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Sit HF, Li G, Chen W, Sou EKL, Wong M, Burchert S, Hong IW, Sit HY, Lam AIF, Hall BJ. A protocol for a type 1 effectiveness-implementation randomized controlled trial of the WHO digital mental health intervention Step-by-Step to address depression among Chinese young adults in Macao (SAR), China. Internet Interv 2022; 30:100579. [PMID: 36217366 PMCID: PMC9547191 DOI: 10.1016/j.invent.2022.100579] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/27/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Among Chinese college students, the burden of depression is considerably high, affecting up to 30 % of the population. Despite this burden, few Chinese students seek mental health treatment. In addition, depression is highly comorbid with other mental health disorders, such as anxiety. Scalable, transdiagnostic, evidence-based interventions are needed for this population. OBJECTIVE The study will evaluate the effectiveness of a World Health Organization transdiagnostic digital mental health intervention, Step-by-Step, to reduce depressive and anxiety symptoms and improve well-being compared with enhanced care as usual and its implementation in a Chinese university community. METHODS A type 1 effectiveness-implementation two-arm, parallel, randomized controlled trial will be conducted. The two conditions are 1) the 5-session Step-by-Step program with minimal guidance by trained peer-helpers and 2) psychoeducational information on depression and anxiety and referrals to local community services. A total of 334 Chinese university students will be randomized with a 1:1 ratio to either of the two groups. Depression, anxiety, wellbeing, and client defined problems will be assessed at pre-intervention, post-intervention, and 3-month follow-up. Endline qualitative interviews and focus group discussions will be conducted to explore SbS implementation among service users, university staff, and stakeholders. Data will be analysed based on the intent-to-treat principle. DISCUSSION Step-by-Step is an innovative approach to address common mental health problems in populations with sufficient digital literacy. It is a promising intervention that can be embedded to scale mental health services within a university setting. It is anticipated that after successful evaluation of the program and its implementation in the type 1 hybrid design RCT study, Step-by-Step can be scaled and maintained as a low-intensity treatment in universities, and potentially extended to other populations within the Chinese community. TRIAL REGISTRATION ChiCTR2100050214.
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Key Words
- AE, adverse event
- Behavioral activation
- CONSORT, Consolidated Standards of Reporting Trials
- CSQ, Client Satisfaction Questionnaire
- College students
- DASS-21, Depression, Anxiety, and Stress Scale – 21 items
- Depression
- Digital intervention
- ECAU, enhanced care as usual
- GAD-7, Generalized Anxiety Disorder
- ITT, intention-to-treat
- Implementation
- PCC, Psychological Counselling Center
- PCL, PTSD Checklist for DSM-5
- PHQ, Patient Health Questionnaire
- PSYCHLOPS, Psychological Outcomes Profile Instrument
- RCT, randomized controlled trial
- RE-AIM, Reach, Effectiveness, Adoption, Implementation, and Maintenance
- Randomized controlled trial
- SAE, serious adverse event
- SPIRIT, Standard Protocol Items: Recommendations for Interventional Trials
- SbS, Step-by-Step
- WHO, World Health Organization
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Affiliation(s)
- Hao Fong Sit
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong (SAR), People's Republic of China
| | - Gen Li
- Center for Global Health Equity, New York University (Shanghai), Shanghai, People's Republic of China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, People's Republic of China,Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, People's Republic of China
| | - Elvo Kuai Long Sou
- Student Affairs Office, University of Macau, Macao (SAR), People's Republic of China
| | - Mek Wong
- Student Affairs Office, University of Macau, Macao (SAR), People's Republic of China
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin (FUB), Germany
| | - Ieng Wai Hong
- Moon Chun Memorial College, University of Macau, Macao (SAR), People's Republic of China
| | - Ho Yi Sit
- Shiu Pong College, University of Macau, Macao (SAR), People's Republic of China
| | - Agnes Iok Fong Lam
- Centre for Macau Studies, University of Macau, Macao (SAR), People's Republic of China
| | - Brian J. Hall
- Center for Global Health Equity, New York University (Shanghai), Shanghai, People's Republic of China,Corresponding author at: Center for Global Health Equity, New York University Shanghai, Shanghai, People's Republic of China.
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Bernard RM, Toppo C, Raggi A, de Mul M, de Miquel C, Pugliese MT, van der Feltz-Cornelis CM, Ortiz-Tallo A, Salvador-Carulla L, Lukersmith S, Hakkaart-van Roijen L, Merecz-Kot D, Staszewska K, Sabariego C. Strategies for Implementing Occupational eMental Health Interventions: Scoping Review. J Med Internet Res 2022; 24:e34479. [PMID: 35648457 PMCID: PMC9201704 DOI: 10.2196/34479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/02/2022] [Accepted: 03/30/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. OBJECTIVE The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. METHODS A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. RESULTS A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. CONCLUSIONS This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review's findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions.
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Affiliation(s)
| | - Claudia Toppo
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Marleen de Mul
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, Netherlands
| | - Carlota de Miquel
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Maria Teresa Pugliese
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | | | - Ana Ortiz-Tallo
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
| | - Luis Salvador-Carulla
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | - Sue Lukersmith
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - Kaja Staszewska
- Department of Health and Work Psychology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Center for Rehabilitation in Global Health Systems, World Health Organization Collaborating Center, University of Lucerne, Lucerne, Switzerland
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Mavragani A, Weingarden H, Wolfe EC, Hall MD, Snorrason I, Wilhelm S. Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review. J Med Internet Res 2022; 24:e33307. [PMID: 35394434 PMCID: PMC9034419 DOI: 10.2196/33307] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/18/2022] [Accepted: 01/31/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Smartphone app-based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. OBJECTIVE The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. METHODS We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. RESULTS Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. CONCLUSIONS Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis.
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Affiliation(s)
| | - Hilary Weingarden
- Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Emma C Wolfe
- Massachusetts General Hospital, Boston, MA, United States
| | | | - Ivar Snorrason
- Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Sabine Wilhelm
- Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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Liem A, Pakingan KA, Garabiles MR, Sit HF, Burchert S, Lam AIF, Hall BJ. Evaluating the Implementation of a Mental Health App for Overseas Filipino Workers in Macao China: A Mixed-Methods Study of Stakeholders' Perspectives. Front Psychiatry 2022; 13:836156. [PMID: 35592383 PMCID: PMC9113052 DOI: 10.3389/fpsyt.2022.836156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Overseas Filipino workers (OFWs) is one of the largest communities of international migrant workers. They face systemic barriers to fulfilling their health needs. The COVID-19 pandemic worsened this condition and provided a context to evaluate the utility of a digital mental health intervention delivered within a stepped-care model to address OFW mental health. Using an implementation science framework, this study aimed to evaluate stakeholders' perspectives on the implementation of Kumusta Kabayan, a mobile phone-based mental health app, for OFWs in Macao. METHODS A mixed-methods convergent design was used by conducting two parallel steps, including quantitative and qualitative measures. The quantitative data was collected from Filipino team members and local non-governmental organization (NGO) staff members (N = 12). The qualitative data were gathered from interviews with OFWs in Macao who used the app (N = 25; 80% females, 76% domestic workers). RESULTS From the online survey, the staff members of the local partner NGO and the Filipino team members strongly perceived that their organization could adapt Kumusta Kabayan to their program and generally evaluated that Kumusta Kabayan achieved its goal and was received well by OFWs. In the interviews, the OFW app users shared their experiences in using Kumusta Kabayan, which was thematically organized into six aspects of the participants' experience: (1) promotional channel and expectation; (2) when to use the app and in what language; (3) lessons learnt; (4) memorable aspects; (5) key facilitators and barriers; and (6) suggestions. CONCLUSION Kumusta Kabayan was well accepted and shows potential to be integrated into the existing support services for OFWs in Macao. This app has the promise of being scaled-up for OFWs in other countries by collaborating with local and overseas stakeholders. Lessons learnt from this evaluation could also be implemented in wider digital mental health services in different settings.
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Affiliation(s)
- Andrian Liem
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Karmia A Pakingan
- Department of Psychology, De La Salle University, Manila, Philippines
| | - Melissa R Garabiles
- Department of Psychology, De La Salle University, Manila, Philippines.,Scalabrini Migration Center, Quezon City, Philippines
| | - Hao Fong Sit
- Department of Psychology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Sebastian Burchert
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Agnes I F Lam
- Department of Communication, University of Macau, Macau, Macau SAR, China.,Centre for Macau Studies, University of Macau, Macau, Macau SAR, China
| | - Brian J Hall
- Center for Global Health Equity, NYU Shanghai, Shanghai, China.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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