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Kozelka EE, Acquilano SC, Al-Abdulmunem M, Guarino S, Elwyn G, Drake RE, Carpenter-Song E. Digital Mental Health and Its Discontents: Assumptions About Technology That Create Barriers to Equitable Access. Psychiatr Serv 2024; 75:299-302. [PMID: 38050440 DOI: 10.1176/appi.ps.20230238] [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] [Indexed: 12/06/2023]
Abstract
Despite the potential of digital mental health interventions to aid recovery for people with serious mental illness, access to these digital tools remains a key barrier. In this column, the authors discuss three key assumptions that shape the integration of digital mental health tools into community health settings: clinical context, digital literacy, and financial burden. Clinical contexts have shifted with the increased use of telehealth, altering intervention environments; access to a mobile device is not the same as digital literacy; and digital mental health care is not necessarily affordable. Context-centered study design through ethnography will facilitate transfer of digital resources to real-world settings.
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Affiliation(s)
- Ellen E Kozelka
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Stephanie C Acquilano
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Monirah Al-Abdulmunem
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Sue Guarino
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Glyn Elwyn
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Robert E Drake
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
| | - Elizabeth Carpenter-Song
- Department of Anthropology, University of Vermont, Burlington (Kozelka); Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Acquilano, Elwyn); Westat, Lebanon, New Hampshire (Al-Abdulmunem, Drake); Mental Health Center of Greater Manchester, Manchester, New Hampshire (Guarino); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Drake); Department of Anthropology, Dartmouth College, Hanover, New Hampshire (Carpenter-Song)
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Kuhn E, Saleem M, Klein T, Köhler C, Fuhr DC, Lahutina S, Minarik A, Musesengwa R, Neubauer K, Olisaeloka L, Osei F, Reinhold AS, Singh I, Spanhel K, Thomas N, Hendl T, Kellmeyer P, Böge K. Interdisciplinary perspectives on digital technologies for global mental health. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002867. [PMID: 38315676 PMCID: PMC10843075 DOI: 10.1371/journal.pgph.0002867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Digital Mental Health Technologies (DMHTs) have the potential to close treatment gaps in settings where mental healthcare is scarce or even inaccessible. For this, DMHTs need to be affordable, evidence-based, justice-oriented, user-friendly, and embedded in a functioning digital infrastructure. This viewpoint discusses areas crucial for future developments of DMHTs. Drawing back on interdisciplinary scholarship, questions of health equity, consumer-, patient- and developer-oriented legislation, and requirements for successful implementation of technologies across the globe are discussed. Economic considerations and policy implications complement these aspects. We discuss the need for cultural adaptation specific to the context of use and point to several benefits as well as pitfalls of DMHTs for research and healthcare provision. Nonetheless, to circumvent technology-driven solutionism, the development and implementation of DMHTs require a holistic, multi-sectoral, and participatory approach.
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Affiliation(s)
- Eva Kuhn
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Maham Saleem
- Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Thomas Klein
- Department of Psychiatry and Psychotherapy II, Ulm University, Guenzburg, Germany
| | - Charlotte Köhler
- Department of Data Science & Decision Support, European University Viadrina, Große, Frankfurt (Oder), Germany
| | - Daniela C. Fuhr
- Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- University of Bremen, Health Sciences, Bremen, Germany
| | - Sofiia Lahutina
- TUM Department of Sport and Health Sciences (TUM SG), Chronobiology and Health, Technical University of Munich, Munich, Germany
- TUM Institute for Advanced Study (TUM-IAS), Technical University of Munich, Garching, Germany
| | - Anna Minarik
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosemary Musesengwa
- Department of Psychiatry and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | | | - Lotenna Olisaeloka
- Institute for Global Health, University College London, London, United Kingdom
| | - Francis Osei
- Department of Health and Physical Activity, Professorship for Medical Sociology and Psychobiology, University of Potsdam, Potsdam, Germany
| | - Annika Stefanie Reinhold
- Medical Faculty Mannheim, Department of Public Mental Health, Central Institute of Mental Health (CIMH), Heidelberg University, Mannheim, Germany
| | - Ilina Singh
- Department of Psychiatry and Welcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Kerstin Spanhel
- Faculty of Medicine, Institute for Medical Psychology and Medical Sociology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| | - Tereza Hendl
- Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Ethics, History and Theory of Medicine, Ludwig-Maximilians-University in Munich, Munich, Germany
| | - Philipp Kellmeyer
- Department of Neurosurgery, University of Freiburg—Medical Center, Freiburg im Breisgau, Germany
- School of Business Informatics and Mathematics, University of Mannheim, Mannheim, Germany
| | - Kerem Böge
- Department of Psychiatry and Neurosciences, Campus Benjamin Franklin, Charité –Universitätsmedizin Berlin, Berlin, Germany
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Koehle H, Kronk C, Lee YJ. Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems. Yearb Med Inform 2022; 31:20-32. [PMID: 36463865 PMCID: PMC9719765 DOI: 10.1055/s-0042-1742512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. METHODS We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar. RESULTS We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. CONCLUSIONS We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies.
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Affiliation(s)
- Han Koehle
- Student Affairs Health Equity Initiative, University of California Santa Barbara, Santa Barbara, California, USA
| | - Clair Kronk
- Center for Medical Informatics, Yale University School of Medicine, Connecticut, USA,Correspondence to: Clair Kronk Center for Medical Informatics, Yale School of Medicine300 George Street, PO Box 208009 New Haven, CT 06520USA
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Bwanika JM, Hawkins C, Kamulegeya L, Onyutta P, Musinguzi D, Kusasira A, Musoke EK, Kabeega J. Qualitative study of mental health attribution, perceptions and care-seeking in Kampala, Uganda. S Afr J Psychiatr 2022; 28:1690. [PMID: 35747338 PMCID: PMC9210188 DOI: 10.4102/sajpsychiatry.v28i0.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mental health problems contribute to a substantial proportion of the global burden of disease. In Uganda, the World Health Organization estimates that 2.2 million people are affected by mental health disorders. Further research is needed to highlight people’s views about mental health in order to ensure that services are appropriate, accessible and effective. Aim This qualitative study aimed to explore perceptions, experiences and care-seeking preferences to inform stakeholders looking to provide contextually appropriate mental health programmes. Setting A diverse neighbourhood in central Kampala, Uganda. Methods The authors conducted 56 in-depth semi-structured interviews with people over the age of 37 years from November 2018 to May 2019. Results Participants discussed interpersonal and systemic issues that affect mental health in their community and the existing coping mechanisms that people employ. Social factors were often associated with mental health problems, with 36% of participants attributing them to economic stressors in particular. Mental health services were often perceived to be unavailable, costly or stigmatised, which can mean that care-seeking is delayed until problems become severe. Some people said they prefer to turn to prayer (25%) or counselling within their family or community (12.5%). Conclusion Mental health problems are often attributed to socioeconomic factors, which can also hinder access to services. An understanding of perceptions about mental health can help to align programmes for appropriateness and effectiveness. Our study suggests that beneficial additional services for people living in low-income urban settings in Uganda could include those which are free, community-based or offering financial support.
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Affiliation(s)
- John M Bwanika
- Department of Research, The Medical Concierge Group, Kampala, Uganda
- Infectious Diseases Institute Limited, Kampala, Uganda
| | - Charlotte Hawkins
- Department of Anthropology, University College London, London, United Kingdom
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