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Benson J, Brand T, Christianson L, Lakeberg M. Localisation of digital health tools used by displaced populations in low and middle-income settings: a scoping review and critical analysis of the Participation Revolution. Confl Health 2023; 17:20. [PMID: 37061703 PMCID: PMC10105546 DOI: 10.1186/s13031-023-00518-9] [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: 09/14/2022] [Accepted: 04/04/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Forced displacement is a crucial determinant of poor health. With 31 people displaced every minute worldwide, this is an important global issue. Addressing this, the Participation Revolution workstream from the World Humanitarian Summit's Localisation commitments has gained traction in attempting to improve the effectiveness of humanitarian aid. Simultaneously, digital health initiatives have become increasingly ubiquitous tools in crises to deliver humanitarian assistance and address health burdens. OBJECTIVE This scoping review explores how the localisation agenda's commitment to participation has been adopted within digital health interventions used by displaced people in low-and-middle-income countries. METHODS This review adopted the Arksey and O'Malley approach and searched five academic databases and three online literature repositories with a Population, Concept and Context inclusion criteria. Data were synthesised and analysed through a critical power lens from the perspective of displaced people in low-and-middle-income-countries. RESULTS 27 papers demonstrated that a heterogeneous group of health issues were addressed through various digital health initiatives, principally through the use of mobile phones. The focus of the literature lay largely within technical connectivity and feasibility assessments, leaving a gap in understanding potential health implications. The varied conceptualisation of the localisation phenomenon has implications for the future of participatory humanitarian action: Authorship of reviewed literature primarily descended from high-income countries exposing global power dynamics leading the narrative. However, power was not a central theme in the literature: Whilst authors acknowledged the benefit of local involvement, participatory activities were largely limited to informing content adaptations and functional modifications within pre-determined projects and objectives. CONCLUSION With over 100 million people displaced globally, effective initiatives that meaningfully address health needs without perpetuating harmful inequalities are an essential contribution to the humanitarian arena. The gap in health outcomes evidence, the limited constructions of health, and the varying and nuanced digital divide factors are all indicators of unequal power in the digital health sphere. More needs to be done to address these gaps meaningfully, and more meaningful participation could be a crucial undertaking to achieve this. Registration The study protocol was registered before the study (10.17605/OSF.IO/9D25R) at https://osf.io/9d25r .
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Affiliation(s)
- Jennifer Benson
- Faculty of Human and Health Sciences, Public Health, The University of Bremen, Bremen, Germany.
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Leibniz Science Campus Digital Public Health, Bremen, Germany.
| | - Tilman Brand
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Meret Lakeberg
- Faculty of Human and Health Sciences, Public Health, The University of Bremen, Bremen, Germany
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Parkes P, Pillay TD, Bdaiwi Y, Simpson R, Almoshmosh N, Murad L, Abbara A. Telemedicine interventions in six conflict-affected countries in the WHO Eastern Mediterranean region: a systematic review. Confl Health 2022; 16:64. [PMID: 36517869 PMCID: PMC9748883 DOI: 10.1186/s13031-022-00493-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 10/31/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has escalated the use of telemedicine in both high and low resource settings however its use has preceded this, particularly in conflict-affected settings. Several countries in the WHO Eastern Mediterranean (EMR) region are affected by complex, protracted crises. Though telemedicine has been used in such settings, there has been no comprehensive assessment of what interventions are used, their efficacy, barriers, or current research gaps. MAIN BODY A systematic search of ten academic databases and 3 grey literature sources from January 1st 2000 to December 31st 2020 was completed, identifying telemedicine interventions in select EMR conflict-affected settings and relevant enablers and barriers to their implementation. Included articles reported on telemedicine use in six conflict-affected EMR countries (or territories) graded as WHO Health Emergencies: Afghanistan, Gaza, Iraq, Libya, Syria and Yemen. Data were extracted and narratively synthesised due to heterogeneity in study design and outcomes. Of 3419 articles identified, twenty-one peer-reviewed and three grey literature sources met the inclusion criteria. We analysed these by context, intervention, and evaluation. CONTEXT eight related to Afghanistan, eight to Syria and seven to Iraq with one each in Yemen and Gaza. Most were implemented by humanitarian or academic organisations with projects mostly initiated in the United States or Europe and mostly by physicians. The in-country links were mostly health professionals rather than patients seeking specialist inputs for specialities not locally available. INTERVENTIONS these included both SAF (store and forward) and RT (real-time) with a range of specialities represented including radiology, histopathology, dermatology, mental health, and intensive care. EVALUATION most papers were observational or descriptive with few describing quality measures of interventions. CONCLUSIONS Telemedicine interventions are feasible in conflict-affected settings in EMR using low-cost, accessible technologies. However, few implemented interventions reported on evaluation strategies or had these built in. The ad hoc nature of some of the interventions, which relied on volunteers without sustained financial or academic investment, could pose challenges to quality and sustainability. There was little exploration of confidentiality, ethical standards, data storage or local healthcare worker and patient acceptability.
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Affiliation(s)
- Pylin Parkes
- grid.7445.20000 0001 2113 8111St Marys Hospital, Imperial College, London, W2 1NY UK
| | - Timesh D. Pillay
- grid.7445.20000 0001 2113 8111St Marys Hospital, Imperial College, London, W2 1NY UK ,grid.13097.3c0000 0001 2322 6764King’s College, London, UK
| | - Yamama Bdaiwi
- grid.7445.20000 0001 2113 8111St Marys Hospital, Imperial College, London, W2 1NY UK ,grid.13097.3c0000 0001 2322 6764King’s College, London, UK
| | - Remi Simpson
- grid.7445.20000 0001 2113 8111St Marys Hospital, Imperial College, London, W2 1NY UK
| | | | - Lina Murad
- Metropolitan Access Centre, Washington, DC USA
| | - Aula Abbara
- grid.7445.20000 0001 2113 8111St Marys Hospital, Imperial College, London, W2 1NY UK ,Syria Public Health Network, London, UK
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Shoib S, Armiya'u AY, Roza TH, Saeed F, Swed S, Arif N, Park C, Chandradasa M. Telepsychiatry for conflict-affected settings: Feasibility, ethics, barriers and prospects. Asian J Psychiatr 2022; 75:103203. [PMID: 35870308 DOI: 10.1016/j.ajp.2022.103203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 01/17/2023]
Abstract
Telehealth is being broadly developed in all fields of medicine, and online visits seem a particularly suitable alternative to in-person visits in outpatient psychiatry especially in conflict setting. Telepsychiatry has numerous advantages over in-person visits.
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Affiliation(s)
- Sheikh Shoib
- Jawaharlal Nehru Memorial hospital, Directorate of Health Services, Jammu and Kashmir, India.
| | - Aishatu Yusha'u Armiya'u
- Department of Psychiatry, College of Medical Sciences, Abubakar Tafawa Balewa University, University Teaching Hospital Bauchi state, Nigeria.
| | - Thiago Henrique Roza
- Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Fahimeh Saeed
- Department of Psychiatry, Psychosis Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Nigar Arif
- Republican Psychiatric Hospital, Azerbaijan.
| | - Chan Park
- 2nd year Resident at UCLA-VA Psychiatry Residency Program, United States.
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Bowsher G, El Achi N, Augustin K, Meagher K, Ekzayez A, Roberts B, Patel P. eHealth for service delivery in conflict: a narrative review of the application of eHealth technologies in contemporary conflict settings. Health Policy Plan 2021; 36:974-981. [PMID: 33860797 PMCID: PMC8355470 DOI: 10.1093/heapol/czab042] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 12/11/2022] Open
Abstract
The role of eHealth in conflict settings is increasingly important to address geographic, epidemiologic and clinical disparities. This study categorizes various forms of eHealth usage in conflict and aims to identify gaps in evidence to make recommendations for further research and practice. The analysis was carried out via a narrative hermeneutic review methodology. Articles that fulfilled the following screening criteria were reviewed: (1) describing an eHealth intervention in active conflict or ongoing insurgency, (2) an eHealth intervention targeting a conflict-affected population, (3) an e-learning platform for delivery in conflict settings and (4) non-interventional descriptive reviews relating to eHealth in conflict. Of the 489 papers eligible for screening, 46 merited final inclusion. Conflict settings described include Somalia, Sudan, Afghanistan, Syria, Iraq, Pakistan, Chechnya, Gaza and the Democratic Republic of Congo. Thirty-six studies described specific eHealth initiatives, while the remainder were more generic review papers exploring general principles. Analysis resulted in the elucidation of three final categories of current eHealth activity in conflict-affected settings: (1) eHealth for clinical management, (2) e-learning for healthcare in conflict and (3) eHealth for information management in conflict. Obvious disparities in the distribution of technological dividends from eHealth in conflict are demonstrated by this review. Conflict-affected populations are predominantly subject to ad hoc and voluntary initiatives delivered by diaspora and civil society organizations. While the deployment of eHealth technologies in conflict settings is increasingly normalized, there is a need for further clarification of global norms relating to practice in this context.
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Affiliation(s)
- Gemma Bowsher
- R4HC-MENA, R4HSSS & Conflict & Health Research Group, King's College London, Strand Ln, London WC2R 2LS, UK
| | - Nassim El Achi
- R4HC-MENA, Global Health Institute, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Katrin Augustin
- School of Population Health & Environmental Sciences, King's College London, Guy's Campus, Great Maze Pond, London SE1 1UL, UK
| | - Kristen Meagher
- R4HC-MENA, R4HSSS & Conflict & Health Research Group, King's College London, Strand Ln, London WC2R 2LS, UK
| | - Abdulkarim Ekzayez
- R4HC-MENA, R4HSSS & Conflict & Health Research Group, King's College London, Strand Ln, London WC2R 2LS, UK
| | - Bayard Roberts
- RECAP, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Preeti Patel
- R4HC-MENA & R4HSSS, Dept War Studies, King's College London, Strand Lane, LondonWC2R 2LS, UK
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Sharma A, Sasser T, Schoenfelder Gonzalez E, Vander Stoep A, Myers K. Implementation of Home-Based Telemental Health in a Large Child Psychiatry Department During the COVID-19 Crisis. J Child Adolesc Psychopharmacol 2020; 30:404-413. [PMID: 32639849 DOI: 10.1089/cap.2020.0062] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: Telemental health (TMH) is not well described for mental health service delivery during crises. Most child and adolescent psychiatry training programs have not integrated TMH into their curricula and are ill equipped to respond during crises to their patients' needs. In this study, we present the implementation of a home-based TMH (HB-TMH) service during the COVID-19 pandemic. Methods: We describe the technological, administrative, training, and clinical implementation components involved in transitioning a comprehensive outpatient child and adolescent psychiatry program to a HB-TMH virtual clinic. Results: The transition was accomplished in 6 weeks. Most in-clinic services were rapidly moved off campus to the home. Owing to challenges encountered with each implementation component, phone sessions bridged the transition from in-clinic to reliable virtual appointments. Within 3 weeks (March 20, 2020) of planning for HB-TMH, 67% of all appointments were conducted at home, and within 4 weeks (March 27, 2020), 90% were conducted at home. By week 6 (April 3, 2020), reliable HB-TMH appointments were implemented. Conclusions: The COVID-19 pandemic crisis created the opportunity to innovate a solution to disrupted care for our established patients and to create a resource for youth who developed problems during the crisis. Our department was experienced in providing TMH services that facilitated the transition to HB-TMH, yet still had to overcome known and unanticipated challenges. Our experience provides a roadmap for establishing a HB-TMH service with focus on rapid implementation. It also demonstrates a role for TMH during (rather than after) future crises when usual community resources are not available.
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Affiliation(s)
- Aditi Sharma
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Tyler Sasser
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Erin Schoenfelder Gonzalez
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ann Vander Stoep
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Kathleen Myers
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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Kamali M, Munyuzangabo M, Siddiqui FJ, Gaffey MF, Meteke S, Als D, Jain RP, Radhakrishnan A, Shah S, Ataullahjan A, Bhutta ZA. Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review. BMJ Glob Health 2020; 5:e002014. [PMID: 32201624 PMCID: PMC7073823 DOI: 10.1136/bmjgh-2019-002014] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/09/2019] [Accepted: 12/22/2019] [Indexed: 01/08/2023] Open
Abstract
Background Over 240 million children live in countries affected by conflict or fragility, and such settings are known to be linked to increased psychological distress and risk of mental disorders. While guidelines are in place, high-quality evidence to inform mental health and psychosocial support (MHPSS) interventions in conflict settings is lacking. This systematic review aimed to synthesise existing information on the delivery, coverage and effectiveness of MHPSS for conflict-affected women and children in low-income and middle-income countries (LMICs). Methods We searched Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO)databases for indexed literature published from January 1990 to March 2018. Grey literature was searched on the websites of 10 major humanitarian organisations. Eligible publications reported on an MHPSS intervention delivered to conflict-affected women or children in LMICs. We extracted and synthesised information on intervention delivery characteristics, including delivery site and personnel involved, as well as delivery barriers and facilitators, and we tabulated reported intervention coverage and effectiveness data. Results The search yielded 37 854 unique records, of which 157 were included in the review. Most publications were situated in Sub-Saharan Africa (n=65) and Middle East and North Africa (n=36), and many reported on observational research studies (n=57) or were non-research reports (n=53). Almost half described MHPSS interventions targeted at children and adolescents (n=68). Psychosocial support was the most frequently reported intervention delivered, followed by training interventions and screening for referral or treatment. Only 19 publications reported on MHPSS intervention coverage or effectiveness. Discussion Despite the growing literature, more efforts are needed to further establish and better document MHPSS intervention research and practice in conflict settings. Multisectoral collaboration and better use of existing social support networks are encouraged to increase reach and sustainability of MHPSS interventions. PROSPERO registration number CRD42019125221.
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Affiliation(s)
- Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mariella Munyuzangabo
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fahad J Siddiqui
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Michelle F Gaffey
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Meteke
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daina Als
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amruta Radhakrishnan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Shailja Shah
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anushka Ataullahjan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Soron TR, Heanoy EZ, Udayasankaran JG. Did Bangladesh miss the opportunity to use telepsychiatry in the Rohingya refugee crisis? Lancet Psychiatry 2019; 6:374. [PMID: 31006432 DOI: 10.1016/s2215-0366(19)30137-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Tanjir Rashid Soron
- Consultant Research, Innovation, Education and Training of Neuro-Developmental Disability Protection Trust, Ministry of Social Welfare, Dhaka, Bangladesh; SynesisIT, Dhaka 1215, Bangladesh.
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Azarang A, Pakyurek M, Giroux C, Nordahl TE, Yellowlees P. Information Technologies: An Augmentation to Post-Traumatic Stress Disorder Treatment Among Trauma Survivors. Telemed J E Health 2019; 25:263-271. [DOI: 10.1089/tmj.2018.0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Atoosa Azarang
- MIND Institute, University of California-Davis Medical Center, Sacramento, California
| | - Murat Pakyurek
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Caroline Giroux
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Thomas E. Nordahl
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
| | - Peter Yellowlees
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, School of Medicine, Sacramento, California
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Naslund JA, Aschbrenner KA, Araya R, Marsch LA, Unützer J, Patel V, Bartels SJ. Digital technology for treating and preventing mental disorders in low-income and middle-income countries: a narrative review of the literature. Lancet Psychiatry 2017; 4:486-500. [PMID: 28433615 PMCID: PMC5523650 DOI: 10.1016/s2215-0366(17)30096-2] [Citation(s) in RCA: 261] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 01/18/2023]
Abstract
Few individuals living with mental disorders around the globe have access to mental health care, yet most have access to a mobile phone. Digital technology holds promise for improving access to, and quality of, mental health care. We reviewed evidence on the use of mobile, online, and other remote technologies for treatment and prevention of mental disorders in low-income and middle-income countries. Of the 49 studies identified, most were preliminary evaluations of feasibility and acceptability. The findings were promising, showing the potential effectiveness of online, text-messaging, and telephone support interventions. We summarised the evaluations as: technology for supporting clinical care and educating health workers, mobile tools for facilitating diagnosis and detection of mental disorders, technologies for promoting treatment adherence and supporting recovery, online self-help programmes for individuals with mental disorders, and programmes for substance misuse prevention and treatment. Continued research is needed to rigorously evaluate effectiveness, assess costs, and carefully consider potential risks of digital technology interventions for mental disorders, while determining how emerging technologies might support the scale-up of mental health treatment and prevention efforts across low-resource settings.
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Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA; Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, NH, USA; Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA.
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, NH, USA; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Ricardo Araya
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, London, UK; Sangath, Goa, India; Center for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA; Health Promotion Research Center at Dartmouth, Dartmouth College, Lebanon, NH, USA; Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
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Almoshmosh N. The role of war trauma survivors in managing their own mental conditions, Syria civil war as an example. Avicenna J Med 2016; 6:54-9. [PMID: 27144143 PMCID: PMC4849190 DOI: 10.4103/2231-0770.179554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
War trauma leads to a wide range of psychological consequences and disorders that can be quite disabling to individuals and their families. At times of war, existing resources become strained to cope with all demands of trauma sufferers. The survivors' role of managing their own mental conditions becomes highly important and relevant as a way of reducing the resulted suffering. Unfortunately, this role is often ignored or trivialized by all concerned. The self-efficacy and resilience of people are the factors not to be underestimated and should be built upon. Reaching solutions are generally more satisfying and long-lasting when the affected person has taken a positive active part in finding them. Encouraging the use of own resources and experiences and using own problem-solving skills can be all that is needed for survivors to feel enabled. Engaging survivors and focusing on promoting recovery and social inclusion along with the use of self-help skills make them feel more positive about their own conditions. Being more involved, taking even small steps reduces the development of learned helplessness and reduces the psychiatric morbidities.
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Nassan M, Frye MA, Adi A, Alarcón RD. Telepsychiatry for post-traumatic stress disorder: a call for action in the Syrian conflict. Lancet Psychiatry 2015; 2:866. [PMID: 26462214 DOI: 10.1016/s2215-0366(15)00380-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Malik Nassan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mark A Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Ahmad Adi
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Renato D Alarcón
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perü; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
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Jefee-Bahloul H, Duchen D, Barkil-Oteo A. Attitudes Towards Implementation of Store-and-Forward Telemental Health in Humanitarian Settings: Survey of Syrian Healthcare Providers. Telemed J E Health 2015. [PMID: 26204132 DOI: 10.1089/tmj.2015.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Store-and-forward (S&F) telemedicine is thought to be most applicable in humanitarian settings. Unlike other kinds of telemental health (TMH), S&F requires engagement and active participation from healthcare providers in submitting text or audio-video clinical material for consultations. To implement such consultative systems there is a need to gauge providers' attitudes towards this technology. MATERIALS AND METHODS An electronic survey was sent to Syrian healthcare providers (physicians and nonphysicians) who are affiliated with humanitarian nongovernmental organizations managing Syrians affected by war. After a description of what TMH and S&F are, participants were asked about their attitudes towards such services. RESULTS Fifty-two providers responded to the electronic survey. Only results from providers inside Syria (n = 30) are presented. The majority of respondents had no experience with TMH. Half of the providers believed that mental healthcare can be provided through S&F and that there would be a benefit from such services. Respondents reported that cultural (68%), financial (84%), and technical (80%) barriers do exist for such services. When asked, providers believed that patients would agree to be audiotaped (58%) for the purpose of S&F compared with being videotaped (15%) (p = 0.007). CONCLUSIONS Electronic surveys of healthcare workers in humanitarian settings are feasible. Providers in the Syrian humanitarian setting have little experience in TMH; however, they are open to using an S&F service while acknowledging cultural, financial, and technical barriers to the implementation.
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Affiliation(s)
| | - Dylan Duchen
- 2 Yale School of Public Health , New Haven, Connecticut
| | - Andres Barkil-Oteo
- 1 Department of Psychiatry, Yale School of Medicine , New Haven, Connecticut
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Jefee-Bahloul H. Telemental health in the middle East: overcoming the barriers. Front Public Health 2014; 2:86. [PMID: 25101255 PMCID: PMC4101432 DOI: 10.3389/fpubh.2014.00086] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 07/03/2014] [Indexed: 12/16/2022] Open
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