Feasibility and acceptability of Facebook for health promotion among people with serious mental illness

Use of new technologies for the promotion of physical activity in patients with mental illness: A systematic review

BACKGROUND

Physical exercise is an underutilized tool for the management of mental disorders. New technologies have made a breakthrough in health care, and one of its possible applications (apps) could be that of customizing exercise programs for special populations, such as patients with mental disorders. However, the app of the so-called e-health to mental health care is still limited.

AIM

To know the efficacy of apps to promote physical activity in patients with mental disorders.

METHODS

We conducted a systematic review of the PubMed and Embase databases with the aim of exploring the use of new technologies for the enhancement of physical exercise in patients with a psychiatric illness. Following the selection process, 10 articles were included in the review.

RESULTS

The most commonly used devices in this type of intervention are wearable devices and web platforms. Good results in terms of effectiveness and acceptability were obtained in most of the studies.

CONCLUSION

Our findings suggest that the use of new technologies in mental health represents a feasible strategy with great potential in clinical practice.

An online mental health informed physical activity intervention for emergency service workers and their families: A stepped-wedge trial

Objective

Emergency service workers are at risk of experiencing poor mental health due to repeated exposure to potentially traumatic events. Promoting healthy lifestyle factors may help improve health outcomes and quality of life among this population. This study aimed to evaluate the efficacy of a 10-week physical activity (PA) and diet programme delivered via Facebook for sedentary emergency service workers and their support partners on levels of psychological distress.

Methods

We delivered a 10-week intervention via a private Facebook group facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly education modules and telehealth calls were delivered, and participants were provided with a PA tracking device (Fitbit accelerometer). A stepped-wedge design was applied to compare levels of psychological distress (K6) during baseline, to intervention by comparing slopes of change. Secondary pre-post outcomes included mental health symptoms, PA, quality of life, social support to exercise, sleep quality and suicidal ideation.

Results

In total, N=90 participants (n=47 emergency service workers and n=43 support partners) were recruited in 4 cohorts (aged 42.3±11.5 years, 51% male). Levels of psychological distress did not change significantly during the baseline (control) slope and reduced significantly during the first 6 weeks of intervention (intervention slope 1). The slopes were significantly different, b=-0.351, p = 0.003 (i.e. the trajectories of change) and improvements plateaued until follow up. Retention was high (92%) and improvements in mental health symptoms, minutes of PA, sedentary time and quality of life were significant.

Conclusions

Our intervention delivered via social media is feasible and associated with reduced levels of psychological distress among emergency service workers and support partners.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN): 12619000877189.

"The potential of social media in health promotion beyond creating awareness: an integrative review"

BACKGROUND

Developing strategies to change health behaviour is one of the biggest challenges of health promotion programs. Social media, as a popular and innovative communication and education tool, offers opportunities to modify health behaviour. While literature on using social media for health promotion campaigns is growing, there is a need to evaluate the approaches used to change health behaviour, rather than only creating awareness.

OBJECTIVE

The paper reviewed the literature on application of social media in health promotion campaigns with a particular focus on the methodologies used in assessing the outcome of the programs for behaviour change. This fills the void in collating evidence to extend health promotion campaigns to effect sustainable behavioural change.

METHOD

Peer-reviewed articles were identified through multiple science databases. A systematic electronic search was conducted to retrieve review and original papers published between January 2010 and April 2022. The titles and abstracts of the articles were screened according to inclusion and exclusion criteria. All authors independently read the full texts and discussed them to reach a consensus about the themes. Concept mapping was used to present results from analysis of the included papers.

RESULTS

Of the 674 citations, 28 (4.1%) studies were included in this review. The methodology approaches of 18 (2.7%) papers, that aimed to evaluate the impact of social media in health promotion campaigns towards behaviour change, were analysed further using concept mapping. The results showed that 10 studies (55.5%) adopted quantitative methods and five studies (27.7%) used mixed methods and three studies (16.6%) used qualitative methods. Facebook and YouTube were used more for intervention purposes to change health behaviour. Twitter and Instagram were used more to observe the trend of changes in health behaviour. Six studies (33.3%) adopted Social Cognitive Theory and one study (5.5%) applied the Transtheoretical Model as the framework to evaluate the outcome. Overall, the results show that though social media has potential in promoting behaviour change, the estimation of this change in long-term lies outside the scope of social media health campaigns. This is also reflected in the methodologies used in existing studies to assess such sustainable changes. The employed measures usually target immediate behaviour or social media engagement rather than addressing the change on a behavioural level.

CONCLUSION

Evaluating the performance of social media campaigns to promote health behaviours towards a sustainable outcome is a complex process. Emerging research is focused on evaluating the potential of social media as an opportunity to create awareness. Such measures require less effort in quantifying and isolating the effect. The design of the campaigns is required to be aligned in relation to stages of the behaviour change. The study provides suggestions on how this can be achieved.

Development, Validation, and Utilization of a Social Media Use and Mental Health Questionnaire among Middle Eastern and Western Adults: A Pilot Study from the UAE

OBJECTIVES

We aimed to develop and validate a mental health stigma measurement tool for use within the social media context, utilizing the tool to assess whether the stigma shown in face-to-face interactions translates to social media, coupled with comparing whether social media use can cause the stigma among a sample of Middle Eastern and Western populations.

METHODS

The development and validation phase comprised a systematic process that was used to develop an assessment tool that could be used within the social media context and establish its validity and reliability. A 5-point Likert-type scale (1 = strongly disagree to 5 = strongly agree) was developed to assess mental health stigma. The anonymous questionnaire was distributed from June 2022 to August 2022 on various social media platforms and groups predominated by the two demographics of interest, enrolling 1328 participants (with only 1001 responses deemed valid). The utilization phase consisted of bivariate and multivariable analysis of the data. The cutoff points for low, medium, and high scores were the 25th, 50th, and 75th percentil, respectively.

RESULTS

The instrument comprised three dimensions: acceptance, intolerance, and digital care sentiment. In the Middle Eastern subset of participants, a higher score of intolerance (more stigma) toward mental illness was found in 72.4% of the participants, with a higher score of acceptance being 35.1% and of digital care sentiment being 46.4%. The mean scores for all the scales were as follows: intolerance (3.08 ± 0.64), acceptance (3.87 ± 0.71), and digital care sentiment (3.18 ± 0.69). For Westerners, a higher score of intolerance toward mental illness was found in 24.0% of the participants, with a higher score of acceptance being 56.8% and of digital care sentiment being 38.2%. The mean scores for all the scales were as follows: intolerance (2.28 ± 0.73), acceptance (4.21 ± 0.61), and digital care sentiment (3.08 ± 0.62). Various results were obtained regarding the effect of individual social media platforms on the different subscales.

CONCLUSIONS

Stigma does follow people on social media, whether they are Middle Easterners or Westerners, although to varying degrees. The results of social media interaction and activity varied based on the group that used them, with some having an impact on one group but not the other. For these reasons, proper guidance is advised when utilizing and interacting with social media platforms.

An Update of Peer Support/Peer Provided Services Underlying Processes, Benefits, and Critical Ingredients

The purpose of this article is to delineate the current state-of-the-knowledge of peer support following the framework employed in the 2004 article (Solomon, Psychiatr Rehabil J. 2004;27(4):392-401 1). A scoping literature was conducted and included articles from 1980 to present. Since 2004, major growth and advancements in peer support have occurred from the development of new specializations to training, certification, reimbursement mechanisms, competency standards and fidelity assessment. Peer support is now a service offered across the world and considered an indispensable mental health service. As the field continues to evolve and develop, peer support is emerging as a standard of practice throughout various, diverse settings and shows potential to impact clinical outcomes for service users throughout the globe. While these efforts have enhanced the professionalism of the peer workforce, hopefully this has enhanced the positive elements of these services and not diluted them.

Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial

OBJECTIVE

Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese.

METHODS

Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m², who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement).

RESULTS

Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01).

CONCLUSION

The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.

Feasibility of an online, mental health-informed lifestyle program for people aged 60+ years during the COVID-19 pandemic

ISSUE ADDRESSED

The COVID-19 pandemic and associated social distancing regulations have disproportionally impacted the health of older adults. Lifestyle interventions targeting physical activity, diet and fostering social connection may help to alleviate the potential negative health consequences. This study aimed to determine the feasibility and preliminary effectiveness of delivering an online group lifestyle intervention for older adults during the COVID-19 pandemic.

METHODS

Adults aged 60+, living in Australia were recruited to a single-arm feasibility study of a 6-week program delivered via a private Facebook group between June-August 2020. Facilitators provided motivation and education on weekly topics including goal setting and reducing sedentary behaviour in the form of Facebook posts and group video calls. Primary outcomes included feasibility and acceptability and secondary outcomes included psychological distress, quality of life (AQoL-6D), functioning, loneliness and physical activity (PA) with assessments conducted at baseline, post-intervention and 4-week follow-up.

RESULTS

N = 11 participants were recruited and n = 10 (91%) completed the post-assessment questionnaires. High acceptability was observed and exploratory analysis from pre-post intervention found evidence of an effect on secondary outcomes.

CONCLUSIONS

A mental health informed lifestyle program delivered online via Facebook appears feasible and well-accepted among older adults and may help to prevent some of the consequences of inactivity and social isolation associated with the pandemic. SO WHAT?: Online lifestyle interventions appear safe and may provide a scalable, cost-effective strategy for protecting the physical and mental health of older adults during the COVID-19 pandemic.

Feasibility of a mental health informed physical activity intervention for the carers of children with developmental and epileptic encephalopathy

AIM

Parents and carers of children with developmental and epileptic encephalopathies (DEEs) experience high rates of mental health disorders including depression and posttraumatic stress disorder. Physical activity is an evidence-based strategy which may help to improve the wellbeing of this population.

METHOD

We delivered a 4-week physical activity group program via a private Facebook group for carers of children with DEEs and their nominated support person. The facilitators provided education and motivation on different weekly topics (e.g. goal setting, overcoming barriers to exercise) and encouraged social support between participants. All participants were provided with a physical activity tracker (Fitbit). The primary outcome was feasibility and secondary outcomes included psychological distress, quality of life, physical activity levels, and PTSD symptoms.

RESULTS

N=20 (parents and support partners) were recruited. All participants remained in the program for the full duration and 85% completed the post assessment questionnaires. High acceptability was observed in the qualitative interviews and exploratory analysis of pre-post outcomes found significant improvements in psychological distress and quality of life (ps < 0.01), while changes in physical activity levels and PTSD symptoms were non-significant.

CONCLUSION

A mental health informed physical activity program delivered via Facebook is feasible for carers of children with DEEs and may help improve wellbeing.

Overview of Facebook Use by Hospitals in Italy: A Nationwide Survey during the COVID-19 Emergency

Background: Facebook is the most popular social network across the world and also allows users access to health information. Our study presents an overview of the official Facebook profiles of hospitals in Italy (n = 1351) and how much they are used. Methods: All hospitals were surveyed on the number of Facebook posts in May (post-lockdown) and October (second pandemic wave) 2020. The number of followers, the creation date of the official page, and the frequency of publication—that is, the average number of days between two subsequent posts—were determined. Results: In Italy, only 28% (n = 379) of the hospitals had official Facebook pages, of which 20.6% (n = 78) were public hospitals, and 79.4% (n = 301) were private hospitals. Of the hospitals with Facebook pages, 49.1% used them every week, and public hospitals published more often. Conclusions: Despite the differences between regions and types of management, the number of hospitals in Italy that use Facebook as a tool for the public dissemination of health information is still low. Hospitals should adopt an effective communication strategy using social networks to improve the quality of health care.

A Mental Health-Informed Physical Activity Intervention for First Responders and Their Partners Delivered Using Facebook: Mixed Methods Pilot Study

BACKGROUND

First responders (eg, police, firefighters, and paramedics) are at high risk of experiencing poor mental health. Physical activity interventions can help reduce symptoms and improve mental health in this group. More research is needed to evaluate accessible, low-cost methods of delivering programs. Social media may be a potential platform for delivering group-based physical activity interventions.

OBJECTIVE

This study aims to examine the feasibility and acceptability of delivering a mental health-informed physical activity program for first responders and their self-nominated support partners. This study also aims to assess the feasibility of applying a novel multiple time series design and to explore the impact of the intervention on mental health symptoms, sleep quality, quality of life, and physical activity levels.

METHODS

We co-designed a 10-week web-based physical activity program delivered via a private Facebook group. We provided education and motivation around different topics weekly (eg, goal setting, overcoming barriers to exercise, and reducing sedentary behavior) and provided participants with a Fitbit. A multiple time series design was applied to assess psychological distress levels, with participants acting as their own control before the intervention.

RESULTS

In total, 24 participants (12 first responders and 12 nominated support partners) were recruited, and 21 (88%) completed the postassessment questionnaires. High acceptability was observed in the qualitative interviews. Exploratory analyses revealed significant reductions in psychological distress during the intervention. Preintervention and postintervention analysis showed significant improvements in quality of life (P=.001; Cohen d=0.60); total depression, anxiety, and stress scores (P=.047; Cohen d=0.35); and minutes of walking (P=.04; Cohen d=0.55). Changes in perceived social support from family (P=.07; Cohen d=0.37), friends (P=.10; Cohen d=0.38), and sleep quality (P=.28; Cohen d=0.19) were not significant.

CONCLUSIONS

The results provide preliminary support for the use of social media and a multiple time series design to deliver mental health-informed physical activity interventions for first responders and their support partners. Therefore, an adequately powered trial is required.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN): 12618001267246; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001267246.

Co-production development of a decision support tool for peers and service users to choose technologies to support recovery

Peer support specialists (i.e., lay interventionists representing one of the fastest-growing mental health workforce) are increasingly using technologies to support individuals with mental health challenges between clinical encounters. The use of technology by peers has been significantly increased During COVID-19. Despite the wide array of technologies available, there is no framework designed specifically for peer support specialists and service users to select technologies to support their personal recovery. The objective of the study was to develop a Decision-Support Tool for Peer Support Specialists and Service Users to facilitate shared decision-making when choosing technologies to support personal recovery. The study used an iterative co-production process, including item formulation and a series of group cognitive interviews with peer support specialists and service users (n=9; n=9, n=4). The total sample included 22 participants: peer support specialists (n=18, 81.8%) and service users (n=4, 18.2%). The final version of the Decision-Support Tool for Peer Support Specialists and Service Users (D-SPSS), includes 8 domains: (1) privacy and security; (2) cost; (3) usability; (4) accessibility; (5) inclusion and equity; (6) recovery principles; (7) personalized for service users' needs; and (8) device set-up. Our study found that involving peer support specialists and service users in the design and co-production phase of a decisionsupport tool is feasible and has the potential to empower both peer support specialists and service users, and potentially increase engagement in the use of technologies that support individuals' recovery from traditional clinical encounters.

Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice

Social media platforms are popular venues for sharing personal experiences, seeking information, and offering peer-to-peer support among individuals living with mental illness. With significant shortfalls in the availability, quality, and reach of evidence-based mental health services across the United States and globally, social media platforms may afford new opportunities to bridge this gap. However, caution is warranted, as numerous studies highlight risks of social media use for mental health. In this commentary, we consider the role of social media as a potentially viable intervention platform for offering support to persons with mental disorders, promoting engagement and retention in care, and enhancing existing mental health services. Specifically, we summarize current research on the use of social media among mental health service users, and early efforts using social media for the delivery of evidence-based programs. We also review the risks, potential harms, and necessary safety precautions with using social media for mental health. To conclude, we explore opportunities using data science and machine learning, for example by leveraging social media for detecting mental disorders and developing predictive models aimed at characterizing the aetiology and progression of mental disorders. These various efforts using social media, as summarized in this commentary, hold promise for improving the lives of individuals living with mental disorders.

Making and Receiving Offers of Help on Social Media Following Disaster Predict Posttraumatic Growth but not Posttraumatic Stress

Objectives:

Social media provides an opportunity to engage in social contact and to give and receive help by means of online social networks. Social support following trauma exposure, even in a virtual community, may reduce feelings of helplessness and isolation, and, therefore, reduce posttraumatic stress symptoms (PTS), and increase posttraumatic growth (PTG). The current study aimed to assess whether giving and/or receiving offers of help by means of social media following large community fires predicted PTS and/or PTG.

Methods:

A convenience sample of 212 adults living in communities that were affected by large-scale community fires in Israel (November 2016) completed questionnaires on giving and receiving offers of help by means of social media within 1 mo of the fire (W1), and the PTSD checklist for DSM-5 (PCL-5) and PTG questionnaire (PTGI-SF), 4 mo after the fire (W2).

Results:

Regression analyses showed that, after controlling for age, gender, and distance from fire, offering help by means of social media predicted higher PTG (β = 0.22; t = 3.18; P < 0.01), as did receiving offers of help by means of social media (β = 0.18; t = 2.64; P < 0.01). There were no significant associations between giving and/or receiving offers of help and PTS.

Conclusions:

Connecting people to social media networks may help in promoting posttraumatic growth, although might not impact on posttraumatic symptoms. This is one of the first studies to highlight empirically the advantages of social media in the aftermath of trauma exposure.

Mental illness on Instagram: a mixed method study to characterize public content, sentiments, and trends of antidepressant use

BACKGROUND

Individuals with mental illness use social media to share treatment experiences and anecdotal information. Despite the significant impact of social media on individuals with mental illness, posts related to antidepressants have not been studied systematically.

AIMS

This study evaluates public sentiments and content posted on Instagram regarding the use of antidepressants.

METHODS

Instagram posts from July 2010 to June 30, 2018 containing hashtags of commonly prescribed antidepressants and anxiety/depression-related terms were gathered (n = 13,096). Approximately 1,000 posts were randomly selected and evaluated for photo content, anecdotal experiences, sentiments towards antidepressants, and mentions of psychotherapy, comorbidities, polypharmacy, or adverse effects.

RESULTS

Instagram posts describing antidepressant use have increased exponentially from 2010, and 43% provided anecdotal experiences. Among these posts, 58% expressed negative sentiments towards antidepressant usage, citing adverse effects and lack of improvement. Posts that also mentioned psychotherapy, comorbidities, or polypharmacy differed in their collective sentiments. Misinformation was present in analyzed posts, and none mentioned recovery-oriented materials (i.e., mental health facility, hotline, etc.).

CONCLUSIONS

Instagram is a useful resource for exploring public sentiments related to antidepressant use. Mental health professionals should be cognizant of these sentiments/perceptions in order to tailor communication with patients and should consider increasing their social media presence.

'Keeping It Real': women's Enactments of Lay Health Knowledges and Expertise on Facebook

This article presents findings from a qualitative study concerning Australian women's use of Facebook for health and medical information and support and the implications for understanding modes of lay knowledge and expertise. Thinking with feminist new materialism theory, we identify the relational connections, affective forces and agential capacities described by participants as technological affordances came together with human bodily affordances. Affective forces were a dominant feature in users' accounts. Women were able to make relational connections with peers based on how valid or relevant they found other group members' expertise and experiences, how supportive other members were, how strong they wanted their personal connection to be and how much privacy they wanted to preserve. We identified three modes of engagement: 1) expertise claims based on appropriation and distribution of biomedical knowledge and experience; 2) sharing experiential knowledge without claiming expertise and 3) evaluation and use of knowledge presented by others principally through observing. We conclude that an 'expert patient' is someone who is familiar with the rules of engagement on sites such as Facebook and is able to negotiate and understand the affects and levels of disclosure and intimacy that such engagement demands.

Patterns and Longitudinal Changes in Negative Emotions of People with Depression on Sina Weibo

Background: This study investigates negative emotional patterns of people with depression on Sina Weibo™ and gives an in-depth analysis of how their negative emotions change over time. Materials and Methods: A text classifier using deep learning methods was built to identify people on Sina Weibo with depression and associated negative emotions. The longitudinal changes in negative emotions were assessed using time series and cluster analysis. Results: Results indicate that people with depression (n = 616) were more active and expressed more negative emotions on social media compared with control users (n = 3,176). Furthermore, negative emotions of people with depression were mostly about their depression issues, such as treatment, hopelessness, suicidal ideation, or self-injury. Both groups of users usually expressed negative emotions in the late evening and early morning hours. Finally, longitudinal changes in negative emotions illustrate that users with depression tended to have relatively high negative emotions in the month when they started using social media to reveal their depression issues and that they exhibited three main evolutionary patterns of negative emotions on social media. Conclusions: Findings from the study could be used to track and monitor negative emotional states of people with depression on social media, in addition to providing an in-depth understanding of how negative emotions change over time, so that better intervention strategies can be adopted to assist them.

Mental health informed physical activity for first responders and their support partner: a protocol for a stepped-wedge evaluation of an online, codesigned intervention

BACKGROUND

First responders (police, fire and ambulance officers) are at a significantly increased risk of experiencing poor mental health, including depression and post-traumatic stress disorder. These conditions are associated with high rates of cardiovascular disease, in part due to low levels of physical activity (PA) and high levels of sedentary behaviour. Using a person's social support system may be an effective solution to help increase PA levels to improve mental and physical health outcomes. We will examine the efficacy of a group-based online intervention in increasing PA in first responders and their support partners, iteratively codesigned with advisors with lived experience of mental illness among first responders.

METHODS

This study will recruit a convenience sample of self-identified sedentary first responders and their self-selected support partners to a 10-week PA programme delivered through a private Facebook group. We will deliver education on predetermined topics related to PA and diet and provide participants with an activity tracker (Fitbit). A stepped-wedged design will be applied to compare multiple baselines to intervention and follow-up phases within subjects. Five cohorts of n=20 will be recruited, with each cohort randomised to a different baseline length. Our primary outcome will be psychological distress (Kessler-6). Secondary outcomes include feasibility, self-report and objective PA data (Simple Physical Activity Questionnaire and Fitbit accelerometry), depression and anxiety (Depression Anxiety and Stress Scale-21 items), post-traumatic stress disorder symptoms (PTSD Checklist for DSM-5), quality of life Assessment of Quality of Life-6 dimensions, sleep quality (The Pittsburgh Sleep Quality Index), suicidal ideation (Suicidal Ideation Attributes Scale) and social support for exercise. The mobile data collection platform MetricWire will be used.

ETHICS AND DISSEMINATION

Ethical approval was obtained from the University of New South Wales, Deupty Vice-Chancellor Research, Human Research Ethics Committee on 3 June 2019, HC180561. Findings will be published in peer-reviewed journals and disseminated at national conferences.

TRIAL REGISTRATION NUMBER

ACTRN12619000877189.

Feasibility and acceptability of a midwife-led health education strategy to reduce exposure to biomass smoke among pregnant women in Uganda, A FRESH AIR project

Biomass smoke exposure is a threat to child and maternal health in many resource-limited countries and is associated with poor pregnancy outcomes and serious lung diseases in the offspring. We aimed to assess the feasibility, acceptability and impact of a midwife-led education programme on biomass risks and prevention for women attending maternity clinics in Uganda. Education materials were co-developed through an iterative process by midwives and other stakeholders. The materials were serially tested and approved by the Ministry of Health and used by midwives and village health teams (VHTs). The district health team, 12 midwives and 40 VHTs were sensitised on biomass smoke. Two hundred and forty-four women were educated about biomass smoke by midwives; pre- and post-session questionnaires showed major improvements in knowledge of biomass smoke risks. Qualitative interviews with women three months after the sessions showed that they made behavioural changes such as avoiding smoke while cooking, using dry wood, solar power for lighting and improved ventilation. The major barrier to behavioural changes was poverty, but some improvements cost no money. The programme delivered by midwives was feasible and acceptable; implementing this programme has the potential to reduce exposure to smoke with major benefits to mother, foetus, and children throughout their lives.

Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders

Persons with severe mental disorders (SMDs) experience dramatically reduced life expectancy compared with the general population. We consider the role of digital technologies for addressing this serious public health concern. In this clinical review, we apply the multilevel risk model recently introduced by the WHO to conceptualise how digital technology can support efforts to reduce excess mortality risk at the individual, health system and social determinants of health levels. In particular, digital technologies show promise for targeting preventable physical health conditions in persons with SMDs. However, evidence on the use of these technologies for addressing early mortality risk factors is lacking. At the individual level, digital interventions show promise for managing mental health symptoms, promoting healthy lifestyle behaviours and targeting substance use concerns. At the health system level, digital interventions can support care coordination, clinician training, screening and monitoring health indices and shared decision-making. At the social determinants of health level, digital interventions can facilitate opportunities to engage peers for illness self-management and health promotion and for delivering and/or augmenting supported employment programmes. The time is ripe to capitalise on early evidence to support future development, testing and delivery of effective digital efforts targeting risk factors that contribute to shorter life expectancy in persons with SMDs. Key challenges and opportunities for future research include increasing user engagement, involving users during development and testing of digital interventions, carefully considering risks/harms and rigorously evaluating effectiveness and costs to support the scalability and sustainability of promising digital approaches.

Atención psicológica y Tecnologías: oportunidades y conflictos

Los desarrollos tecnológicos pueden ser un complemento a la atención tradicional, por ello primero se revisa el impacto que tiene la tecnología en la alianza de trabajo terapéutico. A continuación se señalan algunos recursos tecnológicos disponibles para la actividad psicológica, así como una clasificación de las tecnologías. Finalmente se revisan las posibles ventajas y riesgos en la aplicación de tratamiento mediados por tecnologías, así como los resultados en cuanto a efectividad.

Developing digital applications for tailored communication in orthopaedics using a Research through Design approach

OBJECTIVE

Tailored communication and information provision is expected to contribute to patient-centred care (PCC) in total hip arthroplasty (THA). In previous research, three subgroups of THA patients were identified that are similar in their clinical, psychological and communication characteristics. Preliminary subgroup-specific design guidelines were also formulated. Using these insights as a starting point, a theoretical framework was developed for tailored information provision and communication using digital applications. This study aims to refine the framework as well as subgroup-specific design guidelines for digital applications.

METHODS

This study uses a Research through Design (RtD) approach, generating insights both from the development and evaluation of prototypes in the early design stage. Paper-based prototypes will be made for each subgroup and evaluated with patients and care providers. Semi-structured interviews are held with participants exploring their experiences with the prototype. A quasi-experiment with a non-random control cohort is used to validate the qualitative findings. Post-surgery consultations with and without prototype are videotaped and scored using a structured instrument.

RESULTS

A design diary will be used to summarize design decisions and considerations. Feedback from participants is analysed inductively. Adaptations in subgroup-specific guidelines will be based on comparison of verbal feedback and descriptive statistics from consultations with and without prototype.

CONCLUSIONS

Although mixed-method feasibility studies of digital health interventions are common, this protocol also considers the utility of the early design process and the designer's perspective for realizing PCC and tailored care.

How to Optimize Health Messages About Cancer on Facebook: Mixed-Methods Study

BACKGROUND

Incidence rate of cancer is increasing worldwide, with longer life expectancy being one of the main causes. Yet, between 30% and 50% of cancer cases are preventable, and early detection contributes to a better prognosis. This makes health communication strategies essential. Facebook, the world's most used social networking site in 2017 and 2018, can be a useful tool for disseminating powerful messages on health promotion, prevention, and early detection.

OBJECTIVE

We aimed to (1) offer ways of optimizing health messages about cancer on Facebook, focusing on topics, such as risk factors, prevention, treatment, early diagnosis, and cure, and (2) investigate which aspects of these messages generate greater engagement.

METHODS

To verify what generates greater engagement in topics related to cancer on Facebook, we analyzed 16 Brazilian pages with the main theme of cancer. We performed a manual analysis of texts, content, and engagement rates. Finally, we developed a software program to operationalize the analysis of Facebook posts. The tool we devised aims to automate the analysis of any Facebook page with cancer as the main theme.

RESULTS

We analyzed 712 posts over a 1-month period. We divided the posts into the following 8 categories: "Testimonies or real-life stories," "Solidarity," "Anniversaries," "Science and health," "Events," "Institutional," "Risk factors," and "Beauty." The pages were also organized into groups according to the type of profile to which they belonged (ie, hospitals or foundations, informative, nongovernmental organizations, and personal pages).The results showed that the categories generating greater engagement in Brazil were not those with the highest percentage of cancer-related content. For instance, in the "Informative" group the "Testimonies or real-life stories" category generated an engagement of 79.5%. However, only 9.5% (25/261) of the content within the relevant time period dealt with such topics. Another example concerns the category "Science and health." Despite being the one with the highest number of posts (129/261, 49.4%), it scored 5th in terms of engagement. This investigation served as the basis for the development of a tool designed to automate the analysis of Facebook pages. The list of categories and keywords generated by this analysis was employed to feed the system, which was then able to categorize posts appearing on a Facebook page. We tested the system on 163 posts and only 34 were classified incorrectly, which amounts to a 20.8% error rate (79.2% accuracy).

CONCLUSIONS

The analysis we conducted by categorizing posts and calculating engagement rates shows that the potential of Facebook pages is often underutilized. This occurs because the categories that generate the greatest engagement are often not those most frequently used. The software developed in this research may help administrators of cancer-related pages analyze their posts more easily and increase public interest as a result.

Social media and its relationship with mood, self-esteem and paranoia in psychosis

OBJECTIVE

An evidence-base is emerging indicating detrimental and beneficial effects of social media. Little is known about the impact of social media use on people who experience psychosis.

METHOD

Forty-four participants with and without psychosis completed 1084 assessments of social media use, perceived social rank, mood, self-esteem and paranoia over a 6-day period using an experience sampling method (ESM).

RESULTS

Social media use predicted low mood, but did not predict self-esteem and paranoia. Posting about feelings and venting on social media predicted low mood and self-esteem and high paranoia, whilst posting about daily activities predicted increases in positive affect and self-esteem and viewing social media newsfeeds predicted reductions in negative affect and paranoia. Perceptions of low social rank when using social media predicted low mood and self-esteem and high paranoia. The impact of social media use did not differ between participants with and without psychosis; although, experiencing psychosis moderated the relationship between venting and negative affect. Social media use frequency was lower in people with psychosis.

CONCLUSION

Findings show the potential detrimental impact of social media use for people with and without psychosis. Despite few between-group differences, overall negative psychological consequences highlight the need to consider use in clinical practice.

Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial

BACKGROUND

Individuals with serious mental illness (SMI) such as schizophrenia and bipolar disorder face a higher risk of early death due to cardiovascular disease and other preventable chronic illnesses. Young adulthood is a critical window of development for lifestyle interventions to improve the long-term health and quality of life in this population. Fit Forward is an NIH-funded randomized clinical trial examining the effectiveness of a group lifestyle intervention (PeerFIT) enhanced with mobile health technology compared to one-on-one mobile lifestyle coaching with Basic Education in fitness and nutrition supported by a wearable Activity Tracking device (BEAT) in achieving clinically significant weight loss and improved cardiorespiratory fitness in young adults with SMI.

METHODS

Fit Forward targets 144 young adults (18 to 35 years) with SMI and a body mass index (BMI) of ≥25 receiving public mental health services. In a two-arm randomized clinical trial, participants will be randomly assigned with equal probability to PeerFIT or BEAT, stratified by birth sex and psychiatric diagnosis. Participants will be assessed at baseline, 6, and 12 months. The primary outcome is cardiovascular risk reduction indicated by either clinically significant weight loss (5% or greater) or increased fitness (>50 m on the 6-Minute Walk Test). Secondary outcomes include change in BMI, lipids, and hemoglobin A1c. Perceived self-efficacy for exercise and peer support will be evaluated as mechanisms underlying intervention effects.

CONCLUSION

If effective, PeerFIT will provide a potentially scalable approach to addressing health risks among young adults with SMI in mental health settings.

TRIALS REGISTRATION

ClinicalTrials.gov, NCT02815813.

A Survey of Online and Mobile Technology Use at Peer Support Agencies

Understanding how individuals with mental illness who receive services at peer support agencies use technology can inform the development of online and mobile health interventions tailored for users in these non-traditional mental health settings. The purpose of this study was to assess the use of technology among individuals with mental illness at peer support agencies. A survey delivered within peer support agencies (PSAs) in one state assessed technology use among individuals ages 18 and over with a self-identified mental illness receiving services at these agencies. In total, 195 individuals from 10 PSAs completed the survey. Eighty-two percent of respondents used the internet, with 63% of respondents connected to the internet at the PSAs. Eighty one percent of respondents owned a cell phone, 70% used text messaging, 58% owned smartphones, 61% used mobile applications, and 72% used social media. PSA users under age 55 were significantly more likely to own a smartphone than PSA users age 55 and older. Among internet users, 71% had searched for health information online and 57% had searched for mental health information online. Many individuals who receive services at PSAs have access to online and mobile technologies. These technologies may be leveraged to expand the reach of evidence-based health and mental health programs to individuals in these non-traditional mental health settings. Future research should explore the feasibility of intervention strategies that involve PSAs as a resource for linking people with mental illness to online and mobile support for their health and wellness goals.

Facebook for Supporting a Lifestyle Intervention for People with Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: an Exploratory Study

To examine whether Facebook could support a community-based group lifestyle intervention for adults with serious mental illness. Participants with serious mental illness and obesity enrolled in a 6-month group lifestyle program were invited to join a secret Facebook group to support their weight loss and physical activity goals. Two peer co-facilitators moderated the Facebook group. The proportion of participants who achieved ≥5% weight loss or improved fitness was measured at follow-up. The relationship between this outcome and participants' interactions in the Facebook group was examined. Interactions were defined as active contributions including posts, comments, or likes. Content of participants' Facebook posts was also explored. Participants (n = 25) had major depression (44%), bipolar disorder (36%), and schizophrenia (20%). Nineteen (76%) participants joined the Facebook group, and contributed 208 interactions (70 posts; 81 comments; 57 likes). Participants who achieved ≥5% weight loss or improved fitness contributed more interactions in the Facebook group (mean = 19.1; SD = 20.5) compared to participants who did not (mean = 3.9; SD = 6.7), though this relationship approached statistical significance (t = -2.1; Welch's df = 13.1; p = 0.06). Participants' posts containing personal sharing of successes or challenges to adopting healthy behaviors generated more interaction compared to posts containing program reminders (p < 0.01), motivational messages (p < 0.01), and healthy eating content (p < 0.01). Facebook appears promising for supporting health behavior change among people with serious mental illness. These findings can inform social media initiatives to scale up health promotion efforts targeting this at-risk group.

Use of the Internet and Mobile Phones for Self-Management of Severe Mental Health Problems: Qualitative Study of Staff Views

BACKGROUND

Researchers are currently investigating the feasibility, acceptability, and efficacy of digital health interventions for people who experience severe mental health problems such as psychosis and bipolar disorder. Although the acceptability of digital health interventions for severe mental health problems appears to be relatively high and some people report successfully using the Internet and mobile phones to manage their mental health, the attitudes of mental health care staff toward such approaches have yet to be considered.

OBJECTIVE

The aim of this study was to explore mental health care staff experiences of clients with severe mental health problems engaging with the Internet and mobile phones to self-manage their mental health and their views toward these behaviors. The study also sought to examine the opinions expressed by mental health care staff toward digital health interventions for severe mental health problems to identify potential facilitators and barriers to implementation.

METHODS

Four focus groups were conducted with 20 staff working in mental health care services in the North West of the England using a topic guide. Focus groups involved 12 staff working in secondary care psychological services (7 participants in focus group 1 and 5 participants in focus group 4), 4 staff working in a rehabilitation unit (focus group 2), and 4 staff working in a community mental health team (focus group 3). Focus groups were transcribed verbatim, and transcripts were analyzed thematically to identify key themes that emerged from the data.

RESULTS

Four overarching themes, two with associated subthemes, were identified: (1) staff have conflicting views about the pros and cons of using Web-based resources and digital health interventions to manage mental health; (2) digital health interventions could increase access to mental health support options for severe mental health problems but may perpetuate the digital divide; (3) digital health interventions' impact on staff roles and responsibilities; and (4) digital health interventions should be used to enhance, not replace, face-to-face support.

CONCLUSIONS

This study is the first, to our knowledge, to qualitatively explore the experiences and attitudes of mental health care staff toward individuals with severe mental health problems using the Internet, mobile phones, and digital health interventions to self-manage their mental health. Understanding the positive and negative experiences and views shared by staff toward both current and potential digital health intervention use has enabled the identification of several considerations for implementation. Additionally, the findings suggest mental health care staff need clear guidance and training in relation to their responsibilities in recommending reputable and secure websites, forums, and digital health interventions and in how to manage professional boundaries on the Internet. Overall, the study highlights that digital health interventions could be well received by staff working in mental health services but importantly, such management options must be presented to frontline staff as an avenue to enhance care and extend choice, rather than as a method to reduce costs.

Feasibility of Behavioral Weight Loss Treatment Enhanced with Peer Support and Mobile Health Technology for Individuals with Serious Mental Illness

Effective and scalable lifestyle interventions are needed to address high rates of obesity in people with serious mental illness (SMI). This pilot study evaluated the feasibility of a behavioral weight loss intervention enhanced with peer support and mobile health (mHealth) technology for obese individuals with SMI. The Diabetes Prevention Program Group Lifestyle Balance intervention enhanced with peer support and mHealth technology was implemented in a community mental health setting. Thirteen obese individuals with SMI participated in a pre-post pilot study of the 24-week intervention. Feasibility was assessed by program attendance, and participant satisfaction and suggestions for improving the model. Descriptive changes in weight and fitness were also explored. Overall attendance amounted to approximately half (56 %) of weekly sessions. At 6-month follow-up, 45 % of participants had lost weight, and 45 % showed improved fitness by increasing their walking distance. Participants suggested a number of modifications to increase the relevance of the intervention for people with SMI, including less didactic instruction and more active learning, a simplified dietary component, more in depth technology training, and greater attention to mental health. The principles of standard behavioral weight loss treatment provide a useful starting point for promoting weight loss in people with SMI. However, adaptions to standard weight loss curricula are needed to enhance engagement, participation, and outcomes to respond to the unique challenges of individuals with SMI.