1
|
Naderbagi A, Loblay V, Zahed IUM, Ekambareshwar M, Poulsen A, Song YJC, Ospina-Pinillos L, Krausz M, Mamdouh Kamel M, Hickie IB, LaMonica HM. Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review. J Med Internet Res 2024; 26:e55130. [PMID: 38980719 PMCID: PMC11267096 DOI: 10.2196/55130] [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: 12/04/2023] [Revised: 05/12/2024] [Accepted: 05/21/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. OBJECTIVE This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. METHODS Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. RESULTS The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. CONCLUSIONS Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation.
Collapse
Affiliation(s)
- Aila Naderbagi
- Brain and Mind Centre, The University of Sydney, Sydney NSW, Australia
| | - Victoria Loblay
- Brain and Mind Centre, The University of Sydney, Sydney NSW, Australia
| | | | | | - Adam Poulsen
- Brain and Mind Centre, The University of Sydney, Sydney NSW, Australia
| | - Yun J C Song
- Brain and Mind Centre, The University of Sydney, Sydney NSW, Australia
| | - Laura Ospina-Pinillos
- Department of Psychiatry and Mental Health, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Michael Krausz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | | | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney NSW, Australia
| | - Haley M LaMonica
- Brain and Mind Centre, The University of Sydney, Sydney NSW, Australia
| |
Collapse
|
2
|
Nittas V, Daniore P, Chavez SJ, Wray TB. Challenges in implementing cultural adaptations of digital health interventions. COMMUNICATIONS MEDICINE 2024; 4:7. [PMID: 38182750 PMCID: PMC10770150 DOI: 10.1038/s43856-023-00426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
Differences in the access and use of digital health interventions are driven by culture, in addition to economic and physical factors. To avoid the systematic exclusion of traditionally underserved cultural groups, creating inclusive digital health interventions is essential. One way to achieve this is through cultural adaptations, defined as the systematic modification of an existing intervention that aligns with a target audience's cultural norms, beliefs, and values. In theory, cultural adaptations can potentially increase the reach and engagement of digital health interventions. However, the evidence of whether and how that is achieved is limited. Justifying, planning, and implementing an adaptation comes with various challenges and takes time and money. This perspective provides a critical overview of the field's current state and emphasizes the need for technology-specific frameworks that address when and how to culturally adapt digital health interventions.
Collapse
Affiliation(s)
- Vasileios Nittas
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA.
| | - Paola Daniore
- Institute for Implementation Science in Health Care, University of Zurich Faculty of Medicine, Universitaetstrasse 84, 8006, Zurich, Switzerland
| | - Sarah J Chavez
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA
| | - Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA
| |
Collapse
|
3
|
Talana ALE, Quensell ML, Peltzer NK, Thompson MD, Stupplebeen D, Pirkle CM, Keliikoa LB. Examining Mental Health and Economic Consequences During the COVID-19 Pandemic Among Filipino Residents in Hawai'i: May - Oct 2020. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2024; 83:16-24. [PMID: 38223464 PMCID: PMC10782392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and drastic changes to daily lives, posing a threat to residents' mental health and well-being. Filipinos are disproportionately impacted by COVID-19 and have one of the highest COVID-19 prevalence in Hawai'i. The COVID-19 pandemic has been associated with a rise in mental health concerns, yet little is known about the impact on the mental health of Filipinos in Hawai'i. Using publicly available polling data from the SMS Community Pulse Survey, this study sought to describe the mental distress experienced by Filipino residents during the COVID-19 pandemic. Data were collected from an online panel of Hawai'i residents over 4 timepoints (May 5-10; June 11-17; July 31-August 8; October 19-31, 2020). Compared to non-Filipinos, a higher proportion of Filipinos reported feeling stress and sadness during 3 of the 4 timepoints. Across all timepoints, Filipinos were more likely to respond affirmatively to mental health indicators (62.5%). Similarly, Filipinos reported food insecurity in higher proportions relative to non-Filipinos in most timepoints, particularly notable in Timepoint 4 where 33.0% of Filipino respondents reported food insecurity. These findings suggest that Filipinos would benefit from social policy and community-supported initiatives to address social determinants of health, reduce chronic stress, and prevent further mental health disparities.
Collapse
Affiliation(s)
- Angel Lynn E. Talana
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Michelle L. Quensell
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Nicole K. Peltzer
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Mika D. Thompson
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| | - David Stupplebeen
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Catherine M. Pirkle
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| | - L. Brooke Keliikoa
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai‘i at Mānoa, Honolulu, HI
| |
Collapse
|
4
|
Drissi N, Ouhbi S, Serhani MA, Marques G, de la Torre Díez I. Connected Mental Health Solutions: Global Attitudes, Preferences, and Concerns. Telemed J E Health 2023; 29:315-330. [PMID: 35730979 DOI: 10.1089/tmj.2022.0036] [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: 11/12/2022] Open
Abstract
Background: Connected mental health (CMH) presents several technology-based solutions, which can help overcome many mental care delivery barriers. However, attitudes toward the use of CMH are diverse and differ from a cohort to another. Objective: The purpose of this study is to investigate the global attitudes toward CMH use and assess the use of technology for mental care. Methods: This study presents a synthesis of literature available in Scopus, Science Direct, and PubMed digital libraries, investigating attitudes toward CMH in different cohorts from different countries, based on a systematic review of relevant publications. This study also analyzes technology use patterns of the cohorts investigated, the reported preferred criteria that should be considered in CMH, and issues and concerns regarding CMH use. Results: One hundred and one publications were selected and analyzed. These publications were originated from different countries, with the majority (n = 23) being conducted in Australia. These studies reported positive attitudes of investigated cohorts toward CMH use and high technology use and ownership. Several preferred criteria were reported, mainly revolving around providing blended care functionalities, educational content, and mental health professionals (MHPs) support. Whereas concerns and issues related to CMH use addressed technical problems related to access to technology and to CMH solutions, the digital divide, lack of knowledge and use of CMH, and general reservations to use CMH. Concerns related to institutional and work barriers were also identified. Conclusions: Attitudes toward CMH show promising results from users and MHP views. However, factors such as providing blended care options and considering technical concerns should be taken into consideration for the successful adoption of CMH.
Collapse
Affiliation(s)
- Nidal Drissi
- Department of Information Systems and Security and CIT, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sofia Ouhbi
- Department of Computer Science and Software Engineering, CIT, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mohamed Adel Serhani
- Department of Information Systems and Security and CIT, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Gonçalo Marques
- Polytechnic of Coimbra, School of Technology and Management of Oliveira do Hospital (ESTGOH), Coimbra, Portugal
| | - Isabel de la Torre Díez
- Department of Signal Theory and Communications and Telematics Engineering, University of Valladolid, Valladolid, Spain
| |
Collapse
|
5
|
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.
Collapse
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
Collapse
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.
| |
Collapse
|
6
|
Sabado-Liwag MD, Zamora M, Esmundo S, Sumibcay JR, Kwan PP. Preliminary Observations from The FILLED Project (FILipino Lived Experiences during COVID-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12303. [PMID: 36231606 PMCID: PMC9566375 DOI: 10.3390/ijerph191912303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Health outcomes for Asian American subgroups are often aggregated, masking unique experiences and disparities exacerbated by the COVID-19 pandemic, specifically among Filipino Americans (FilAms). The FILLED (Filipino Lived Experiences during COVID-19) Project launched a cross-sectional online survey between April-August 2021 among FilAm adults in Southern California to document community issues and outcomes during the pandemic. Among 223 participants, 47.5% were immigrants, 50.9% identified as essential workers, and 40.6% had a pre-existing health condition before the pandemic. Despite high rates of health insurance (93.3%), 24.4% of the sample did not have a regular health care provider. During the pandemic, 32.7% needed mental health help but did not get it and 44.2% did not know where to get such services. Most respondents felt that the COVID-19 vaccination was a personal responsibility to others (76.9%) and the majority had received at least one dose of a COVID-19 vaccine (82.4%). Regarding COVID-19 impact, participants reported moderate-severe changes in their daily routines (73.5%), access to extended social support (38.9%), housing issues (15.4%), and access to medical care (11.6%). To our knowledge, this study is the first community-driven effort highlighting FilAm community experiences in Southern California, where the highest proportion of FilAms in the United States reside, specifically after the COVID-19 vaccine was made widely available. The observational findings may help community leaders, policy makers, and public health researchers in the design, development, and implementation of post-pandemic intervention strategies used by community-partnered projects that address FilAm and sub-Asian group health disparities at grassroots to societal levels.
Collapse
Affiliation(s)
| | - Mayra Zamora
- Department of Public Health, California State University, Los Angeles, CA 90032, USA
| | - Shenazar Esmundo
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
| | - Jake Ryann Sumibcay
- Department of Public Health, California State University, Los Angeles, CA 90032, USA
| | - Patchareeya P. Kwan
- Department of Health Sciences, California State University, Northridge, CA 91330, USA
| |
Collapse
|
7
|
Adaptation of a school-based mental health program for adolescents in Vietnam. PLoS One 2022; 17:e0271959. [PMID: 35925878 PMCID: PMC9352022 DOI: 10.1371/journal.pone.0271959] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/11/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Cultural adaptation of a school-based mental health intervention developed in a high-income country is a cost-effective method to address the mental health needs of adolescents in resource-constrained settings. The aim of this study was to translate and culturally adapt the Resourceful Adolescent Program for Adolescents (RAP-A) for adolescents attending high school in Vietnam. Methods The translation and adaptation were conducted using a five-step process including (1) initial stakeholder consultation, (2) forward translation, (3) backward translation, (4) adaptation, and (5) finalising the adapted version. An adaptation panel was established, including the RAP-A authors and mental health and public health experts from Australia, and psychology and public health experts from Vietnam. The panel collaborated closely with a group of stakeholders, including bilingual psychologists and psychiatrists, high school (grades 10–12) students and teachers throughout the adaptation process. Results The adapted version of RAP-A was named ‘Happy House’. Happy House was adapted to be delivered in larger groups and in longer sessions than the RAP-A. The 11 sessions in RAP-A were restructured to 6 sessions in Happy House. Major changes were not required for any of the materials. However, some content, illustrations and videos were adapted to be more feasible for the school context and to enhance the comprehensibility, acceptability and appropriateness. Conclusion Happy House has great potential to be relevant, comprehensible and acceptable for Vietnamese adolescents. Further research is warranted to examine the relevance, comprehensibility, acceptability, and effectiveness of this program on adolescents’ mental health before advocating for scaling up program delivery in high schools throughout Vietnam.
Collapse
|
8
|
Sit HF, Hong IW, Burchert S, Sou EKL, Wong M, Chen W, Lam AIF, Hall BJ. A Feasibility Study of the WHO Digital Mental Health Intervention Step-by-Step to Address Depression Among Chinese Young Adults. Front Psychiatry 2022; 12:812667. [PMID: 35069297 PMCID: PMC8777229 DOI: 10.3389/fpsyt.2021.812667] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/13/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Chinese young adults experience barriers to mental health treatment, including the lack of treatment providers and stigma around treatment seeking. Evidence-based digital mental health interventions are promising and scalable alternatives to face-to-face treatment for this population, but lack rigorous evidence to support scale-up in China. Aim: The study was a feasibility study for a large-scale RCT of Step-by-Step, a behavioral activation-based, mental health intervention to address depression and anxiety symptoms in Chinese young adults. It sought to assess feasibility of recruitment and of delivery of Step-by-Step in a University setting, to assess acceptability of the intervention, and to examine potential effectiveness. Method: An uncontrolled, feasibility trial was conducted to assess the feasibility and acceptability of Chinese Step-by-Step for Chinese University students with elevated depressive symptoms (PHQ-9 scores at or above 10) in Macao, China. Data was collected at two different time points (i.e., baseline and 8-weeks after baseline), administered via questionnaires embedded in an interventional mobile application. Participation rate and dropout rate were measured. Depressive and anxiety symptom severity, well-being, and self-defined stress were assessed. Satisfaction with the program was assessed using qualitative interviews. Results: A total of 173 students were screened, 22.0% (n = 38) were eligible, and 63.2% of them (n = 24) started the intervention. The dropout rate by post-test was 45.8%. Results from completers showed that Step-by-Step was potentially effective in reducing depressive and anxiety symptom severity, and self-defined stress. Students were generally satisfied with the program, but also offered suggestions for continued improvement. Qualitative feedback was reported within the RE-AIM framework, covering recruitment, effectiveness, adoption, implementation, and maintenance. Amendments to the program were made according to the feedback (e.g., adding notification for new session, modify the time zone). Conclusion: A minimally guided Step-by-Step protocol and the study procedure were successfully pilot tested for use for Chinese University students. The intervention was acceptable and no adverse events were reported. The results support the potential effectiveness and feasibility of a large-scale evaluation of the program.
Collapse
Affiliation(s)
- Hao Fong Sit
- Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ieng Wai Hong
- Moon Chun Memorial College, University of Macau, Macau, Macau SAR, China
| | - Sebastian Burchert
- Department of Education and Psychology, Division of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | | | - Mek Wong
- Student Affairs Office, University of Macau, Macau, Macau SAR, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Brian J. Hall
- Center for Global Health Equity, NYU Shanghai, Shanghai, China
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Spanhel K, Balci S, Feldhahn F, Bengel J, Baumeister H, Sander LB. Cultural adaptation of internet- and mobile-based interventions for mental disorders: a systematic review. NPJ Digit Med 2021; 4:128. [PMID: 34433875 PMCID: PMC8387403 DOI: 10.1038/s41746-021-00498-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 08/03/2021] [Indexed: 02/07/2023] Open
Abstract
Providing accessible and effective healthcare solutions for people living in low- and middle-income countries, migrants, and indigenous people is central to reduce the global mental health treatment gap. Internet- and mobile-based interventions (IMI) are considered scalable psychological interventions to reduce the burden of mental disorders and are culturally adapted for implementation in these target groups. In October 2020, the databases PsycInfo, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were systematically searched for studies that culturally adapted IMI for mental disorders. Among 9438 screened records, we identified 55 eligible articles. We extracted 17 content, methodological, and procedural components of culturally adapting IMI, aiming to consider specific situations and perspectives of the target populations. Adherence and effectiveness of the adapted IMI seemed similar to the original IMI; yet, no included study conducted a direct comparison. The presented taxonomy of cultural adaptation of IMI for mental disorders provides a basis for future studies investigating the relevance and necessity of their cultural adaptation.PROSPERO registration number: CRD42019142320.
Collapse
Affiliation(s)
- Kerstin Spanhel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany.
| | - Sumeyye Balci
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Felicitas Feldhahn
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Juergen Bengel
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany
| |
Collapse
|
11
|
Ling R, Sit HF, Balaji S, Lam AI, Latkin CA, Tucker JD, Hall BJ. Crowdsourcing to design a marketing package to promote a WHO digital mental health intervention among Chinese young adults. Internet Interv 2021; 25:100397. [PMID: 34036050 PMCID: PMC8138601 DOI: 10.1016/j.invent.2021.100397] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/09/2021] [Accepted: 04/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Digital mental health is an emerging field that can leverage technology and mobile apps to deliver mental health treatment to populations in areas with limited mental health services. Despite widespread availability of these apps, uptake remains low. Enhanced marketing is necessary to increase public engagement. There is growing recognition that mental health intervention beneficiaries should be engaged in all phases of treatment development, adaptation, and delivery. Crowdsourcing - consulting the public to solve problems and sharing the solutions - can foster community-informed ideas for public health, but has yet been applied to digital mental health marketing. OBJECTIVE With the goal of engaging potential intervention beneficiaries in digital mental health dissemination, the current project implemented a digital mental health crowdsourcing designathon for Chinese college students in Macao SAR, China and evaluated the feasibility of the contest and the products. The contest asked participants to design marketing packages for Step-by-Step, a scalable WHO digital mental health intervention focusing on depression. METHODS Designathon participants, recruited from a global health class, were sorted into teams with balanced areas of expertise. Two judging panels - one of experts in relevant fields and another of Chinese college students - evaluated the marketing packages and selected finalists. The designathon was held in-person over four days and involved debriefing, workshops, a contest, and an awards ceremony. A parallel mixed-methods approach was applied, including qualitative feedback from judges and participants alongside quantitative data on participant satisfaction and depressive symptoms to enrich our understanding of the event. Additionally, based on judges' feedback given to participants, the communication packages of the contest were ranked. RESULTS 49 participants (8 teams of 6-7 members each) were involved in the designathon. Using a cutoff score of 10 on the Patient Health Questionnaire-9 (PHQ-9), 11.4% of participants had moderate or higher depressive symptoms. All teams successfully produced complete digital mental health marketing packages. Four finalists' packages were selected quantitatively with judges' scores and the top finalist's package was described by judges' comments as simple, thoughtful, and appealing, although not informative enough. Participants were overall satisfied with the designathon, but some mentioned that time was insufficient and that organization/instruction clarity could have been improved. CONCLUSIONS The designathon is a novel, feasible strategy to collect crowd input for the dissemination of a mental health intervention. Compared with traditional communication strategies, this bottom-up approach included and engaged potential intervention beneficiaries to take an active role in creating digital mental health marketing communication. Future contests should allow participants more time and reconsider aspects of event organization.
Collapse
Affiliation(s)
- Rui Ling
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Hao Fong Sit
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China
| | - Suvasini Balaji
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China,Program in Public Health Studies, Johns Hopkins University, Baltimore, MD, USA
| | | | - Carl A. Latkin
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D. Tucker
- UNC Project China, University of North Carolina at Chapel Hill, USA,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian J. Hall
- Global and Community Mental Health Research Group, New York University (Shanghai), Shanghai, People's Republic of China,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA,Corresponding author at: Global and Community Mental Health Research Group, New York University (Shanghai), 1555 Century Ave, Pudong, Shanghai 200122, People's Republic of China.
| |
Collapse
|
12
|
Liem A, Natari RB, Jimmy, Hall BJ. Digital Health Applications in Mental Health Care for Immigrants and Refugees: A Rapid Review. Telemed J E Health 2021; 27:3-16. [DOI: 10.1089/tmj.2020.0012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Andrian Liem
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
- School of Psychology and The University of Queensland, Brisbane, Australia
| | - Rifani B. Natari
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Pharmacy, Jambi Regional Psychiatric Hospital, Jambi City, Indonesia
| | - Jimmy
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
- Department of Computer Science, The University of Surabaya, Surabaya, Indonesia
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Domestic Workers from the Philippines in China: An Opportunity for Health Promotion Within the Belt and Road Initiative. J Immigr Minor Health 2020; 22:1-2. [PMID: 31664586 DOI: 10.1007/s10903-019-00942-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Liem A, Garabiles MR, Pakingan KA, Chen W, Lam AIF, Burchert S, Hall BJ. A digital mental health intervention to reduce depressive symptoms among overseas Filipino workers: protocol for a pilot hybrid type 1 effectiveness-implementation randomized controlled trial. Implement Sci Commun 2020; 1:96. [PMID: 33145495 PMCID: PMC7602760 DOI: 10.1186/s43058-020-00072-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/10/2020] [Indexed: 01/21/2023] Open
Abstract
Background The current pilot randomized controlled trial (RCT) protocol will comprehensively describe the implementation of a culturally adapted Filipino version of the World Health Organization Step-by-Step (SbS-F) program, unguided online psychological intervention for people with depression based on behavioral activation, among overseas Filipino workers (OFWs) in Macao (Special Administrative Region). The main objective of this pilot study is to explore the preliminary effectiveness of the SbS-F program to decrease participant-reported depressive symptoms compared to enhanced care as usual (ECAU); and the secondary objectives are to explore the preliminary effectiveness of the SbS-F to decrease participant-reported anxiety symptoms and improve wellbeing, and to evaluate the potential for SbS-F implementation in real-world settings. Methods This trial will follow an effectiveness-implementation hybrid type 1 trial design and utilize the Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to accelerate the translation of clinical research into more effective implementation strategies and policies. Participants will be randomized 1:1 to control and treatment groups. Control group participants will receive ECAU that consists of brief depression psychoeducation and referral to local community partners. Treatment group participants will receive a 5-session of digital intervention through a mobile phone application. The primary outcome (depression) and psychological secondary outcomes (anxiety symptoms and wellbeing) will be measured using validated instruments. To evaluate study implementation, an embedded mixed-methods design will be used to collect data from various stakeholders. Data then will be analyzed using intention to treat principle and reported following the Consolidated Standards of Reporting Trials (CONSORT) guideline. Discussion This study will provide important new knowledge about the preliminary effectiveness of SbS-F, a mobile application, as a digital mental health intervention and its scalability. If SbS-F shows positive results among OFWs in Macao, it has strong potential to be used by OFWs in other countries that may also experience depression and difficulty accessing mental health services. Trial registration Prospective registration, Chinese Clinical Trial Registry (ChiCTR2000034959) on 26/07/2020.
Collapse
Affiliation(s)
- Andrian Liem
- Department of Communication, University of Macau, Macao, SAR China
| | | | - Karmia A Pakingan
- Department of Psychology, De La Salle University, Manila, Philippines
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, China.,Sun Yat-sen Centre for Migrant Health Policy, Sun Yat-sen University, Zhongshan Road 2, Guangzhou, China
| | - Agnes Iok Fong Lam
- Department of Communication & Centre for Macau Studies, University of Macau, Macao, SAR China
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Brian J Hall
- New York University (Shanghai), Shanghai, People's Republic of China.,Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| |
Collapse
|
15
|
Shala M, Morina N, Burchert S, Cerga-Pashoja A, Knaevelsrud C, Maercker A, Heim E. Cultural adaptation of Hap-pas-Hapi, an internet and mobile-based intervention for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. Internet Interv 2020; 21:100339. [PMID: 32983906 PMCID: PMC7495109 DOI: 10.1016/j.invent.2020.100339] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/24/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Internet- and mobile-based mental health interventions have the potential to narrow the treatment gap in ethnic groups. Little evidence exists on the cultural adaptation of such interventions. Cultural adaptation of evidence-based interventions distinguishes between surface and deep structure adaptation. Surface refers to matching materials (e.g., illustrations, language) or methods of treatment delivery to the target population, whereas deep structure adaptation considers cultural concepts of distress (CCD). So far, CCD have only been considered to a limited extent in cultural adaptation of psychological interventions, and there is a lack of well documented adaptation procedures. AIMS With a cross-disciplinary and mixed-method approach, following a new conceptual framework for cultural adaptation of scalable psychological interventions, this study aimed to develop both surface and deep structure adaptations of an internet- and mobile-based intervention called Hap-pas-Hapi for the treatment of psychological distress among Albanian migrants in Switzerland and Germany. METHODS A qualitative ethnopsychological study was conducted to examine the target group's CCD. Focus group discussions, an online survey, and individual key informant interviews were utilised to evaluate the original intervention, adaptation drafts and the final adapted intervention. A reporting system was developed to support the decision-making process and to report all adaptations in a transparent and replicable way. RESULTS The ongoing involvement of target population key informants provided valuable feedback for the development of a more person-centred intervention, which might enhance treatment acceptance, motivation and adherence. DISCUSSION This study provides empirical and theory-based considerations and suggestions for future implementation that may foster acceptability and effectiveness of culturally adapted evidence-based interventions.
Collapse
Affiliation(s)
- Mirëlinda Shala
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zurich, University of Zurich, Switzerland
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Arlinda Cerga-Pashoja
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central and North West London NHS Foundation Trust, London, United Kingdom
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| | - Eva Heim
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Switzerland
| |
Collapse
|
16
|
Drissi N, Ouhbi S, Janati Idrissi MA, Fernandez-Luque L, Ghogho M. Connected Mental Health: Systematic Mapping Study. J Med Internet Res 2020; 22:e19950. [PMID: 32857055 PMCID: PMC7486675 DOI: 10.2196/19950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/02/2020] [Accepted: 07/28/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. OBJECTIVE The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. METHODS A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. RESULTS The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. CONCLUSIONS CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues.
Collapse
Affiliation(s)
- Nidal Drissi
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates.,National School For Computer Science, Mohammed V University in Rabat, Rabat, Morocco
| | - Sofia Ouhbi
- Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Mounir Ghogho
- TICLab, International University of Rabat, Rabat, Morocco
| |
Collapse
|
17
|
Sit HF, Ling R, Lam AIF, Chen W, Latkin CA, Hall BJ. The Cultural Adaptation of Step-by-Step: An Intervention to Address Depression Among Chinese Young Adults. Front Psychiatry 2020; 11:650. [PMID: 32733296 PMCID: PMC7359726 DOI: 10.3389/fpsyt.2020.00650] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital mental health interventions leverage digital communication technology to address the mental health needs of populations. Culturally adapting interventions can lead to a successful, scalable mental health intervention implementation, and cultural adaptation of digital mental health interventions is a critical component to implementing interventions at scale within contexts where mental health services are not well supported. OBJECTIVE The study aims to describe the cultural adaptation of a digital mental health intervention Step-by-Step in order to address depression among Chinese young adults. METHODS Cultural adaptation was carried out in four phases following Ecological Validity Model: (1) stage setting and expert consultation; (2) preliminary content adaptation; (3) iterative content adaptation with community members; (4) finalized adaptation with community feedback meetings. Cognitive interviewing was applied to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Six mental health experts and 34 Chinese young adults were recruited for key informant interviews and focus group discussions. RESULTS We adapted the text and illustrations to fit the culture among Chinese young adults. Eight elements of the intervention were chosen as the targets of cultural adaptation (e.g., language, metaphors, content). Samples of major adaptations included: adding scenarios related to university life (relevance), changing leading characters from a physician to a peer and a cartoon (acceptability), incorporating two language versions (traditional Chinese and simplified Chinese) in the intervention (comprehensibility), and maintaining fundamental therapeutic components (completeness). CONCLUSION This study showed the utility of using Ecological Validity Model and a four-point procedure framework for cultural adaptation and achieved a culturally appropriate version of the Step-by-Step program for Chinese young adults.
Collapse
Affiliation(s)
- Hao Fong Sit
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
| | - Rui Ling
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Agnes Iok Fong Lam
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
- Department of Communication, Faculty of Social Science, University of Macau, Macau, China
- Centre for Macau Studies, University of Macau, Macau, China
| | - Wen Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Carl A. Latkin
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macau, China
- Centre for Macau Studies, University of Macau, Macau, China
- Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
18
|
Garabiles MR, Lao CK, Wang S, Hall BJ. The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression. Eur J Psychotraumatol 2020; 11:1765544. [PMID: 34630933 PMCID: PMC8500701 DOI: 10.1080/20008198.2020.1765544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Labour migrants are exposed to potentially traumatic events throughout the migration cycle, making them susceptible to developing mental disorders. Posttraumatic stress disorder (PTSD) is often comorbid with depression. Comorbidity worsens the course of illness, prognosis, treatment response, and increases suicidal risk. Using network analysis, this study examined the structure of PTSD and depression in a sample of migrant domestic workers, an especially vulnerable community of labour migrants. This study sought to derive the central or most important symptoms, strongest edges or relationships among symptoms, and bridge symptoms between PTSD and depression. METHODS Data were obtained from 1,375 Filipina domestic workers in Macao SAR, China. Data from a subsample of 1,258 trauma-exposed participants were analysed using R software. RESULTS Most of the strongest edges were within the same disorder and, for PTSD, within the same symptom cluster. Highest node centrality were PCL-5's 'avoid thoughts', 'lose interest', 'negative emotions', and 'not concentrate', and PHQ-9's 'sleep difficulties'. The bridge symptoms were PHQ-9's 'sleep difficulties,' 'psychomotor agitation/retardation,' and 'fatigue,' PCL-5's 'not concentrate', and PHQ-9's 'worthlessness' and 'anhedonia'. LIMITATIONS Results may not generalize to Filipino migrant workers in other occupations and to male migrant workers. Potentially relevant symptoms like somatic symptoms and fear of somatic and mental symptoms were not included. CONCLUSIONS Central and bridge symptoms are the most important nodes in the network. Developing interventions targeting these symptoms, particularly depression symptoms, is a promising alternative to PTSD treatment given substantial barriers to specialist care for this population.
Collapse
Affiliation(s)
- Melissa R Garabiles
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China.,Department of Psychology, Ateneo de Manila University, Quezon City, Philippines
| | - Chao K Lao
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China
| | - Siyuan Wang
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China
| | - Brian J Hall
- Global and Community Mental Health Research Group, Department of Psychology, Faculty of Social Sciences, The University of Macau, Macao (SAR), People's Republic of China
| |
Collapse
|
19
|
The mental health impact of the pro-democracy movement in Hong Kong. Lancet Psychiatry 2019; 6:982. [PMID: 31777345 DOI: 10.1016/s2215-0366(19)30382-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/01/2019] [Accepted: 10/01/2019] [Indexed: 11/21/2022]
|