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Lostelius PV, Gustavsson C, Adolfsson ET, Söderlund A, Revenäs Å, Zakrisson AB, Mattebo M. Identification of health-related problems in youth: a mixed methods feasibility study evaluating the Youth Health Report System. BMC Med Inform Decis Mak 2024; 24:64. [PMID: 38443898 PMCID: PMC10913260 DOI: 10.1186/s12911-024-02465-8] [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: 06/14/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. METHODS This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16-23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants' quantitative Youth Health Report System data were analyzed for descriptive statistics. RESULTS Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. CONCLUSIONS The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.
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Affiliation(s)
- Petra V Lostelius
- Centre for Innovation, Research and Education, Region Västmanland, Västmanland Hospital Västerås, Västerås, Sweden.
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
- Clinic for Pain Rehabilitation Västmanland, Region Västmanland, Västerås, Sweden.
- Centre for Clinical Research, Region Västmanland- Uppsala University, Västerås, Sweden.
| | - Catharina Gustavsson
- Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research, Region Västmanland- Uppsala University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Åsa Revenäs
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Centre for Clinical Research, Region Västmanland- Uppsala University, Västerås, Sweden
- Orthopedic Clinic, Västerås Hospital Region Västmanland, Västerås, Sweden
| | - Ann-Britt Zakrisson
- University Health Care Research Center, Faculty of Medicine, and Health, Örebro University, Örebro, Sweden
| | - Magdalena Mattebo
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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2
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Walsh AEL, Naughton G, Sharpe T, Zajkowska Z, Malys M, van Heerden A, Mondelli V. A collaborative realist review of remote measurement technologies for depression in young people. Nat Hum Behav 2024; 8:480-492. [PMID: 38225410 PMCID: PMC10963268 DOI: 10.1038/s41562-023-01793-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/20/2023] [Indexed: 01/17/2024]
Abstract
Digital mental health is becoming increasingly common. This includes use of smartphones and wearables to collect data in real time during day-to-day life (remote measurement technologies, RMT). Such data could capture changes relevant to depression for use in objective screening, symptom management and relapse prevention. This approach may be particularly accessible to young people of today as the smartphone generation. However, there is limited research on how such a complex intervention would work in the real world. We conducted a collaborative realist review of RMT for depression in young people. Here we describe how, why, for whom and in what contexts RMT appear to work or not work for depression in young people and make recommendations for future research and practice. Ethical, data protection and methodological issues need to be resolved and standardized; without this, RMT may be currently best used for self-monitoring and feedback to the healthcare professional where possible, to increase emotional self-awareness, enhance the therapeutic relationship and monitor the effectiveness of other interventions.
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Affiliation(s)
- Annabel E L Walsh
- The McPin Foundation, London, UK.
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | | | - Thomas Sharpe
- Young People's Advisory Group, The McPin Foundation, London, UK
| | - Zuzanna Zajkowska
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mantas Malys
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alastair van Heerden
- Centre for Community-based Research, Human and Social Capabilities Department, Human Sciences Research Council, Johannesburg, South Africa
- MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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3
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Otero-González I, Pacheco-Lorenzo MR, Fernández-Iglesias MJ, Anido-Rifón LE. Conversational agents for depression screening: A systematic review. Int J Med Inform 2024; 181:105272. [PMID: 37979500 DOI: 10.1016/j.ijmedinf.2023.105272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
OBJECTIVE This work explores the advances in conversational agents aimed at the detection of mental health disorders, and specifically the screening of depression. The focus is put on those based on voice interaction, but other approaches are also tackled, such as text-based interaction or embodied avatars. METHODS PRISMA was selected as the systematic methodology for the analysis of existing literature, which was retrieved from Scopus, PubMed, IEEE Xplore, APA PsycINFO, Cochrane, and Web of Science. Relevant research addresses the detection of depression using conversational agents, and the selection criteria utilized include their effectiveness, usability, personalization, and psychometric properties. RESULTS Of the 993 references initially retrieved, 36 were finally included in our work. The analysis of these studies allowed us to identify 30 conversational agents that claim to detect depression, specifically or in combination with other disorders such as anxiety or stress disorders. As a general approach, screening was implemented in the conversational agents taking as a reference standardized or psychometrically validated clinical tests, which were also utilized as a golden standard for their validation. The implementation of questionnaires such as Patient Health Questionnaire or the Beck Depression Inventory, which are used in 65% of the articles analyzed, stand out. CONCLUSIONS The usefulness of intelligent conversational agents allows screening to be administered to different types of profiles, such as patients (33% of relevant proposals) and caregivers (11%), although in many cases a target profile is not clearly of (66% of solutions analyzed). This study found 30 standalone conversational agents, but some proposals were explored that combine several approaches for a more enriching data acquisition. The interaction implemented in most relevant conversational agents is text-based, although the evolution is clearly towards voice integration, which in turns enhances their psychometric characteristics, as voice interaction is perceived as more natural and less invasive.
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4
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Bazargan M, Dehghani A, Ramezani MA, Ramezani A. Prevalence of depression among Iranian children and adolescents: An updated systematic review and meta-analysis. Health Sci Rep 2023; 6:e1584. [PMID: 37795313 PMCID: PMC10545890 DOI: 10.1002/hsr2.1584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/03/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
Background and Aims One of the most common mental disorders among children and adolescent is depression. Some of the conducted studies indicate a too-high prevalence of depression, which cannot be generalized to the entire country. So the pooled estimation of the results of different studies is very important to reach valid results. So the current study aimed to determine the prevalence of depression among Iranian children and adolescents using an updated systematic review and meta-analysis. Methods A random-effects model was used to estimate the pooled prevalence of depression (I 2 = 99.7% and Cochran's Q, p < 0.001). To assess the effect of different factors on heterogeneity, the univariate meta-regression model was used. Publication bias was evaluated by Beggs and Eggers tests as well as funnel plots. Data were analyzed by STATA v 11 (StataCorp.). The significance level of the tests was considered less than 0.05. Results The prevalence of depression was 33.3% (95% CI: 27.3-39.2). The most prevalence estimated using the Beak questionnaire (57.1% [95% CI: 50.2-64.0]) and the lowest was estimated using the K-SADS-PL (9.0% [95% CI: 4.0-13.6]). This estimate among females was more than among males (47.2% [95% CI: 35.4-58.9] vs. 30.5 [95% CI: 7.4-53.6]). Regarding the geographical region, the most and the lowest amount of depression was seen in the central with 41.7% (95% CI: 19.2-64.3) and southern region with 21.9% (95% CI: 14.2-29.6), respectively. Conclusion The high prevalence of depressive disorders in Iranian children emphasizes the importance of prevention measures for these disorders.
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Affiliation(s)
- Maedeh Bazargan
- Department of Psychology, Najafabad BranchIslamic Azad UniversityNajafabadIran
| | - Akram Dehghani
- Department of Psychology, Najafabad BranchIslamic Azad UniversityNajafabadIran
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Nabayinda J, Kizito S, Ssentumbwe V, Namatovu P, Sensoy Bahar O, Damulira C, Nabunya P, Kiyingi J, Namuwonge F, Mwebembezi A, McKay MM, Ssewamala FM. The Relationship Between Family Cohesion and Depression Among School-Going Children With Elevated Symptoms of Behavioral Challenges in Southern Uganda. J Adolesc Health 2023; 72:S11-S17. [PMID: 37062578 PMCID: PMC10161871 DOI: 10.1016/j.jadohealth.2022.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 11/28/2022] [Accepted: 12/09/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE Depression is among the leading causes of disability and contributes significantly to the overall disease burden affecting children. Family cohesion has been identified as a protective factor against depression. Examining this relationship is necessary in sub-Saharan Africa, specifically in Uganda-a country characterized by a high prevalence of HIV/AIDS, and high rates of chronic poverty, all of which stress family functioning and elevate child behavioral challenges. This study examined the relationship between family cohesion and depression among school-going children with elevated symptoms of behavioral challenges in southern Uganda. METHODS At baseline, 2089 children were enrolled in the National Institutes of Health-funded Strengthening Mental Health and Research Training Africa study in Southwestern Uganda. This article analyzed data from 626 children aged 8-13 years with elevated behavioral challenges. We conducted multilevel mixed-effects Poisson regression to determine the association between family cohesion and depression. We controlled for sociodemographic and household characteristics. RESULTS The mean age was 10.3 years. The overall mean depression score was 3.2 (standard deviation = 2.7, range = 0-15). Family cohesion (β = -0.03, 95% confidence interval [CI]: -0.04, -0.02, p < .001) and owning essential items by the child (β = -0.13, 95% CI: -0.23, -0.04, p = .005) were protective against depression among children. Additionally, we observed being a single orphan (β = -0.44, 95% CI: -0.03, -0.86, p = .036) and having both parents (β = -0.43, 95% CI: -0.06, -0.81, p = .023) were associated with depression among children. DISCUSSION Findings from this study reveal that family cohesion was protective against depression. Therefore, it is vital to strengthen family support systems by developing programs aimed at strengthening family relationships as a catalyst for addressing depression among children.
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Affiliation(s)
| | - Samuel Kizito
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Vicent Ssentumbwe
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Phionah Namatovu
- International Centre for Child Health and Development, Masaka Field Office, Masaka, Uganda
| | - Ozge Sensoy Bahar
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | | | - Proscovia Nabunya
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Joshua Kiyingi
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Centre for Child Health and Development, Masaka Field Office, Masaka, Uganda
| | | | - Mary M McKay
- Brown School Washington University in St. Louis, St. Louis, Missouri
| | - Fred M Ssewamala
- Brown School Washington University in St. Louis, St. Louis, Missouri.
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Saunders V, McCalman J, Tsey S, Askew D, Campbell S, Jongen C, Angelo C, Spurling G, Cadet-James Y. Counting what counts: a systematic scoping review of instruments used in primary healthcare services to measure the wellbeing of Indigenous children and youth. BMC PRIMARY CARE 2023; 24:51. [PMID: 36803458 PMCID: PMC9936129 DOI: 10.1186/s12875-023-02001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 02/02/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Primary healthcare services have principal responsibility for providing child and youth wellbeing and mental health services, but have lacked appropriate measurement instruments to assess the wellbeing of Indigenous children and youth or to evaluate the effectiveness of programs and services designed to meet their needs. This review assesses the availability and characteristics of measurement instruments that have been applied in primary healthcare services in Canada, Australia, New Zealand and the United States (CANZUS countries) to assess the wellbeing of Indigenous children and youth. METHODS Fifteen databases and 12 websites were searched in December 2017 and again in October 2021. Pre-defined search terms pertained to Indigenous children and youth, CANZUS country names, and wellbeing or mental health measures. PRISMA guidelines were followed, with eligibility criteria guiding screening of titles and abstracts, and selected full-text papers. Results are presented based on the characteristics of documented measurement instruments assessed according to five desirability criteria: development for Indigenous youth populations, adherence to relational strength-based constructs, administration by child and or youth self-report, reliability and validity, and usefulness for identifying wellbeing or risk levels. RESULTS Twenty-one publications were found that described the development and or use by primary healthcare services of 14 measurement instruments, employed across 30 applications. Four of the 14 measurement instruments were developed specifically for Indigenous youth populations, four focused solely on strength-based wellbeing concepts but none included all Indigenous wellbeing domains. CONCLUSION There is a diversity of measurement instruments available, but few fit our desirability criteria. Although it is possible that we missed relevant papers and reports, this review clearly supports the need for further research to develop, refine or adapt instruments cross-culturally to measure the wellbeing of Indigenous children and youth.
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Affiliation(s)
- Vicki Saunders
- Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD, 4870, Australia.
| | - Janya McCalman
- grid.1023.00000 0001 2193 0854Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD 4870 Australia
| | - Sena Tsey
- grid.1023.00000 0001 2193 0854Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD 4870 Australia
| | - Deborah Askew
- grid.1003.20000 0000 9320 7537General Practice Clinical Unit and School of Public Health, Faculty of Medicine, University of Queensland, Level 2, Public Health Building, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Sandy Campbell
- grid.1043.60000 0001 2157 559XMolly Wardaguga Research Centre, Charles Darwin University, Level 11, 410 Ann St, Brisbane, QLD 4000 Australia
| | - Crystal Jongen
- grid.1023.00000 0001 2193 0854Jawun Research Centre, Central Queensland University, Cnr Shields and Aplin St, Cairns, QLD 4870 Australia
| | - Candace Angelo
- grid.1013.30000 0004 1936 834XAboriginal and Torres Strait Islander Public Health, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building, Fisher Road, Sydney, NSW 2006 Australia
| | - Geoff Spurling
- grid.1003.20000 0000 9320 7537General Practice Clinical Unit and School of Public Health, Faculty of Medicine, University of Queensland, Level 2, Public Health Building, 288 Herston Road, Brisbane, QLD 4006 Australia
| | - Yvonne Cadet-James
- Yvonne Cadet-James, Apunipima Cape York Health Council, 186 McCoombe St, Cairns, QLD 4870 Australia
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7
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Thabrew H, Gega L. Editorial: Control alt delete - technology and children's mental health. Child Adolesc Ment Health 2023; 28:1-3. [PMID: 36642701 DOI: 10.1111/camh.12631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Indexed: 01/17/2023]
Abstract
With international contributions from Denmark, Peru, Italy, Turkey, Estonia, Russia, Canada, the USA, Australia and the UK, this special issue offers insights and evidence about the technology's ability to act as a force of good and a source of harm for young people's mental health. As we better understand the complex and bidirectional relationship between technology and mental health, we need to move beyond dichotomous narratives about it being good or bad; it is both, depending on how it is used. Collective responsibility across technology companies, researchers, public services and community organisations, parents and the young people themselves can make a difference in the way technology is used to protect and improve mental health.
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Affiliation(s)
- Hiran Thabrew
- Te Ara Haro, Centre for Infant, Child and Adolescent Mental Health, University of Auckland, Auckland, New Zealand
| | - Lina Gega
- Department of Health Sciences, University of York, York, UK
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8
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Brijnath B, Gahan L, Dow B, Hickey L, Braddy L, Collins M, Antoniades J. When co-design works (sort of): the case of the Australian elder abuse screening instrument. J Elder Abuse Negl 2022; 34:302-313. [PMID: 35818632 DOI: 10.1080/08946566.2022.2098218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Applying co-design methodologies is increasingly recommended for engaging diverse end-users and bridging evidence-practice gaps. Yet, one of the ongoing challenges for research using co-design is the lack of evidence as to whether co-design leads to better outcomes than not using co-design. In this article, we outline how, despite adhering to a time and resource intensive co-design process with strong moral and ethical foundations, its implementation by end-users led to mixed outcomes around improved elder abuse screening. We discuss the implications of these ambiguous results, arguing that "noise" in our data might be inevitable due to the inherent sensitivities associated with elder abuse screening and offer a polemical recommendation about why the Australian Elder Abuse Screening Instrument (AuSI) should nevertheless be rolled out.
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Affiliation(s)
- Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia.,School of Social Sciences, University of Western Australia, Perth, Australia
| | - Luke Gahan
- Defence & Veteran Family Research, Australian Institute of Family Studies, Melbourne, Australia
| | - Briony Dow
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia.,School of Global and Population Health, University of Melbourne, Melbourne, Australia.,School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Lyndal Hickey
- Department of Social Work, The University of Melbourne, Melbourne, Australia
| | - Lisa Braddy
- Department of Social Work, St Vincent's Hospital, Melbourne, Australia
| | - Melinda Collins
- Department of Social Work, St Vincent's Hospital, Melbourne, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute, Melbourne, Australia
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9
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Lostelius PV, Mattebo M, Söderlund A, Revenäs Å, Thors Adolfsson E. An electronic patient-reported outcome created based on my needs is worth using: an explorative qualitative study investigating young people's opinions for a health assessment tool. J Patient Rep Outcomes 2022; 6:29. [PMID: 35347495 PMCID: PMC8960482 DOI: 10.1186/s41687-022-00436-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Young people in different healthcare settings are positive about using electronic patient-reported outcomes (ePROs), which are meant to increase the effectiveness and safety of interventions from the patient's perspective. Sweden offers free healthcare to young people aged 12-25 years at 275 youth health clinics (YHCs), whose goals are to strengthen young people and promote sexual, physical, and mental health. YHCs need effective ways to identify the overall picture of young people's health and health-related problems. To our knowledge, there is no ePRO for YHCs that provides an overview of young people's health from several health perspectives. The aim of this study was to explore young people's view on content and design of an ePRO to provide an overview of their health and health related problems when visiting a YHC, and their opinion on what healthcare needs to consider when using the ePRO. This was an explorative qualitative study. The participants were included from five YHCs, in different socioeconomic areas in central Sweden. Fifteen participants were included: 10 girls, three boys, and two non-binary participants with an age range of 16-22 years. Data were collected using a semi-structured interview guide and individual interviews, and inductive content analysis was performed. RESULTS One main theme, "ePRO created based on my needs is worth using" and two sub-themes, "Appealing content and design" and "Trusting healthcare", emerged. The participants wanted that an ePRO should include overall questions about mental-, physical-, and sexual health and social support. Participants also believed the ePRO must disclose the risks of self-harm or suicide. The participants noted the importance of emotional and digital security when using the ePRO and having a confidential conversation with a healthcare provider. To share health information means to trust to gain health. CONCLUSIONS The study participants' views on content and design can form the basis for designing an ePRO for young people. Their thoughts on safety and treatment in healthcare can be considered in the development process. This study is the starting point for developing an ePRO for young people at YHCs.
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Affiliation(s)
- Petra V Lostelius
- Clinic for Pain Rehabilitation Västmanland, Region Västmanland, Västerås, Sweden. .,School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden. .,Centre for Clinical Research Region, Hospital of Västmanland Västerås, Region Västmanland - Uppsala University, 721 89, Västerås, Sweden.
| | - Magdalena Mattebo
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Anne Söderlund
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Åsa Revenäs
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.,Centre for Clinical Research Region, Hospital of Västmanland Västerås, Region Västmanland - Uppsala University, 721 89, Västerås, Sweden.,Orthopedic Clinic, Region Västmanland, Västerås, Sweden
| | - Eva Thors Adolfsson
- Centre for Clinical Research Region, Hospital of Västmanland Västerås, Region Västmanland - Uppsala University, 721 89, Västerås, Sweden
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10
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Bellairs-Walsh I, Byrne SJ, Bendall S, Perry Y, Krysinska K, Lin A, Michail M, Lamblin M, Li TY, Hetrick S, Robinson J. Working with Young People at Risk of Suicidal Behaviour and Self-Harm: A Qualitative Study of Australian General Practitioners' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12926. [PMID: 34948536 PMCID: PMC8701929 DOI: 10.3390/ijerph182412926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/25/2022]
Abstract
General Practitioners (GPs) play a crucial role in the identification and support of young people at risk of suicidal behaviour and self-harm; however, no studies have explored GPs' perspectives, approaches, challenges, and resource needs when working with this cohort in an Australian setting. This was a qualitative study where fifteen GPs (Mage = 45.25 years) from multiple clinics in Western Australia took part in semi-structured interviews, and data were analysed thematically. Seven main themes were identified: (1) working with young people has its unique challenges; (2) screening and assessment tools can help to manage uncertainty and discomfort; (3) going beyond tools-the dialogue and relationship are most important; (4) there are limits to what we can offer in the time available; (5) the service access and referral pathways lack clarity and coordination; (6) the provision of mental health support should not fall on GPs alone; and (7) more comprehensive training in suicide and self-harm is needed. The findings highlight a number of opportunities to enhance care and better assist GPs working with young people who present with suicidal behaviour and self-harm, including considerations for conducting assessments, targeted resources such as training, and system and service improvements.
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Affiliation(s)
- India Bellairs-Walsh
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Sadhbh J. Byrne
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Global Health, Trinity College Dublin, D02 PN40 Dublin, Ireland
| | - Sarah Bendall
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Yael Perry
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Karolina Krysinska
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Centre for Mental Health, School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia; (Y.P.); (A.L.)
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham B15 2TT, UK;
| | - Michelle Lamblin
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
| | - Tina Yutong Li
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Townsville University Hospital, Douglas, QLD 4814, Australia
| | - Sarah Hetrick
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1010, New Zealand
| | - Jo Robinson
- Orygen, Parkville, VIC 3052, Australia; (S.J.B.); (S.B.); (K.K.); (M.L.); (T.Y.L.); (J.R.)
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3010, Australia;
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11
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Martel R, Shepherd M, Goodyear-Smith F. Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review. JMIR Ment Health 2021; 8:e30479. [PMID: 34807833 PMCID: PMC8663603 DOI: 10.2196/30479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. OBJECTIVE This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. METHODS Electronic databases-MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews-were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. RESULTS e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. CONCLUSIONS To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work.
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Affiliation(s)
- Rhiannon Martel
- Department of General Practice & Primary Health Care, Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
| | | | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, Faculty of Medical & Health Science, University of Auckland, Auckland, New Zealand
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12
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Goodyear-Smith F. Use of codesign in primary care research: real-life examples. Fam Med Community Health 2021. [PMCID: PMC8278916 DOI: 10.1136/fmch-2021-001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, The University of Auckland, Auckland, New Zealand
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13
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Zidaru T, Morrow EM, Stockley R. Ensuring patient and public involvement in the transition to AI-assisted mental health care: A systematic scoping review and agenda for design justice. Health Expect 2021; 24:1072-1124. [PMID: 34118185 PMCID: PMC8369091 DOI: 10.1111/hex.13299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/07/2021] [Accepted: 05/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Machine‐learning algorithms and big data analytics, popularly known as ‘artificial intelligence’ (AI), are being developed and taken up globally. Patient and public involvement (PPI) in the transition to AI‐assisted health care is essential for design justice based on diverse patient needs. Objective To inform the future development of PPI in AI‐assisted health care by exploring public engagement in the conceptualization, design, development, testing, implementation, use and evaluation of AI technologies for mental health. Methods Systematic scoping review drawing on design justice principles, and (i) structured searches of Web of Science (all databases) and Ovid (MEDLINE, PsycINFO, Global Health and Embase); (ii) handsearching (reference and citation tracking); (iii) grey literature; and (iv) inductive thematic analysis, tested at a workshop with health researchers. Results The review identified 144 articles that met inclusion criteria. Three main themes reflect the challenges and opportunities associated with PPI in AI‐assisted mental health care: (a) applications of AI technologies in mental health care; (b) ethics of public engagement in AI‐assisted care; and (c) public engagement in the planning, development, implementation, evaluation and diffusion of AI technologies. Conclusion The new data‐rich health landscape creates multiple ethical issues and opportunities for the development of PPI in relation to AI technologies. Further research is needed to understand effective modes of public engagement in the context of AI technologies, to examine pressing ethical and safety issues and to develop new methods of PPI at every stage, from concept design to the final review of technology in practice. Principles of design justice can guide this agenda.
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Affiliation(s)
- Teodor Zidaru
- Department of Anthropology, London School of Economics and Political Science (LSE), London, UK
| | | | - Rich Stockley
- Surrey Heartlands Health and Care Partnership, Guildford and Waverley CCG, Guildford, UK.,Insight and Feedback Team, Nursing Directorate, NHS England and NHS Improvement, London, UK.,Surrey County Council, Kingston upon Thames, UK
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14
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Rassy J, Bardon C, Dargis L, Côté LP, Corthésy-Blondin L, Mörch CM, Labelle R. Information and Communication Technology Use in Suicide Prevention: Scoping Review. J Med Internet Res 2021; 23:e25288. [PMID: 33820754 PMCID: PMC8132980 DOI: 10.2196/25288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The use of information and communication technology (ICT) in suicide prevention has progressed rapidly over the past decade. ICT plays a major role in suicide prevention, but research on best and promising practices has been slow. OBJECTIVE This paper aims to explore the existing literature on ICT use in suicide prevention to answer the following question: what are the best and most promising ICT practices for suicide prevention? METHODS A scoping search was conducted using the following databases: PubMed, PsycINFO, Sociological Abstracts, and IEEE Xplore. These databases were searched for articles published between January 1, 2013, and December 31, 2018. The five stages of the scoping review process were as follows: identifying research questions; targeting relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. The World Health Organization suicide prevention model was used according to the continuum of universal, selective, and indicated prevention. RESULTS Of the 3848 studies identified, 115 (2.99%) were selected. Of these, 10 regarded the use of ICT in universal suicide prevention, 53 referred to the use of ICT in selective suicide prevention, and 52 dealt with the use of ICT in indicated suicide prevention. CONCLUSIONS The use of ICT plays a major role in suicide prevention, and many promising programs were identified through this scoping review. However, large-scale evaluation studies are needed to further examine the effectiveness of these programs and strategies. In addition, safety and ethics protocols for ICT-based interventions are recommended.
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Affiliation(s)
- Jessica Rassy
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- School of Nursing, Université de Sherbrooke, Longueuil, QC, Canada
- Quebec Network on Nursing Intervention Research, Montréal, QC, Canada
| | - Cécile Bardon
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Luc Dargis
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Louis-Philippe Côté
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Laurent Corthésy-Blondin
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Carl-Maria Mörch
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Algora Lab, Université de Montréal, Montréal, QC, Canada
- Mila, Quebec Artificial Intelligence Institute, Montréal, QC, Canada
| | - Réal Labelle
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
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15
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Li J, Bornheimer LA, Fernandez L, Dagher J. The Relationships Between Risk-Taking, Depression, and Alcohol Use in the Experience of Suicidal Ideation Among Adults in the General Population. CRISIS 2021; 43:228-235. [PMID: 33890825 DOI: 10.1027/0227-5910/a000775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Risk-taking is associated with suicide among depressed adolescents. In the United States, alcohol is among the most used substances resulting in need for treatment. While alcohol use relates to greater depression and suicidality, less is known about these relationships with risk-taking tendencies, particularly among adult populations. The current study examined suicidal ideation, alcohol use, depression, and risk-taking tendencies among adults 18-65 years old who participated in the 2017 National Survey on Drug Use and Health. Structural equation modeling was used to examine the specific aims in Mplus8. A total of 1,740 (21.4%) participants endorsed suicidal ideation. The model demonstrated good fit and findings indicate increases in alcohol abuse or dependence (b = 0.094, SE = 0.01, p < .001), depression (b = 0.036, SE = 0.01, p < .001), and risk-taking (b = 0.044, SE = 0.01, p < .001) all independently related to increased odds of ideation. Increases in alcohol abuse or dependence (b = 0.210, SE = 0.02, p < .001) and depression (b = 0.026, SE = 0.01, p < .05) also related to elevated risk-taking. Based on the joint significance test, risk-taking tendencies served as a partial mediator, functioning as a mechanism in the relationships between alcohol use, depression, and ideation. Risk-taking thus serves as an important treatment target in the prevention of suicide. Implications for practice and future research are discussed.
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Affiliation(s)
- Juliann Li
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Lindsay A Bornheimer
- School of Social Work, University of Michigan, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | | | - Jenna Dagher
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
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16
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Previsit Multidomain Psychosocial Screening Tools for Adolescents and Young Adults: A Systematic Review. J Adolesc Health 2021; 68:449-459. [PMID: 33221191 DOI: 10.1016/j.jadohealth.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 11/21/2022]
Abstract
Adolescence and young adulthood constitute a period when exploratory behaviors can evolve into risky behaviors. Most causes of adolescent ill health are preventable; therefore, it is a priority to detect them early before they turn into health problems. Previsit multidomain psychosocial screening tools are used by professionals to detect and prioritize potentially problematic issues. In conjunction with appropriate clinician training, these tools have improved clinician screening rates in several areas of adolescent health. This article reviews existing multidomain previsit psychosocial screening tools developed in the 21st century and describes their characteristics using a systematic methodology. We reviewed 10,623 records to identify 15 different tools in use since 2000 and described their characteristics. Results show that all tools were developed in high-income countries. The tools provide sufficient coverage of many psychosocial domains relevant to young people's health. However, some psychosocial domains such as screen use and strengths are seldomly addressed. Furthermore, the tools rarely focus on young adults as a target population. Future research should assess the effectiveness, acceptability, and psychometric properties of validated psychosocial screening tools and examine how to expand their use in low- and middle-income countries.
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17
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Affiliation(s)
- Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Murdoch Children's Research Institute, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
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18
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Martel R, Reihana-Tait H, Lawrence A, Shepherd M, Wihongi T, Goodyear-Smith F. Reaching out to reduce health inequities for Māori youth. Int Nurs Rev 2020; 67:275-281. [PMID: 31898328 DOI: 10.1111/inr.12565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 01/25/2023]
Abstract
AIM This paper describes an initiative facilitating comprehensive assessment and delivery of brief interventions for Māori youth in Northland, New Zealand. BACKGROUND The population in Northland is predominantly Māori and is one of New Zealand's most deprived populations. Māori youth have the highest youth suicide rate in the developed world and elevated numbers of youth displaying mental health issues and/or risk behaviours are of grave national concern. Like Indigenous peoples worldwide, inequities persist for Māori youth accessing and engaging with healthcare services. DESCRIPTION Taking services out to Māori youth in remote and isolated areas, Northland's youth specialist nurses are reducing some barriers to accessing health care. The youth version of the Case-finding and Help Assessment Tool is a New Zealand-developed, e-screening tool for youth psychosocial issues, facilitating comprehensive assessment and brief intervention delivery. DISCUSSION Early detection of, and timely intervention for, mental health and risk behaviours can significantly improve health outcomes in youth. However, for this to happen barriers preventing youth from accessing appropriate care need to be overcome. CONCLUSION Youth specialist nurses could improve access to care for youth from ethnic minorities, rural and isolated regions, and areas of high deprivation without overwhelming the medical profession. IMPLICATIONS FOR NURSING POLICY Specialist nurses are trained and empowered to practice at the top of their scope. With general practitioner oversight and standing order sign off specialist nurses can work autonomously to improve access to health services, without increasing the workload of doctors. IMPLICATIONS FOR NURSING PRACTICE Encouraging continuous self-reflection of the nurse's effectiveness in meeting patient needs, holistically and culturally, facilitates the provision of accessible care that is patient-centred and culturally safe.
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Affiliation(s)
- R Martel
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - H Reihana-Tait
- Te Tai Tokerau Primary Health Organisation, Kerikeri, New Zealand
| | - A Lawrence
- Te Tai Tokerau Primary Health Organisation, Kerikeri, New Zealand.,Manaia Health Primary Health Organisation, Whangarei, New Zealand
| | - M Shepherd
- School of Psychology, Massey University, Auckland, New Zealand
| | - T Wihongi
- Northland District Health Board, Whangarei, New Zealand
| | - F Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
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19
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Thabrew H, Goodyear-Smith F. Youth version, Case-finding and Help Assessment Tool (YouthCHAT): An electronic, psychosocial screener for young people with long-term physical conditions. J Paediatr Child Health 2020; 56:102-106. [PMID: 31140675 DOI: 10.1111/jpc.14503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 11/29/2022]
Abstract
AIM This study investigated the acceptability, clinical utility and preliminary effectiveness of Youth version, Case-finding and Help Assessment Tool (YouthCHAT), a novel electronic, tablet-based screener designed to identify issues similar to Home, Education/Employment, Activity, Drugs, Sexuality, Suicide/Depression, Safety assessment. METHODS YouthCHAT was administered to a group of 30 young people aged 13-17 years with different long-term physical conditions attending outpatient clinics between September and December 2017. Outcome measures were: (i) acceptability and feasibility of YouthCHAT as assessed via feedback from young people and clinicians and the time taken to complete YouthCHAT screening; and (ii) detection rates for each domain of YouthCHAT measured by mental health or life-style issues 'present' or 'absent', and where relevant, validated symptom scores. RESULTS YouthCHAT was quick to administer and positively received by both young people and clinicians. Rates of anxiety (37%) and depression (13%) detected using YouthCHAT were similar to those in previous studies of young people with long-term physical conditions. Rates of other problems were similar to a previously screened high school sample. CONCLUSIONS YouthCHAT is a viable and acceptable psychosocial screener with the potential to improve the holistic care of young people with long-term physical conditions attending outpatient clinics. TRIAL REGISTRATION This study has been registered with the Australian New Zealand Clinical Trials Network Registry ACTRN12616001243404p.
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Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand
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20
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Thabrew H, D'Silva S, Darragh M, Goldfinch M, Meads J, Goodyear-Smith F. Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13911. [PMID: 31793890 PMCID: PMC6918206 DOI: 10.2196/13911] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/23/2019] [Accepted: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS Objective This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Trial Registration Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422.
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Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Simona D'Silva
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Margot Darragh
- Department of General Practice, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Jake Meads
- School of Health Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Felicity Goodyear-Smith
- Department of General Practice, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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21
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Gahan L, Gaffy E, Dow B, Brijnath B. Advancing methodologies to increase end-user engagement with complex interventions: The case of co-designing the Australian elder abuse screening instrument (AuSI). J Elder Abuse Negl 2019; 31:325-339. [PMID: 31647378 DOI: 10.1080/08946566.2019.1682098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Australia there is an absence of an elder abuse screening instrument that is widely accepted and that has been designed with, and for, end-users. This study aimed to develop an effective and acceptable elder abuse screening instrument by engaging with frontline professionals through a co-design process. To date, co-design methodologies are recommended to ensure successful adoption and implementation of complex interventions by end-users, but the scholarship is limited on the specific steps to achieve this as well as the pragmatics of such work. Addressing this lacunae, results demonstrate how qualitative methods align with a co-design approach; underscore the importance of multidisciplinary perspectives; showcase how to streamline complex processes into routine practice; and accentuate the importance of good design. These are valuable insights necessary to develop inter-professional and community-based solutions to the challenge of elder abuse.
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Affiliation(s)
- Luke Gahan
- National Ageing Research Institute, Melbourne, Australia.,School of Social Sciences and Humanities, La Trobe University, Melbourne, Australia
| | - Ellen Gaffy
- National Ageing Research Institute, Melbourne, Australia.,School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, Australia.,School of Global and Population Health, University of Melbourne, Melbourne, Australia
| | - Bianca Brijnath
- National Ageing Research Institute, Melbourne, Australia.,The School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Department of General Practice, Monash University, Melbourne, Australia
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22
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Sisler SM, Schapiro NA, Stephan L, Mejia J, Wallace AS. Consider the root of the problem: increasing trainee skills at assessing and addressing social determinants of health. Transl Behav Med 2019; 9:523-532. [PMID: 31094436 PMCID: PMC6520804 DOI: 10.1093/tbm/ibz046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
National pediatrics guidelines recommend screening all patients for unmet social needs to improve self-management of chronic conditions and health outcomes and to reduce costs. Practitioners involved in training pediatric clinicians need to understand how to prepare pediatric clinicians to effectively conduct social needs screening and where current training methods fall short. Our qualitative study investigated whether using "standardized" patients during trainee education improved trainees' ability to assess and address adolescent patients' social needs. Vulnerable adolescents should be prioritized in social determinants of health translational research because increased risk taking and emotionality may predispose this population to lower self-esteem and self-efficacy. We trained 23 adolescents (aged 16-18) recruited from an urban health-career education program to act as standardized patients (SPs). Two cohorts of nurse practitioner trainees (n = 36) enrolled in a simulation where the patient-actor presented with a minor chief complaint and related a fabricated complex social history. Pre-encounter, Cohort 1 (n = 18) reviewed psychosocial screeners; Cohort 2 (n = 18) were given in-depth information about social needs before meeting patients. SPs gave individualized feedback to trainees, and self-reflections were analyzed using thematic analysis. In Cohort 1, trainees identified some social needs, yet few intervened. Trainees expressed discomfort in: (a) asking socially sensitive questions and (b) triaging patient versus clinician priorities. Cohort 2 demonstrated improvements compared to Cohort 1 in identifying needs yet had similar difficulty with organization and questioning. Trainees were able to utilize a lower-stakes interaction with patient-actors to raise awareness regarding a patient's sensitive needs and to organize care surrounding these patient-centered concerns.
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Affiliation(s)
- Shawna M Sisler
- University of Utah, College of Nursing, Salt Lake City, UT, USA
| | - Naomi A Schapiro
- University of California, San Francisco, Department of Family Health Care Nursing, San Francisco, CA, USA
| | - Linda Stephan
- University of California, San Francisco, Department of Family Health Care Nursing, San Francisco, CA, USA
| | - Jayme Mejia
- University of California, San Francisco, Department of Family Health Care Nursing, San Francisco, CA, USA
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23
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Martel RM, Darragh ML, Lawrence AJ, Shepherd MJ, Wihongi T, Goodyear-Smith FA. YouthCHAT as a Primary Care E-Screening Tool for Mental Health Issues Among Te Tai Tokerau Youth: Protocol for a Co-Design Study. JMIR Res Protoc 2019; 8:e12108. [PMID: 30626568 PMCID: PMC6329425 DOI: 10.2196/12108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 01/13/2023] Open
Abstract
Background In New Zealand (NZ), 1 in 4 adolescents is affected by mental health issues (eg, depression and anxiety) and engages in risk behaviors (eg, harmful drinking and substance abuse), with rates among Māori youth being significantly higher. The majority of NZ secondary school students visit their local primary health care providers (PHPs) at least annually, yet most do not seek help for mental health and risk behavior (MHB) concerns. While youth think it acceptable to discuss sensitive issues during a consultation with their PHPs, unless problems are severe, such conversations are not initiated by PHPs. Early intervention for MHB concerns can prevent long-term health and well-being issues. However, this relies on the early identification of developing problems and youth being offered and accepting help. YouthCHAT is an electronic, multi-item screening tool developed in 2016 to assess MHB concerns among youth. YouthCHAT is completed before a consultation with the PHP, who can access a summary report straight away. A help question allows young people to identify issues that need addressing. A resource pack uses stepped care pathways to guide providers to use appropriate brief interventions. Objective This study aimed to explore the utility, feasibility, and acceptability of YouthCHAT when tailored for use with youth in primary care settings with large Māori populations. Objectives of the study are to evaluate the implementation of YouthCHAT in nurse-led youth clinics, school-based clinics, and general practice in Te Tai Tokerau (Northland, NZ); to develop a framework for the scaling up of YouthCHAT across further settings; to assess health provider and youth acceptability of the tool; to improve screening rates for mental health and help-seeking behavior; to enable early identification of emerging problems; and to improve brief intervention delivery. Methods Using a bicultural mixed-methods co-design approach, 3 phases over a 3-year period will provide an iterative evaluation of the utility, feasibility, and acceptability of YouthCHAT, aiming to create a framework for wider-scale rollout and implementation. Results Recruitment for the first phase began in September 2018. YouthCHAT was implemented at the first site in October 2018 and is expected to be at a further two sites in late January to early February 2019. The study is due for completion at the end of 2021. Conclusions YouthCHAT has potential as a user-friendly, time efficient, and culturally safe screening tool for early detection of MHB issues in NZ youth. The resource pack assists the clinician to provide appropriate interventions for emerging and developed youth mental health and lifestyle issues. Involving input from community providers, users, and stakeholders will ensure that modifiable elements of YouthCHAT are tailored to meet the health needs specific to each context and will have a positive influence on future mental, physical, and social outcomes for NZ youth. International Registered Report Identifier (IRRID) PRR1-10.2196/12108
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Affiliation(s)
- Rhiannon Mary Martel
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Margot Louise Darragh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
| | - Aniva Joanne Lawrence
- Manaia Health Primary Health Organisation, Whangarei, New Zealand.,Te Tai Tokerau Primary Health Organisation, Kerikeri, New Zealand
| | - Matthew John Shepherd
- Faculty of Education and Social Work, Department of Counselling, Human Services and Social Work, The University of Auckland, Auckland, New Zealand
| | | | - Felicity Anne Goodyear-Smith
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand
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Abstract
PURPOSE OF REVIEW This review summarizes digital health solutions being used for Indigenous mental well-being, with emphasis on available evidence and examples reported in the literature. We also describe our own local experience with a rural telemental health service for Indigenous youth and discuss the unique opportunities and challenges. RECENT FINDINGS Digital health solutions can be grouped into three main categories: (1) remote access to specialists, (2) building and supporting local capacity, and (3) patient-directed interventions. Limited evidence exists for the majority of digital solutions specifically in Indigenous contexts, although examples and pilot projects have been described. Telemental health has the strongest evidence, along with a growing evidence for web-based applications, largely led by Australia. Other digital approaches remain areas of promise requiring additional study. Co-design and service integration and respect for Indigenous history and ideologies are essential for success. While the use of digital health solutions for Indigenous mental well-being holds promise, there is a limited evidence base for most of them. Future efforts to expand the use of digital solutions in this population should adhere to best practices for the delivery of Indigenous health services.
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Affiliation(s)
- Jennifer M. Hensel
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Katherine Ellard
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Mark Koltek
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Gabrielle Wilson
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
| | - Jitender Sareen
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Ave, Winnipeg, MB Canada
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Shah K, Corter A, Bird A, Goodyear-Smith F. A primary care programme to improve identification and stepped-care support of Asians with mental health and lifestyle issues. J Prim Health Care 2019; 11:39-46. [DOI: 10.1071/hc18043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 01/02/2019] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTIONAsians living in Western countries have a higher incidence of mental health and lifestyle issues, but are less likely to disclose these to health-care professionals due to stigma. Instead, they tend to present to primary care with somatic concerns.
AIMTo assess the feasibility and acceptability of a well-validated electronic screening and stepped-care support tool (eCHAT) to identify mental health and lifestyle issues among Asian patients.
METHODSA mixed-methods (interviews and survey) co-design approach explored patient and clinic staff perspectives on a translated version of eCHAT (AsiaCHAT). Recruitment was through a large primary care organisation with a high proportion of Asian patients. Of the 307 approached, 277 participated (92% acceptance rate).
RESULTSProblems of depression (n = 12) and anxiety (n = 69) were identified among patients, as were sexual health concerns (n = 22) among younger participants. Overall, participants and clinic staff rated AsiaCHAT as a useful and acceptable tool for disclosing and discussing patient concerns. Problems of finances, time constraints and competing demands made long-term implementation challenging.
DISCUSSIONAsiaCHAT is a promising tool for identifying mental health and lifestyle concerns among Asians presenting to primary care. The electronic screener supports patient and provider discussion of sensitive topics and the stepped-care support function helps direct care. Its flexible functionality means that there is potential to integrate it into busy clinic settings as well as online patient portals, and the programme aligns with current policy to improve Asian health in New Zealand.
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Park WS, Yang KI, Kim H. Insufficient sleep and suicidal ideation: a survey of 12,046 female adolescents. Sleep Med 2018; 53:65-69. [PMID: 30447401 DOI: 10.1016/j.sleep.2018.08.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Adolescence is a period of adaptation to social, hormonal, and physical changes. Because of these changes, adolescents are at risk for depression and suicidal thoughts. Female adolescents tend to be more sensitive to hormonal and emotional changes. Although the reciprocal relationship among depression, poor sleep quality, and suicide has been studied, whether decreased sleep time leads to depression-mediated suicide or induces suicide itself remains to be determined. Therefore, this study aimed to analyze (using a path analysis) the indirect (i.e., due to depression) and direct effects of sleep on suicidal ideation for female adolescents. METHODS We use nationally representative data from the Korean juvenile health behavior online survey to analyze the sleep effects on suicidal ideation. A total of 12,046 Korean female adolescents were included in this study. We analyzed data from the juvenile health behavior online survey (2017) conducted by the Korea Centers for Disease Control and Prevention and identified variables that could affect the mental health of female adolescents. A path analysis was performed to determine the direct role of sleep in suicidal ideation. RESULTS Decreased sleep was one of the several risk factors for suicidal ideation. Unexpectedly, after controlling for other risk factors including depression and socioeconomic factors, insufficient sleep was found to have direct effects on suicidal ideation. The indirect effect of insufficient sleep on suicidal ideation was mediated by depression. CONCLUSION Sleep is a modifiable factor that could reduce the suicide rate among female adolescents and could be targeted through public health prevention efforts.
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Affiliation(s)
- Woong-Sub Park
- Department of Preventive Medicine & Public Health Catholic Kwandong University College of Medicine, Gangwon, Republic of Korea
| | - Kwang Ik Yang
- Sleep Disorders Center, Department of Neurology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Republic of Korea
| | - Hyeyun Kim
- Department of Neurology, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon, Republic of Korea.
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Brinker TJ, Brieske CM, Esser S, Klode J, Mons U, Batra A, Rüther T, Seeger W, Enk AH, von Kalle C, Berking C, Heppt MV, Gatzka MV, Bernardes-Souza B, Schlenk RF, Schadendorf D. A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic. J Med Internet Res 2018; 20:e10976. [PMID: 30111525 PMCID: PMC6115598 DOI: 10.2196/10976] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. OBJECTIVE The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. METHODS We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. RESULTS During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). CONCLUSIONS A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking.
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Affiliation(s)
- Titus Josef Brinker
- National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Christian Martin Brieske
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Stefan Esser
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ute Mons
- Cancer Prevention Unit, German Cancer Research Center, Heidelberg, Germany
| | - Anil Batra
- Section for Addiction Medicine and Addiction Research, University Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Werner Seeger
- Universities of Giessen and Marburg Lung Center, Department of Internal Medicine, Justus-Liebig-University, Gießen, Germany
| | - Alexander H Enk
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Carola Berking
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Markus V Heppt
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Martina V Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | | | - Richard F Schlenk
- Trial Center, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
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