-of-concept trial of the MemFlex intervention for trauma-exposed Afghan youth. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 38736135 DOI: 10.1111/bjc.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 04/18/2024] [Accepted: 04/29/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Low-intensity interventions targeting a range of mental health issues offer a scalable approach for young trauma survivors in low-middle income countries. AIMS Here, we present results from a proof-of-concept, randomized, waitlist-controlled trial evaluating MemFlex, an autobiographical memory-based intervention, for trauma-exposed Afghan youth residing in Iran. MemFlex seeks to reduce the negative and overgeneral memory biases which maintain and predict poor mental health. MATERIALS AND METHODS Young people aged 12-18 years (N = 40) with parents who had experienced forced migration from Afghanistan were recruited from high schools in Karaj City in Iran. All had experienced a traumatic event in the last year. Participants were randomized to receive four weeks of a group-based delivery of MemFlex or Waitlist. Our primary cognitive outcome was autobiographical memory flexibility, that is, the ability to deliberately retrieve any memory type on demand. Primary clinical outcome was emotional distress, measured on the Farsi version of the Hopkins Symptom Checklist. RESULTS Results indicated that MemFlex participants demonstrated large effect sizes for pre-to-post improvement in memory flexibility (d = 2.04) and emotional distress (d = 1.23). These improvements were significantly larger than Waitlist (ds < .49), and were maintained at three-month follow-up. DISCUSSION Positive benefits were observed for completion of MemFlex, and future comparison against an active intervention appears warranted. CONCLUSION Further evaluation of MemFlex in this context may offer a low-cost, and low-resource intervention to improve access to psychological intervention for young migrants in low-middle income countries.
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Affiliation(s)
- Vida Mirabolfathi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Mohammad H Choobin
- Department of Cognitive Neuroscience, Institute for Cognitive Science Studies, Tehran, Iran
| | | | | | | | - Mohamad Mahdavi
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Caitlin Hitchcock
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Ho TQA, Le LKD, Engel L, Le N, Melvin G, Le HND, Mihalopoulos C. Barriers to and facilitators of user engagement with web-based mental health interventions in young people: a systematic review. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02386-x. [PMID: 38356043 DOI: 10.1007/s00787-024-02386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
Many young people (YP) are diagnosed with mental illnesses and require support. Web-based mental health interventions (W-MHIs) have been increasingly utilized by YP, healthcare providers, and parents due to reasons including convenience and anonymity. W-MHIs are effective in improving mental health in YP. However, real-world engagement with W-MHIs remains low. Therefore, understanding barriers/facilitators of user engagement with W-MHIs is necessary to promote W-MHIs and help users gain optimal benefits through higher engagement. This review aims to identify barriers/facilitators of user engagement with W-MHIs in YP aged 10-24 years. A systematic search of five databases for English language, peer-reviewed publications was conducted between January 2010 and February 2023. Studies examining factors influencing user engagement with W-MHIs, described as barriers or facilitators, were included. Study quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed. Of 4088 articles identified, 69 studies were included. Barriers/facilitators were reported by young people (63 studies), providers (17 studies), and parents/caregivers (8 studies). YP perceived that usefulness and connectedness were the most common facilitators, whereas low-perceived need was the most reported barrier. Both providers and parents reported that perceived usefulness for YP was the most common facilitator, whereas concerns about program effectiveness and privacy were noted as barriers. This review found that program- and individual-related factors were important determinants of engagement with W-MHIs. This review provides guidance on the future design and development of new interventions, narrowing the gap between existing W-MHIs and unmet needs of users.
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Affiliation(s)
- Thi Quynh Anh Ho
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia.
| | - Long Khanh-Dao Le
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ngoc Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Glenn Melvin
- School of Psychology, Deakin University, Melbourne, VIC, Australia
| | - Ha N D Le
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Boettcher J, Heinrich M, Boettche M, Burchert S, Glaesmer H, Gouzoulis-Mayfrank E, Heeke C, Hernek M, Knaevelsrud C, Konnopka A, Muntendorf L, Nilles H, Nohr L, Pohl S, Paskuy S, Reinhardt I, Sierau S, Stammel N, Wirz C, Renneberg B, Wagner B. Internet-based transdiagnostic treatment for emotional disorders in Arabic- and Farsi-speaking refugees: study protocol of a randomized controlled trial. Trials 2024; 25:13. [PMID: 38167060 PMCID: PMC10759366 DOI: 10.1186/s13063-023-07845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Refugee populations have an increased risk for mental disorders, such as depression, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receive adequate help. The planned trial evaluates a low-threshold, transdiagnostic Internet-based treatment. The trial aims at establishing its efficacy and cost-effectiveness compared with no treatment. METHODS N = 131 treatment-seeking Arabic- or Farsi-speaking patients, meeting diagnostic criteria for a depressive, anxiety, and/or posttraumatic stress disorder will be randomized to either the intervention or the waitlist control group. The intervention group receives an Internet-based treatment with weekly written guidance provided by Arabic- or Farsi-speaking professionals. The treatment is based on the Common Elements Treatment Approach (CETA), is tailored to the individual patient, and takes 6-16 weeks. The control group will wait for 3 months and then receive the Internet-based treatment. DISCUSSION The planned trial will result in an estimate of the efficacy of a low-threshold and scalable treatment option for the most common mental disorders in refugees. TRIAL REGISTRATION German Registry for Clinical Trials DRKS00024154. Registered on February 1, 2021.
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Affiliation(s)
- Johanna Boettcher
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany.
- Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany.
| | - Manuel Heinrich
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Maria Boettche
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Sebastian Burchert
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Heide Glaesmer
- Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | | | - Carina Heeke
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Martina Hernek
- Clinical Psychology and Psychotherapie, Freie Universitaet Berlin, Berlin, Germany
| | | | - Alexander Konnopka
- Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Louisa Muntendorf
- Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah Nilles
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Laura Nohr
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Steffi Pohl
- Methods and Evaluation/Quality Assurance, Freie Universitaet Berlin, Berlin, Germany
| | - Sophia Paskuy
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Isabelle Reinhardt
- Section of Healthcare Research, LVR-Institute for Research and Education, Cologne, Germany
| | - Susan Sierau
- Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Freie Universitaet Berlin, Berlin, Germany
| | - Christina Wirz
- Clinical Psychology and Psychotherapie, Freie Universitaet Berlin, Berlin, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapie, Freie Universitaet Berlin, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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Demetry Y, Wasteson E, Lindegaard T, Abuleil A, Geranmayeh A, Andersson G, Shahnavaz S. Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study. JMIR Form Res 2023; 7:e46253. [PMID: 37999955 DOI: 10.2196/46253] [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: 02/03/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. OBJECTIVE This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. METHODS A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. RESULTS The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. CONCLUSIONS The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation.
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Affiliation(s)
- Youstina Demetry
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Elisabet Wasteson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Amjad Abuleil
- Competence Team for migration health, Region Jämtland Härjedalen, Östersund, Sweden
| | - Anahita Geranmayeh
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Shervin Shahnavaz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Whitehead L, Talevski J, Fatehi F, Beauchamp A. Barriers to and Facilitators of Digital Health Among Culturally and Linguistically Diverse Populations: Qualitative Systematic Review. J Med Internet Res 2023; 25:e42719. [PMID: 36853742 PMCID: PMC10015358 DOI: 10.2196/42719] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/09/2022] [Accepted: 01/19/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Health care systems have become increasingly more reliant on patients' ability to navigate the digital world. However, little research has been conducted on why some communities are less able or less likely to successfully engage with digital health technologies (DHTs), particularly among culturally and linguistically diverse (CaLD) populations. OBJECTIVE This systematic review aimed to determine the barriers to and facilitators of interacting with DHTs from the perspectives of CaLD population groups, including racial or ethnic minority groups, immigrants and refugees, and Indigenous or First Nations people. METHODS A systematic review and thematic synthesis of qualitative studies was conducted. Peer-reviewed literature published between January 2011 and June 2022 was searched across 3 electronic databases. Terms for digital health were combined with terms for cultural or linguistic diversity, ethnic minority groups, or Indigenous and First Nations people and terms related to barriers to accessing digital technologies. A qualitative thematic synthesis was conducted to identify descriptive and analytical themes of barriers to and facilitators of interacting with DHTs. Quality appraisal was performed using the Mixed Methods Appraisal Tool. RESULTS Of the 1418 studies identified in the electronic search, a total of 34 (2.4%) were included in this review. Half of the included studies (17/34, 50%) were conducted in the United States. There was considerable variation in terms of the CaLD backgrounds of the participants. In total, 26% (9/34) of the studies focused on Indigenous or First Nations communities, 41% (14/34) were conducted among ethnic minority populations, 15% (5/34) of the studies were conducted among immigrants, and 18% (6/34) were conducted in refugee communities. Of the 34 studies, 21 (62%) described the development or evaluation of a digital health intervention, whereas 13 (38%) studies did not include an intervention but instead focused on elucidating participants' views and behaviors in relation to digital health. From the 34 studies analyzed, 18 descriptive themes were identified, each describing barriers to and facilitators of interacting with DHTs, which were grouped into 7 overarching analytical themes: using technology, design components, language, culture, health and medical, trustworthiness, and interaction with others. CONCLUSIONS This study identified several analytic and descriptive themes influencing access to and uptake of DHTs among CaLD populations, including Indigenous and First Nations groups. We found that cultural factors affected all identified themes to some degree and that cultural and linguistic perspectives should be considered in the design and delivery of DHTs, with this best served through the inclusion of the target communities at all stages of development. This may improve the potential of DHTs to be more acceptable, appropriate, and accessible to population groups currently at risk of not obtaining the full benefits of digital health.
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Affiliation(s)
- Lara Whitehead
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia
| | - Jason Talevski
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia.,Institute for Physical Activity and Nutrition Research (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.,Australian Institute for Musculoskeletal Science, The University of Melbourne and Western Health, Melbourne, Australia
| | - Farhad Fatehi
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Alison Beauchamp
- School of Rural Health, Faculty of Medicine, Nursing and Health Science, Monash University, Warragul, Australia
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Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature. Glob Ment Health (Camb) 2023; 10:e6. [PMID: 36843879 PMCID: PMC9947632 DOI: 10.1017/gmh.2022.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
According to the United Nations, an estimated 26.6 million people worldwide were refugees in 2021. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. A possible strategy to close this gap might be to offer smartphone-delivered mental health care. This systematic review summarizes the current state of research on smartphone-delivered interventions for refugees, answering the following research questions: (1) Which smartphone-delivered interventions are available for refugees? (2) What do we know about their clinical (efficacy) and (3) nonclinical outcomes (e.g., feasibility, appropriateness, acceptance, and barriers)? (4) What are their dropout rates and dropout reasons? (5) To what extent do smartphone-delivered interventions consider data security? Relevant databases were systematically searched for published studies, gray literature, and unpublished information. In total, 456 data points were screened. Twelve interventions were included (nine interventions from 11 peer-reviewed articles and three interventions without published study reports), comprising nine interventions for adult refugees and three for adolescent and young refugees. Study participants were mostly satisfied with the interventions, indicating adequate acceptability. Only one randomized controlled trial (RCT; from two RCTs and two pilot RCTs) found a significant reduction in the primary clinical outcome compared to the control group. Dropout rates ranged from 2.9 to 80%. In the discussion, the heterogeneous findings are integrated into the current state of literature.
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Juniar D, van Ballegooijen W, Schulte M, van Schaik A, Passchier J, Heber E, Lehr D, Sadarjoen SS, Riper H. A Web-Based Stress Management Intervention for University Students in Indonesia (Rileks): Feasibility Study Using a Pretest-Posttest Design. JMIR Form Res 2022; 6:e37278. [PMID: 35852838 PMCID: PMC9491829 DOI: 10.2196/37278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background University students are susceptible to excessive stress. A web-based stress management intervention holds promise to improve stress but is still at a novel stage in Indonesia. Objective The aim of this paper was to report the feasibility of the intervention we developed—Rileks—among university students in Indonesia in terms of acceptability and usability, and to propose recommendations for future improvements. Methods A single-group pretest and posttest design was used. Participants with scores of 15 or higher on the stress subscale of the 42-item Depression Anxiety Stress Scales were given access to the intervention (N=68). The main outcome measures were the 8-item Client Satisfaction Questionnaire (CSQ-8) score, the System Usability Scale (SUS) score, and intervention uptake. Participants’ experience in each session was evaluated using closed- and open-ended questions for future improvements. Descriptive statistics were used to examine primary outcome and qualitative session evaluations. Participants’ responses to each topic of the open questions were summarized. Results The intervention was evaluated as being satisfactory (CSQ-8 mean score 21.89, SD 8.72; range 8-32). However, the intervention’s usability was still below expectation (SUS mean score 62.8, SD 14.74; range 0-100). The core modules were completed by 10 out of 68 participants (15%), and the study dropout rate was 63% (43/68) at postassessment. In general, the module content was rated positively, with some notes for improvement covering content and technical aspects. Conclusions This study indicates that Rileks is potentially feasible for Indonesian university students. In order to be optimally applied in such a context and before scaling up web-based interventions in Indonesia, in general, further development and refinement are needed. International Registered Report Identifier (IRRID) RR2-10.2196/11493
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Affiliation(s)
- Dilfa Juniar
- Faculty of Psychology, YARSI University, Jakarta, Indonesia
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Geestelijke Gezondheids Zorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Mieke Schulte
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Anneke van Schaik
- Department of Psychiatry, Amsterdam University Medical Centers, Amsterdam, Netherlands
- Geestelijke Gezondheids Zorg inGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Jan Passchier
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Elena Heber
- HelloBetter - GET.ON Institut für Online Gesundheitstrainings GmbH, Hamburg, Germany
| | - Dirk Lehr
- Institute of Psychology, Leuphana University, Lüneburg, Germany
| | | | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands
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