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Mahmoud H, Naal H, Mitchell B, Arenivar L. Presenting a Framework for Telebehavioral Health Implementation. Curr Psychiatry Rep 2023; 25:825-837. [PMID: 37955800 DOI: 10.1007/s11920-023-01470-4] [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] [Accepted: 10/11/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE OF REVIEW This paper presents OPTIC as a framework to guide the conceptualization and implementation of telebehavioral health (TBH) in a comprehensive, structured, and accessible manner. RECENT FINDINGS There is a need for comprehensive frameworks for TBH implementation, yet current models and frameworks described in the literature have limitations. Many studies highlight favorable outcomes of TBH during COVID-19, along with increased adoption. However, despite the plethora of publications on general telehealth implementation, knowledge is disparate, inconsistent, not comprehensive, and not TBH-specific. The framework incorporates five components: Originating site, Patient population, Teleclinician, Information and communication technologies, and Cultural and regulatory context. These components, abbreviated using the acronym OPTIC, are discussed, with examples of implementation considerations under each component throughout the project cycle. The value and larger implications of OPTIC are discussed as a foundation for stakeholders involved with TBH, in addition to key performance indicators, and considerations for quality enhancement.
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Affiliation(s)
- Hossam Mahmoud
- Department of Psychiatry, Tufts University, Boston, MA, USA.
| | - Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
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Joubert AE, Grierson AB, Li I, Sharrock MJ, Moulds ML, Werner-Seidler A, Stech EP, Mahoney AEJ, Newby JM. Managing Rumination and worry: A randomised controlled trial of an internet intervention targeting repetitive negative thinking delivered with and without clinician guidance. Behav Res Ther 2023; 168:104378. [PMID: 37595354 DOI: 10.1016/j.brat.2023.104378] [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: 11/14/2021] [Revised: 06/05/2023] [Accepted: 07/23/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Rumination and worry, forms of repetitive negative thinking (RNT), are implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. This randomised controlled trial evaluated an internet intervention targeting both rumination and worry in adults compared to treatment-as-usual (TAU) and compared treatment effects and adherence when delivered with and without clinician guidance. METHODS Adults (N = 137) with elevated RNT were randomly allocated to a 3-lesson clinician guided (n = 45) or self-help (n = 47) online program delivered over 6 weeks, or a TAU control group which waited 18 weeks to receive the program (n = 45). The clinician guided group received semi-structured phone support after each lesson. All three groups continued any pre-trial TAU. RNT, anxiety, depression, and psychological distress were assessed at baseline, post-treatment (week 7), and 3-month follow-up. RESULTS Intention-to-treat linear mixed models showed that participants in the self-help and clinician guided groups had significantly lower RNT, anxiety, depression, and distress at post-treatment and 3-month follow-up compared to TAU. Treatment effects were significantly larger in the clinician guided group compared to self-help (between-group gs = 0.41-0.97). No significant between-group differences were found in adherence/program completion (guided: 76%; self-guided: 79%) or treatment satisfaction (1-5 scale: guided: M = 4.17, SD = 1.20; self-guided: M = 3.89, SD = 0.93). Total time spent on clinician guidance was M = 48.64 min (SD = 21.28). CONCLUSION This brief online intervention for RNT is acceptable and efficacious in reducing RNT, anxiety, depression, and distress in both clinician guided and self-help formats. The program appeared most effective when delivered with clinician guidance. Larger definitive trials comparing guided and self-guided programs are needed. Australian and New Zealand Clinical Trials Registration number: ACTRN12620000959976.
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Affiliation(s)
- Amy E Joubert
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michelle L Moulds
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Eileen P Stech
- Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia
| | - Alison E J Mahoney
- Clinical Research Unit for Anxiety and Depression (CRUfAD), St. Vincent's Hospital, Level 4 O'Brien Centre, 394- 404 Victoria Street, Darlinghurst, Sydney, New South Wales, 2010, Australia; School of Psychiatry, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Jill M Newby
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia; Black Dog Institute, The University of New South Wales, Sydney, NSW, 2052, Australia.
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Scott S, Knott V, Finlay-Jones AL, Mancini VO. Australian Psychologists Experiences with Digital Mental Health: a Qualitative Investigation. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 8:1-11. [PMID: 35991293 PMCID: PMC9381152 DOI: 10.1007/s41347-022-00271-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/11/2022] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
Digital mental health is changing the landscape of service delivery by addressing challenges associated with traditional therapy. However, practitioners' use of these resources remains underexamined. This study explored psychologists' attitudes and experiences with digital mental health intervention. Taking a qualitative exploratory approach via thematic analysis, the study sought to answer the following research questions: (i) How do psychologists perceive digital mental health? and (ii) What is their experience using digital mental health as part of routine practice? Ten practising psychologists participated in online semi-structured interviews (approximately 50 min), with interviews then transcribed verbatim. Interview data were analysed according to the six-phase approach to thematic analysis proposed by Braun and Clarke. Three themes were identified: (1) attitudes towards digital mental health; (2) use within routine practice; and (3) perspectives on an effective model for implementation. Practitioners play a major role in the design and delivery of digital mental health services. Barriers and facilitators at the practitioner-level (e.g. knowledge and competence with tools, perceptions on the utility of digital interventions) and the service-level (e.g. government support for digital health) should be considered in the future design of digital mental health resources and service delivery. Supplementary Information The online version contains supplementary material available at 10.1007/s41347-022-00271-5.
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Affiliation(s)
- Stephanie Scott
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
| | - Vikki Knott
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
| | - Amy L. Finlay-Jones
- School of Population Health, Curtin University, Perth, WA Australia
- Telethon Kids Institute, Perth, WA Australia
- UWA Medical School, Division of Paediatrics, University of Western Australia, Perth, WA Australia
| | - Vincent O. Mancini
- Discipline of Psychological Sciences, Australian College of Applied Psychology (ACAP), Sydney, NSW Australia
- School of Population Health, Curtin University, Perth, WA Australia
- Telethon Kids Institute, Perth, WA Australia
- UWA Medical School, Division of Paediatrics, University of Western Australia, Perth, WA Australia
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Leach B, Parkinson S, Gkousis E, Abel G, Atherton H, Campbell J, Clark C, Cockcroft E, Marriott C, Pitchforth E, Sussex J. Digital Facilitation to Support Patient Access to Web-Based Primary Care Services: Scoping Literature Review. J Med Internet Res 2022; 24:e33911. [PMID: 35834301 PMCID: PMC9335178 DOI: 10.2196/33911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of web-based services within primary care (PC) in the National Health Service in England is increasing, with medically underserved populations being less likely to engage with web-based services than other patient groups. Digital facilitation-referring to a range of processes, procedures, and personnel that seek to support patients in the uptake and use of web-based services-may be a way of addressing these challenges. However, the models and impact of digital facilitation currently in use are unclear. OBJECTIVE This study aimed to identify, characterize, and differentiate between different approaches to digital facilitation in PC; establish what is known about the effectiveness of different approaches; and understand the enablers of digital facilitation. METHODS Adopting scoping review methodology, we searched academic databases (PubMed, EMBASE, CINAHL, Web of Science, and Cochrane Library) and gray literature published between 2015 and 2020. We conducted snowball searches of reference lists of included articles and articles identified during screening as relevant to digital facilitation, but which did not meet the inclusion criteria because of article type restrictions. Titles and abstracts were independently screened by 2 reviewers. Data from eligible studies were analyzed using a narrative synthesis approach. RESULTS A total of 85 publications were included. Most (71/85, 84%) were concerned with digital facilitation approaches targeted at patients (promotion of services, training patients to improve their technical skills, or other guidance and support). Further identified approaches targeted PC staff to help patients (eg, improving staff knowledge of web-based services and enhancing their technical or communication skills). Qualitative evidence suggests that some digital facilitation may be effective in promoting the uptake and use of web-based services by patients (eg, recommendation of web-based services by practice staff and coaching). We found little evidence that providing patients with initial assistance in registering for or accessing web-based services leads to increased long-term use. Few studies have addressed the effects of digital facilitation on health care inequalities. Those that addressed this suggested that providing technical training for patients could be effective, at least in part, in reducing inequalities, although not entirely. Factors affecting the success of digital facilitation include perceptions of the usefulness of the web-based service, trust in the service, patients' trust in providers, the capacity of PC staff, guidelines or regulations supporting facilitation efforts, and staff buy-in and motivation. CONCLUSIONS Digital facilitation has the potential to increase the uptake and use of web-based services by PC patients. Understanding the approaches that are most effective and cost-effective, for whom, and under what circumstances requires further research, including rigorous evaluations of longer-term impacts. As efforts continue to increase the use of web-based services in PC in England and elsewhere, we offer an early typology to inform conceptual development and evaluations. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42020189019; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189019.
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Affiliation(s)
| | | | | | - Gary Abel
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - John Campbell
- University of Exeter Medical School, Exeter, United Kingdom
| | | | - Emma Cockcroft
- University of Exeter Medical School, Exeter, United Kingdom
| | - Christine Marriott
- National Institute of Health and Care Research Collaboration South West Peninsula Patient Engagement Group, University of Exeter Medical School, Exeter, United Kingdom
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Davies F, Harris M, Shepherd HL, Butow P, Beatty L, Kemp E, Shaw J. Promise unfulfilled: Implementing web‐based psychological therapy in routine cancer care, a qualitative study of oncology health professionals’ attitudes. Psychooncology 2022; 31:1127-1135. [PMID: 35129251 PMCID: PMC9546389 DOI: 10.1002/pon.5900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/17/2022]
Abstract
Background Web‐based mental health interventions (e‐MhIs) show promise for increasing accessibility and acceptability of therapy for cancer patients. Aim This study aimed to elicit health professionals' (HPs) views on optimal models for including e‐MhIs within standard cancer care. Materials & Method Cancer HPs who worked in a service where an e‐MhI was available to patients, and multi‐disciplinary HPs interested in supportive care, were invited to participate via email. In semi‐structured phone interviews, participants' views on e‐MhIs were elicited. They were then presented with five model vignettes varying in local and centralised staff input, and asked to indicate their preference and views on each. A thematic analysis was applied to the data. Results Twelve nurses, nine psychologists, seven social workers, and three oncologists participated. Four key themes were identified: looking after patients, relationships and multidisciplinary care, trust, and feasibility, all contributing to a meta‐theme of tension. Participants were motivated to ensure optimal patient outcomes and thus needed to trust the intervention content and process. They believed personal relationships increased patient engagement while affording greater work satisfaction for HPs. Most participants preferred a fully integrated model of care involving local HP assessment and design of a tailored therapy incorporating some e‐MhI components where appropriate, but recognised this gold standard was likely not feasible given current resources. Discussion and Conclusion Co‐design with local staff of optimal models of care for the content and process of implementing e‐MhIs is required, with due consideration of the patient group, staffing levels, local workflows and HP preferences, to ensure sustainability and optimal patient outcomes. Clinical Trial Registration The ADAPT Cluster RCT is registered with the ANZCTR Registration number: ACTRN12617000411347.
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Affiliation(s)
- Fiona Davies
- Psycho‐Oncology Co‐operative Research Group (PoCoG) School of Psychology University of Sydney NSW Australia
| | - Marnie Harris
- Psycho‐Oncology Co‐operative Research Group (PoCoG) School of Psychology University of Sydney NSW Australia
| | - Heather L Shepherd
- Psycho‐Oncology Co‐operative Research Group (PoCoG) School of Psychology University of Sydney NSW Australia
- The University of Sydney Sydney Nursing School Faculty of Medicine and Health Sydney NSW Australia
| | - Phyllis Butow
- Psycho‐Oncology Co‐operative Research Group (PoCoG) School of Psychology University of Sydney NSW Australia
| | - Lisa Beatty
- Flinders Health and Medical Research Institute College of Medicine and Public Health Flinders University Australia
| | - Emma Kemp
- Psycho‐Oncology Co‐operative Research Group (PoCoG) School of Psychology University of Sydney NSW Australia
| | - Joanne Shaw
- Psycho‐Oncology Co‐operative Research Group (PoCoG) School of Psychology University of Sydney NSW Australia
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Rowland DP, Casey LM, Ganapathy A, Cassimatis M, Clough BA. A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders. PSYCHOSOCIAL INTERVENTION = INTERVENCION PSICOSOCIAL 2022; 31:1-20. [PMID: 37362616 PMCID: PMC10268557 DOI: 10.5093/pi2021a8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 06/28/2023]
Abstract
Research is increasingly demonstrating the therapeutic benefits of virtual reality interventions for various mental health conditions, though these rarely translate from research to application in clinical settings. This systematic review aims to examine the efficacy of current virtual reality interventions for emotional disorders, with a focus on clinical and technological features that influence translation of treatments from research to clinical practice. A comprehensive systematic literature search was conducted following PRISMA guidelines, for studies including the application of a virtual reality intervention to a clinical population of adults with an emotional disorder. Thirty-seven eligible studies were identified, appraised, and assessed for bias. Treatment effects were typically large across studies, with virtual reality being considered an efficacious treatment modality for various anxiety disorders and post-traumatic stress disorder. Virtual reality interventions were typically used for delivering exposure in cognitive behavioural therapy approaches. Considerable variability was seen in cost, technological specifications, degree of therapist involvement, delivery format, dosage, duration, and frequency of treatment. Suboptimal methodological rigour was identified in some studies. Remote use of virtual reality was rare, despite increasing options for in home use. Virtual reality interventions have the potential to overcome barriers to care and better meet the needs of consumers. Future research should examine the efficacy of virtual reality for treatment of depressive disorders and obsesive compulsive disorder. Improved methodological reporting and development of transdiagnostic and remotely delivered virtual reality interventions, will likely increase the translation of this treatment modality.
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Affiliation(s)
- Dale P. Rowland
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Leanne M. Casey
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Aarthi Ganapathy
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Mandy Cassimatis
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Bonnie A. Clough
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
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Whiting DL, Chuah SL, Simpson GK, Deane FP, Reynolds J. Video-consulting to address mental health needs after traumatic brain injury: evaluation of a training workshop to build capacity among psychologists. Brain Inj 2021; 35:1065-1074. [PMID: 34334058 DOI: 10.1080/02699052.2021.1953594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) can lead to significant psychological distress, but few psychologists in Australia are trained in working with this complex clinical group. Despite government funding to provide video-consulting (VC) services in Australia, uptake before COVID-19 was limited. OBJECTIVE This mixed methods study evaluated whether training in eHealth and evidence based TBI psychological therapies increased provider uptake of VC in clinical practice, and delivery of mental health services to individuals with TBI. METHODS Mental health professionals completed a range of self-report measures before (n = 50), after (n = 48), and four months following (n = 30) a one-day workshop. Participants' TBI knowledge, client-base and levels of access, confidence, motivation and attitudes toward VC were assessed. Knowledge did not increase after training but participants had significant increases in their confidence and motivation to using VC at follow up. Significant reductions in pragmatic barriers to using VC were reported post training and at follow up, all barrier categories indicated significant reductions. There was no significant change in clinical practice of the participants. CONCLUSIONS Training to increase TBI knowledge requires specific assessment tools and although training appears to reduce barriers to using VC, uptake in clinical practice may require additional supervision and warrants further research.
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Affiliation(s)
- Diane L Whiting
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Australia.,School of Psychology, University of Wollongong, Wollongong, Australia
| | - Sarah L Chuah
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Grahame K Simpson
- Brain Injury Rehabilitation Research Group, Ingham Institute for Applied Medical Research, Liverpool, Australia.,John Walsh Centre for Rehabilitation Research, Sydney School of Medicine, the University of Sydney, Australia
| | - Frank P Deane
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Julia Reynolds
- Research School of Psychology, The Australian National University, Australia
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Hanf M, Hirt J, van den Akker M. Primary care professionals' attitudes towards digital health interventions for common mental disorders: study protocol for a mixed methods systematic review. BMJ Open 2021; 11:e045657. [PMID: 34127490 PMCID: PMC8204153 DOI: 10.1136/bmjopen-2020-045657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Mental disorders such as depression are common, and an estimated 264 million people are affected by them throughout the world. In recent years, studies on digital health interventions to treat mental disorders have shown evidence of their efficacy, and interest in using them has increased as a result. In the primary care setting, depression and anxiety are the two most frequently diagnosed and treated mental disorders. When they do not refer them to specialists, primary care professionals such as general practitioners treat patients with mental disorders themselves but have insufficient time to treat them adequately. Furthermore, there is a shortage of psychotherapists and those that exist have long waiting lists for an appointment. The purpose of this mixed methods systematic review is to explore the attitudes of primary care professionals towards the use of digital health interventions in the treatment of patients with mental disorders. Their attitudes will provide an indication whether digital mental health interventions can effectively complement standard care in the primary care setting. METHODS AND ANALYSIS We searched for qualitative, quantitative and mixed methods studies published in English, German, Spanish, Russian, French and Dutch after January 2010 for inclusion in the review. The included studies must involve digital mental health interventions conducted via computer and/or mobile devices in the primary care setting. The search was conducted in July 2020 in the following electronic bibliographic databases: MEDLINE, Embase, CINAHL, PsycINFO and Web of Science Core Collection. Two reviewers will independently screen titles, abstracts and full texts and extract data. We will use the 'Integrated methodology' framework to combine both quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval is not required. We will disseminate the results of the mixed methods systematic review in a peer-reviewed journal and scientific conferences. PROSPERO REGISTRATION NUMBER CRD42020188879.
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Affiliation(s)
- Maria Hanf
- Institute of General Practice, University of Frankfurt, Frankfurt am Main, Germany
| | - Julian Hirt
- Center for Dementia Care, Institute of Applied Nursing Sciences, Department of Health, University of Applied Sciences of Eastern Switzerland, St Gallen, Switzerland
- International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Marjan van den Akker
- Institute of General Practice, University of Frankfurt, Frankfurt am Main, Germany
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Academic Centre for General Practice, Leuven, Belgium
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Newby J, Mason E, Kladnistki N, Murphy M, Millard M, Haskelberg H, Allen A, Mahoney A. Integrating internet CBT into clinical practice: a practical guide for clinicians. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2020.1843968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Jill Newby
- School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Elizabeth Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Natalie Kladnistki
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Michael Murphy
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Hila Haskelberg
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
| | - Adrian Allen
- Hyde Park Clinical Psychology, Sydney, Australia
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital Sydney, Sydney, Australia
- School of Psychiatry, UNSW Sydney, Sydney, Australia
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Gulliver A, Calear AL, Sunderland M, Kay-Lambkin F, Farrer LM, Banfield M, Batterham PJ. Consumer-Guided Development of an Engagement-Facilitation Intervention for Increasing Uptake and Adherence for Self-Guided Web-Based Mental Health Programs: Focus Groups and Online Evaluation Survey. JMIR Form Res 2020; 4:e22528. [PMID: 33118939 PMCID: PMC7661236 DOI: 10.2196/22528] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/28/2020] [Accepted: 10/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Self-guided web-based mental health programs are effective in treating and preventing mental health problems. However, current engagement with these programs in the community is suboptimal, and there is limited evidence indicating how to increase the use of existing evidence-based programs. Objective This study aims to investigate the views of people with lived experience of depression and anxiety on factors influencing their engagement with self-guided web-based mental health (e–mental health) programs and to use these perspectives to develop an engagement-facilitation intervention (EFI) to increase engagement (defined as both uptake and adherence) with these programs. Methods A total of 24 community members (female=21; male=3) with lived experience of depression and anxiety or depression or anxiety alone participated in 1 of 4 focus groups discussing the factors influencing their engagement with self-guided e–mental health programs and the appearance, delivery mode, and functionality of content for the proposed EFI. A subsequent evaluation survey of the focus group participants (n=14) was conducted to evaluate the resultant draft EFI. Data were thematically analyzed using both inductive and deductive qualitative methods. Results Participants suggested that the critical component of an EFI was information that would challenge personal barriers to engagement, including receiving personalized symptom feedback, information regarding the program’s content or effectiveness and data security, and normalization of using e–mental health programs (eg, testimonials). Reminders, rewards, feedback about progress, and coaching were all mentioned as facilitating adherence. Conclusions EFIs have the potential to improve community uptake of e–mental health programs. They should focus on providing information on the content and effectiveness of e–mental health programs and normalizing their use. Given that the sample comprised predominantly young females, this study may not be generalizable to other population groups. There is a strong value in involving people with a lived experience in the design and development of EFIs to maximize their effectiveness.
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Affiliation(s)
- Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Matthew Sunderland
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, University of Newcastle, Newcastle, Australia
| | - Louise M Farrer
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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Raudenská J, Steinerová V, Javůrková A, Urits I, Kaye AD, Viswanath O, Varrassi G. Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic. Best Pract Res Clin Anaesthesiol 2020; 34:553-560. [PMID: 33004166 PMCID: PMC7367798 DOI: 10.1016/j.bpa.2020.07.008] [Citation(s) in RCA: 162] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/07/2023]
Abstract
This comprehensive review aims to explain the potential impact of coronavirus disease 2019 (COVID-19) on mental wellbeing of healthcare professionals (HCPs). Based on up-to-date research and psychological diagnostic manuals of Diagnostic and Statistical Manual of Mental Disorders, 5th edition and International Classification of Diseases, 11th revision, we describe associated psychological disorders and experiences that may arise related to COVID-19. Appropriate psychological measures are introduced, along with potential methodological limitations. Lastly, resilience building and preventative measures with interventions that may mitigate the impact on mental health of HCPs are described.
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Affiliation(s)
- Jaroslava Raudenská
- Department of Psychology, Faculty of Arts, Charles University, Department of Nursing, 2nd Medical School and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Veronika Steinerová
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne, Australia
| | - Alena Javůrková
- Department of Psychology, Faculty of Arts, Charles University, Department of Nursing, 2nd Medical School and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA; Valley Pain Consultants - Envision Physician Services, Phoenix, AZ, USA; University of Arizona College of Medicine-Phoenix, Department of Anesthesiology Phoenix, AZ, USA; Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA
| | - Giustino Varrassi
- Paolo Procacci Fdn, Via Tacito 7, 00193, Roma, Italy; World Institute of Pain, Winston-Salem, NC, USA.
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12
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Davies F, Shepherd HL, Beatty L, Clark B, Butow P, Shaw J. Implementing Web-Based Therapy in Routine Mental Health Care: Systematic Review of Health Professionals' Perspectives. J Med Internet Res 2020; 22:e17362. [PMID: 32706713 PMCID: PMC7413287 DOI: 10.2196/17362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/05/2020] [Accepted: 06/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Web-based therapies hold great promise to increase accessibility and reduce costs of delivering mental health care; however, uptake in routine settings has been low. OBJECTIVE Our objective in this review was to summarize what is known about health care professionals' perceptions of the barriers to and facilitators of the implementation of web-based psychological treatments in routine care of adults in health care settings. METHODS We searched 5 major databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Library) for qualitative, quantitative, or mixed-methods studies exploring health professionals' views on computer- or internet-based psychological treatment programs. We coded included articles for risk of bias and extracted data using a prepiloted extraction sheet. RESULTS We identified 29 eligible articles: 14 qualitative, 11 quantitative, and 4 mixed methods. We identified the following themes: patient factors, health professional factors, the therapeutic relationship, therapy factors, organizational and system factors, and models of care. Health professionals supported web-based therapies only for patients with relatively straightforward, low-risk diagnoses, strong motivation and engagement, high computer literacy and access, and low need for tailored content. They perceived flexibility with timing and location as advantages of web-based therapy, but preferred blended therapy to facilitate rapport and allow active monitoring and follow-up of patients. They emphasized the need for targeted training and organizational support to manage changed workflows. Health professionals were concerned about the confidentiality and security of client data for web-based programs, suggesting that clear and transparent protocols need to be in place to reassure health professionals before they will be willing to refer. CONCLUSIONS Without health professionals' support, many people will not access web-based therapies. To increase uptake, it is important to ensure that health professionals receive education, familiarization, and training to support them in incorporating web-based therapies into their practice, and to design systems that support health professionals in this new way of working with patients and addressing their concerns. TRIAL REGISTRATION PROSPERO CRD42018100869; https://tinyurl.com/y5vaoqsk.
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Affiliation(s)
- Fiona Davies
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Lisa Beatty
- Flinders Centre for Innovation in Cancer, College of Medicine & Public Health, Flinders University South Australia, Adelaide, Australia
| | - Brodie Clark
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
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13
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Clough BA, Rowland DP, Casey LM. Development of the eTAP-T: A measure of mental health professionals' attitudes and process towards e-interventions. Internet Interv 2019; 18:100288. [PMID: 31890635 PMCID: PMC6926282 DOI: 10.1016/j.invent.2019.100288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The development of technological applications within psychotherapy has opened up new opportunities for mental health professionals (MHPs) to address client need. Despite the clinical efficacy and utility of evidence-based electronic interventions, MHPs' engagement with these interventions remains poorly understood. OBJECTIVE The aim of the current study was to develop and conduct a preliminary psychometric investigation of the measurement properties of the electronic-therapy attitudes and process questionnaire - therapist version (eTAP-T). Based upon the theory of planned behaviour (TPB), the eTAP-T measures factors related to MHPs' engagement with e-interventions for clients' mental health concerns. METHODS Participants were 222 practicing MHPs who reported being in direct contact with clients. Participants completed the eTAP-T and related measures with a subsample of 40 participants completing a two-week follow up questionnaire. RESULTS Exploratory factor analysis with item reduction resulted in a 12-item eTAP-T, with four factors accounting for 82% of variance. The four factors (subjective norms, perceived behavioural control, attitudes and intentions) were consistent with the four TPB domains. The eTAP-T demonstrated satisfactory validity and reliability as per the consensus-based standards for the selection of health measurement instruments. CONCLUSIONS The development and preliminary psychometric investigation supported the validity and reliability of the eTAP-T. Further research is required for confirmatory analyses. The eTAP-T may be useful in identifying the training needs of MHPs and evaluating training programs. Specific areas for intervention, such as attitudes or perceived credibility may be identified and targetted, with the measure then also used to evaluate change across these domains. It is anticipated that the eTAP-T may useful tool in improving uptake of digital interventions by MHPs.
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Affiliation(s)
- Bonnie A. Clough
- Corresponding author at: School of Applied Psychology, Griffith University, Parklands Drive, Southport 4215, Queensland, Australia.
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14
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Wootton BM, Karin E, Titov N, Dear BF. Self-guided internet-delivered cognitive behavior therapy (ICBT) for obsessive-compulsive symptoms: A randomized controlled trial. J Anxiety Disord 2019; 66:102111. [PMID: 31301476 DOI: 10.1016/j.janxdis.2019.102111] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022]
Abstract
Internet-delivered cognitive behavior therapy (ICBT) for obsessive-compulsive disorder (OCD) has been demonstrated to be efficacious across multiple clinical trials. However, most of these interventions include clinician support, and many individuals with OCD prefer to manage their own symptoms. Self-guided ICBT overcomes this problem, but to date the efficacy of self-guided interventions has only been studied in uncontrolled trials. The present study aims to examine the efficacy and acceptability of ICBT for OCD symptoms when delivered in a self-guided format using a randomized controlled trial design. In the present study, 190 participants were randomized to either a self-guided ICBT condition or a waitlist control group. 140 participants completed the baseline assessment, initiated treatment, and were included in the analyses. The between-group effect size at post-treatment was large on the self-report version of the Yale-Brown Obsessive-Compulsive Scale (d = 1.05; 95% CI 0.89-1.21). Twenty-seven percent of the ICBT condition met conservative criteria for clinically significant change at post-treatment, which increased to thirty-eight percent at three-month follow-up. Participants rated the program as highly acceptable. The results indicate that self-guided ICBT may be a viable treatment option for some individuals with OCD symptoms.
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Affiliation(s)
- Bethany M Wootton
- University of Technology Sydney, NSW, Australia; Macquarie University, Sydney, NSW, Australia.
| | - Eyal Karin
- Macquarie University, Sydney, NSW, Australia
| | - Nick Titov
- Macquarie University, Sydney, NSW, Australia
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15
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Gulliver A, Banfield M, Morse AR, Reynolds J, Miller S, Galati C. A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial. JMIR Form Res 2019; 3:e12550. [PMID: 31165708 PMCID: PMC6746099 DOI: 10.2196/12550] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/01/2019] [Accepted: 04/29/2019] [Indexed: 01/29/2023] Open
Abstract
Background There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings. Objective This exploratory proof-of-concept study aimed to determine if a peer worker–led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness. Methods Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service. Results Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff. Conclusions The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit.
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Affiliation(s)
- Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Alyssa R Morse
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Julia Reynolds
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
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16
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Marks B, Sisirak J, Magallanes R, Krok K, Donohue-Chase D. Effectiveness of a HealthMessages Peer-to-Peer Program for People With Intellectual and Developmental Disabilities. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2019; 57:242-258. [PMID: 31120402 PMCID: PMC8118146 DOI: 10.1352/1934-9556-57.3.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Effective strategies to improve health education, food choices, and physical activity are vital for people with intellectual and developmental disabilities (IDD), as their sedentary lifestyles and high fat diets are contributing to poor health, such as cardiovascular disease, osteoporosis, hypertension, Type II diabetes, and obesity. This study examined the effectiveness of a peer-led health promotion program for people with IDD. One group pre/post-test design was used to test the feasibility and effectiveness of the 12-week HealthMessages Program for three groups: peer health coaches (PHCs), mentors, and peer participants. A total of 379 volunteers participated including PHCs people with IDD (n = 33), mentors-staff from community organizations (n = 35), and peer participants-peers with IDD (n = 311). Following the intervention and 12-week HealthMessages Program, PHCs had significant changes in physical activity and hydration knowledge, mentors had significant changes in self-efficacy scores, and peer participants had significant changes in physical activity and hydration knowledge, social supports, and total health behaviors. A dyad approach supported PHCs and mentors to implement a successful HealthMessages Program with their peers.
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Affiliation(s)
- Beth Marks
- Beth Marks, Jasmina Sisirak, and Rubia Magallanes, University of Illinois at Chicago, Department of Disability & Human Development, Rehabilitation Research Training Center on Developmental Disabilities and Health; Kristin Krok and Dina Donohue-Chase, NorthPointe Resources, Inc., Zion, IL
| | - Jasmina Sisirak
- Beth Marks, Jasmina Sisirak, and Rubia Magallanes, University of Illinois at Chicago, Department of Disability & Human Development, Rehabilitation Research Training Center on Developmental Disabilities and Health; Kristin Krok and Dina Donohue-Chase, NorthPointe Resources, Inc., Zion, IL
| | - Rubia Magallanes
- Beth Marks, Jasmina Sisirak, and Rubia Magallanes, University of Illinois at Chicago, Department of Disability & Human Development, Rehabilitation Research Training Center on Developmental Disabilities and Health; Kristin Krok and Dina Donohue-Chase, NorthPointe Resources, Inc., Zion, IL
| | - Kristin Krok
- Beth Marks, Jasmina Sisirak, and Rubia Magallanes, University of Illinois at Chicago, Department of Disability & Human Development, Rehabilitation Research Training Center on Developmental Disabilities and Health; Kristin Krok and Dina Donohue-Chase, NorthPointe Resources, Inc., Zion, IL
| | - Dina Donohue-Chase
- Beth Marks, Jasmina Sisirak, and Rubia Magallanes, University of Illinois at Chicago, Department of Disability & Human Development, Rehabilitation Research Training Center on Developmental Disabilities and Health; Kristin Krok and Dina Donohue-Chase, NorthPointe Resources, Inc., Zion, IL
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17
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Brunero S, Ramjan LM, Salamonson Y, Nicholls D. Generalist health professional's interactions with consumers who have a mental illness in nonmental health settings: A systematic review of the qualitative research. Int J Ment Health Nurs 2018; 27:1634-1649. [PMID: 29749009 DOI: 10.1111/inm.12472] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 01/09/2023]
Abstract
Generalist health professionals (GHPs) or those healthcare professionals working in nonmental health facilities are increasingly being required to provide care to consumers with a mental illness. The review aimed to synthesize the qualitative research evidence on the meanings and interpretations made by GHPs (nonmental health professional) who interact with consumers with mental illness in nonmental health settings. A systematic review of the qualitative literature was undertaken for the years 1994-2016. The following electronic databases were searched: CINAHL, MEDLINE, PsycINFO, and Sociological Abstracts. Using narrative synthesis methods, the following themes were identified: mental health knowledge (the GHPs' knowledge level about mental illness and how this impacts their experiences and perceptions); GHPs perceive mental illness as a safety risk (GHPs concern over harm to the consumer and themselves); organizational support (the system response from the environmental design, and expert support and care); and emotional consequences of care (the feelings expressed by GHPs based on their experiences and perceptions of consumers). The results suggest that GHPs provide care in a setting which consists of multiple understandings of what care means. Efforts beyond educational initiatives such as organizational and system-level changes will need to be implemented if we are to progress care for this consumer group.
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Affiliation(s)
- Scott Brunero
- Prince of Wales Hospital, Sydney, New South Wales, Australia.,School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia.,Centre for Applied Nursing Research (CANR), Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Daniel Nicholls
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
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18
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Kyrios M, Ahern C, Fassnacht DB, Nedeljkovic M, Moulding R, Meyer D. Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial. J Med Internet Res 2018; 20:e242. [PMID: 30089607 PMCID: PMC6105869 DOI: 10.2196/jmir.9566] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 05/18/2018] [Accepted: 06/21/2018] [Indexed: 11/13/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder with a chronic course if left untreated. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment, but access to face-to-face CBT is not always possible. Internet-based CBT (iCBT) has become an increasingly viable option. However, no study has compared iCBT to an analogous control condition using a randomized controlled trial (RCT). Objective A 2-armed RCT was used to compare a therapist-assisted 12-module iCBT to an analogous active attention control condition (therapist-assisted internet-based standard progressive relaxation training, iPRT) in adult OCD. This paper reports pre-post findings for OCD symptom severity. Method In total, 179 participants (117 females, 65.7%) were randomized (stratified by gender) into iCBT or iPRT. The iCBT intervention included psychoeducation, mood and behavioral management, exposure and response prevention (ERP), cognitive therapy, and relapse prevention; the iPRT intervention included psychoeducation and relaxation techniques as a way of managing OCD-related anxiety but did not incorporate ERP or other CBT elements. Both treatments included audiovisual content, case stories, demonstrations of techniques, downloadable audio content and worksheets, and expert commentary. All participants received 1 weekly email, with a maximum 15-minute preparation time per client from a remote therapist trained in e-therapy. Emails aimed to monitor progress, provide support and encouragement, and assist in individualizing the treatment. Participants were assessed for baseline and posttreatment OCD severity with the telephone-administered clinician-rated Yale-Brown Obsessive-Compulsive Scale and other measures by assessors who were blinded to treatment allocation. Results No pretreatment differences were found between the 2 conditions. Intention-to-treat analysis revealed significant pre-post improvements in OCD symptom severity for both conditions (P<.001). However, relative to iPRT, iCBT showed significantly greater symptom severity improvement (P=.001); Cohen d for iCBT was 1.05 (95% CI 0.72-1.37), whereas for iPRT it was 0.48 (95% CI 0.22-0.73). The iCBT condition was superior in regard to reliable improvement (25/51, 49% vs 16/55, 29%; P=.04) and clinically significant pre-post-treatment changes (17/51, 33% vs 6/55, 11%; P=.005). Those undertaking iCBT post completion of iPRT showed further significant symptom amelioration (P<.001), although the sequential treatment was no more efficacious than iCBT alone (P=.63). Conclusion This study is the first to compare a therapist-assisted iCBT program for OCD to an analogous active attention control condition using iPRT. Our findings demonstrate the large magnitude effect of iCBT for OCD; interestingly, iPRT was also moderately efficacious, albeit significantly less so than the iCBT intervention. The findings are compared to previous internet-based and face-to-face CBT treatment programs for OCD. Future directions for technology-enhanced programs for the treatment of OCD are outlined. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12611000321943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336704 (Archived by WebCite at http://www.webcitation.org/70ovUiOmd)
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Affiliation(s)
- Michael Kyrios
- College of Education, Psychology & Social Work, Flinders University, Adelaide, Australia.,Research School of Psychology, The Australian National University, Canberra, Australia.,Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Claire Ahern
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Daniel B Fassnacht
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Maja Nedeljkovic
- Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Richard Moulding
- School of Psychology, Faculty of Health, Deakin University, Geelong, Australia.,Centre for Drug Use, Addictive and Anti-Social Behaviour Research, Deakin University, Geelong, Australia
| | - Denny Meyer
- Department of Statistics Data Science and Epidemiology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
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19
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Wozney L, McGrath PJ, Gehring ND, Bennett K, Huguet A, Hartling L, Dyson MP, Soleimani A, Newton AS. eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes. JMIR Ment Health 2018; 5:e48. [PMID: 29945858 PMCID: PMC6039769 DOI: 10.2196/mental.9655] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/15/2018] [Accepted: 05/19/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anxiety disorders and depression are frequent conditions in childhood and adolescence. eMental healthcare technologies may improve access to services, but their uptake within health systems is limited. OBJECTIVE The objective of this review was to examine and describe how the implementation of eMental healthcare technologies for anxiety disorders and depression in children and adolescents has been studied. METHODS We conducted a search of 5 electronic databases and gray literature. Eligible studies were those that assessed an eMental healthcare technology for treating or preventing anxiety or depression, included children or adolescents (<18 years), or their parents or healthcare providers and reported findings on technology implementation. The methodological quality of studies was evaluated using the Mixed Methods Appraisal Tool. Outcomes of interest were based on 8 implementation outcomes: acceptability (satisfaction with a technology), adoption (technology uptake and utilization), appropriateness ("fitness for purpose"), cost (financial impact of technology implementation), feasibility (extent to which a technology was successfully used), fidelity (implementation as intended), penetration ("spread" or "reach" of the technology), and sustainability (maintenance or integration of a technology within a healthcare service). For extracted implementation outcome data, we coded favorable ratings on measurement scales as "positive results" and unfavorable ratings on measurement scales as "negative results." Those studies that reported both positive and negative findings were coded as having "mixed results." RESULTS A total of 46 studies met the inclusion criteria, the majority of which were rated as very good to excellent in methodological quality. These studies investigated eMental healthcare technologies for anxiety (n=23), depression (n=18), or both anxiety and depression (n=5). Studies of technologies for anxiety evaluated the following: (1) acceptability (78%) reported high levels of satisfaction, (2) adoption (43%) commonly reported positive results, and (3) feasibility (43%) reported mixed results. Studies of technologies for depression evaluated the following: (1) appropriateness (56%) reported moderate helpfulness and (2) acceptability (50%) described a mix of both positive and negative findings. Studies of technologies designed to aid anxiety and depression commonly reported mixed experiences with acceptability and adoption and positive findings for appropriateness of the technologies for treatment. Across all studies, cost, fidelity, and penetration and sustainability were the least measured implementation outcomes. CONCLUSIONS Acceptability of eMental healthcare technology is high among users and is the most commonly investigated implementation outcome. Perceptions of the appropriateness and adoption of eMental healthcare technology were varied. Implementation research that identifies, evaluates, and reports on costs, sustainability, and fidelity to clinical guidelines is crucial for making high-quality eMental healthcare available to children and adolescents.
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Affiliation(s)
- Lori Wozney
- Izaak Walton Killam Centre, Centre for Research in Family Health, Halifax, NS, Canada
| | | | - Nicole D Gehring
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Bennett
- Offord Centre for Child Studies, Department of Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), McMaster University, Hamilton, ON, Canada
| | - Anna Huguet
- Izaak Walton Killam Centre, Centre for Research in Family Health, Halifax, NS, Canada.,Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michele P Dyson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amir Soleimani
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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20
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Howard A, Flanagan M, Drouin M, Carpenter M, Chen EM, Duchovic C, Toscos T. Adult experts' perceptions of telemental health for youth: A Delphi study. JAMIA Open 2018; 1:67-74. [PMID: 31984319 PMCID: PMC6951899 DOI: 10.1093/jamiaopen/ooy002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/02/2018] [Accepted: 02/22/2018] [Indexed: 11/26/2022] Open
Abstract
Objectives Our objectives were to measure experts’ opinions and develop consensus via the Delphi process on the barriers, applications, and concerns associated with telemental health (TMH) for youth. Materials and methods We delivered 3 online surveys over 2 months in Summer, 2016–2025 adult experts, including adults who experienced youth depression or suicidality, parents of youth with lived experience, and professionals (ie youth mental health researchers, clinicians/staff, or educators). We used the Delphi method to construct Likert and open-ended questions, developing expert consensus over 3 iterative surveys on the barriers and benefits of TMH for youth. Results Adult experts identified stigma and knowledge barriers to youth mental health care. Although TMH is perceived as beneficial for screening, education, follow-up, and emotional support, no single delivery method (eg websites or instant messaging) was deemed universally beneficial. Discussion Adults are the developers, administrators, and gatekeepers of youth mental health care. Although adult experts see potential for TMH to supplement traditional therapy via familiar technologies, there is no consensus on the technologies by which TMH should be delivered. However, there is consensus that family members and friends provide potential pathways to care; thus, an online TMH toolkit for youth would be beneficial for both caretakers and practitioners. Conclusion Telemental health may not overcome barriers for crisis management but adult experts agreed that TMH had potential benefits for youth. Health care organizations should conduct research and provide training and education to youth caretakers and practitioners on potential barriers and benefits of TMH technologies for youth.
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Affiliation(s)
- Abigail Howard
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
| | - Mindy Flanagan
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA.,Indiana University Center for Health Services Research, School of Medicine, Indianapolis, Indiana, USA
| | - Michelle Drouin
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA.,Indiana University-Purdue University Fort Wayne, Fort Wayne, Indiana, USA
| | - Maria Carpenter
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
| | - Elizabeth M Chen
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | | | - Tammy Toscos
- Parkview Research Center, Parkview Health, Fort Wayne, Indiana, USA
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21
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Hopia H, Siitonen M, Raitio K. Mental health service users' and professionals' relationship with games and gaming. Digit Health 2018; 4:2055207618779718. [PMID: 31463073 PMCID: PMC6034349 DOI: 10.1177/2055207618779718] [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: 12/20/2017] [Accepted: 05/06/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Games and elements of gamification can be utilized in mental healthcare to provide customized interventions for the service users. However, very little evidence exists as to what kind of experiences service users and professionals have towards games and gaming, and what their perceptions of the phenomenon are. This sort of information is needed to help professionals put game-based interventions actively into practice in mental health services. RESEARCH OBJECTIVES The objective is to describe the experiences and perceptions of digital games and gaming from the perspectives of mental health service users and mental health professionals. METHODS In this qualitative study, data consisted of interviews of 23 mental health service users and professionals working in the mental health field. We conducted altogether 39 interviews. Sixteen of the participants were interviewed twice. Main categories and subcategories were identified using qualitative content analysis. RESULTS The analysis revealed four distinct orientations towards games and gaming: (a) compulsive gaming; (b) closet gaming; (c) gaming as a hobby; and (d) late bloomers. Each group was characterized by different personal histories, experiences, conceptions and attitudes regarding gaming and digital games. CONCLUSION When attempting to implement a game-based intervention in mental health services, it is essential to recognize the different attitudes that both service users and staff exhibit concerning games and gaming. The attitudes of service users and professionals described in this study can be utilized in the implementation of game-based methods as part of care and rehabilitation in mental health services.
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Affiliation(s)
- Hanna Hopia
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyvaskyla, Finland
| | - Marko Siitonen
- Department of Language and Communication Studies, University of Jyvaskyla, Jyvaskyla, Finland
| | - Katja Raitio
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyvaskyla, Finland
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Williams A, Fossey E, Farhall J, Foley F, Thomas N. Going Online Together: The Potential for Mental Health Workers to Integrate Recovery Oriented E-Mental Health Resources Into Their Practice. Psychiatry 2018; 81:116-129. [PMID: 30273103 DOI: 10.1080/00332747.2018.1492852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Internet offers a growing range of e-mental health resources for people experiencing severe mental illness. How these resources may be used in face-to-face interactions with consumers in mental health practice is not well understood. AIM This article explores mental health workers' current use of online resources and their views about integrating e-mental health resources for promoting self-management and recovery into community-based practice. METHOD A total of 37 mental health workers from six services attended focus groups to discuss their views about using online and e-mental health resources in face-to-face interactions with consumers. Data were analyzed using qualitative content analysis. RESULTS Participants described accessing Internet information but having little opportunity to use online resources with consumers. Limited access to mobile technology and perceptions that consumers lacked technological experience constrained current use. Three approaches to using e-mental health resources were perceived: directing, collaborating, and empowering. Access to mobile technology within worker-consumer interactions was identified as a potential catalyst for creating recovery-oriented therapeutic relationships. CONCLUSION Mental health workers are ready to grasp opportunities to use e-mental health resources with consumers. This has the potential to develop and strengthen collaborative, partnership-based relationships if mental health services support workers and consumers to use online resources together.
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Gulliver A, Banfield M, Reynolds J, Miller S, Galati C, Morse AR. A Peer-Led Electronic Mental Health Recovery App in an Adult Mental Health Service: Study Protocol for a Pilot Trial. JMIR Res Protoc 2017; 6:e248. [PMID: 29217501 PMCID: PMC5740261 DOI: 10.2196/resprot.8795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/19/2017] [Accepted: 10/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background There is growing demand for peer workers (people who use their own lived experience to support others in their recovery) to work alongside consumers to improve outcomes and recovery. Augmenting the workforce with peer workers has strong capacity to enhance mental health and recovery outcomes and make a positive contribution to the workforce within mental health systems and to the peer workers themselves. Technology-based applications are highly engaging and desirable methods of service delivery. Objective This project is an exploratory proof-of-concept study, which aims to determine if a peer worker-led electronic mental (e-mental) health recovery program is a feasible, acceptable, and effective adjunct to usual treatment for people with moderate to severe mental illness. Methods The study design comprises a recovery app intervention delivered by a peer worker to individual consumers at an adult mental health service. Evaluation measures will be conducted at post-intervention. To further inform the acceptability and feasibility of the model, consumers will be invited to participate in a focus group to discuss the program. The peer worker, peer supervisor, and key staff at the mental health service will also be individually interviewed to further evaluate the feasibility of the program within the health service and further inform its future development. Results The program will be delivered over a period of approximately 4 months, commencing June 2017. Conclusions If the peer worker-led recovery app is found to be feasible, acceptable, and effective, it could be used to improve recovery in mental health service consumers.
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Affiliation(s)
- Amelia Gulliver
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
| | - Julia Reynolds
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
| | | | | | - Alyssa R Morse
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Canberra, Australia
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Abstract
PURPOSE OF REVIEW The current review aims to provide an update on the recent work in mental health promotion with a special emphasis on emerging evidence and innovations in the field. RECENT FINDINGS Studies reviewed across settings like the home, school, workplace, communities, and internet-based platforms, have indicated a growing evidence base for effective mental health promotion strategies that are holistic, multicomponent, and targeted at both, specific vulnerable groups and whole populations. Innovative approaches involving online delivery platforms, sports and exercise, positive psychology and lifestyle interventions, mobilizing community networks, and mental health first aid, are some exciting and upcoming areas for future research. SUMMARY Mental health promotion interventions are applicable to individuals, groups, and whole populations and can be delivered in many ways, including media and communication technology. They can be applied in low-resource settings by mobilizing existing community resources like opinion leaders, health workers, and peer educators, thereby increasing cost-efficiency, cultural acceptability, and local capacity. There needs to be a greater focus on study designs and variable measures that examine process-factors affecting well being outcomes. Early interventions through intersectorial collaborations may result in improved long-term positive mental health outcomes for individuals, families, and communities.
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Sprenger M, Mettler T, Osma J. Health professionals' perspective on the promotion of e-mental health apps in the context of maternal depression. PLoS One 2017; 12:e0180867. [PMID: 28704442 PMCID: PMC5507525 DOI: 10.1371/journal.pone.0180867] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 06/22/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Our study focuses on exploring (1) the intention of health professionals to use and recommend e-mental health applications, (2) how this intention of health professionals might be influenced, (3) which group of health professionals might be most accessible to promote e-mental health applications for maternal depression, and (4) for which tasks they rate them to be most useful. MATERIALS AND METHODS Based on a questionnaire informed by the theory of planned behavior, we collected 131 responses of U.S., Spanish, and Swiss health professionals in the field of pregnancy and maternal care (including psychologists, psychiatrists, midwives, and doctors) by means of an online survey. We analyzed the gathered data applying a structured equation model. RESULTS Our study reveals that health professionals would in general intend to recommend and use e-mental health applications. However, their attitude towards e-mental health applications varies regarding the respective use cases and also differs among health professions. CONCLUSION We offer three alternative propositions for private or public organizations, associations, or any other entity whose purpose is service to the community for introducing e-mental health applications into practice.
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Affiliation(s)
- Michaela Sprenger
- University of St. Gallen, Institute of Information Management, St. Gallen, Switzerland
| | - Tobias Mettler
- University of Lausanne, Swiss Graduate School of Public Administration, Lausanne, Switzerland
| | - Jorge Osma
- University of Zaragoza, Department of Psychology and Sociology, Teruel, Spain
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Bird J, Rotumah D, Bennett-Levy J, Singer J. Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers. JMIR Ment Health 2017; 4:e17. [PMID: 28554880 PMCID: PMC5468542 DOI: 10.2196/mental.7878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 05/11/2017] [Accepted: 05/12/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In Australia, mental health services are undergoing major systemic reform with eMental Health (eMH) embedded in proposed service models for all but those with severe mental illness. Aboriginal and Torres Strait Islander service providers have been targeted as a national priority for training and implementation of eMH into service delivery. Implementation studies on technology uptake in health workforces identify complex and interconnected variables that influence how individual practitioners integrate new technologies into their practice. To date there are only two implementation studies that focus on eMH and Aboriginal and Torres Strait Islander service providers. They suggest that the implementation of eMH in the context of Aboriginal and Torres Strait Islander populations may be different from the implementation of eMH with allied health professionals and mainstream health services. OBJECTIVE The objective of this study is to investigate how Aboriginal and Torres Strait Islander service providers in one regional area of Australia used eMH resources in their practice following an eMH training program and to determine what types of eMH resources they used. METHODS Individual semistructured qualitative interviews were conducted with a purposive sample of 16 Aboriginal and Torres Strait Islander service providers. Interviews were co-conducted by one indigenous and one non-indigenous interviewer. A sample of transcripts were coded and thematically analyzed by each interviewer and then peer reviewed. Consensus codes were then applied to all transcripts and themes identified. RESULTS It was found that 9 of the 16 service providers were implementing eMH resources into their routine practice. The findings demonstrate that participants used eMH resources for supporting social inclusion, informing and educating, assessment, case planning and management, referral, responding to crises, and self and family care. They chose a variety of types of eMH resources to use with their clients, both culturally specific and mainstream. While they referred clients to online treatment programs, they used only eMH resources designed for mobile devices in their face-to-face contact with clients. CONCLUSIONS This paper provides Aboriginal and Torres Strait islander service providers and the eMH field with findings that may inform and guide the implementation of eMH resources. It may help policy developers locate this workforce within broader service provision planning for eMH. The findings could, with adaptation, have wider application to other workforces who work with Aboriginal and Torres Strait Islander clients. The findings highlight the importance of identifying and addressing the particular needs of minority groups for eMH services and resources.
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Affiliation(s)
- Jennifer Bird
- University Centre for Rural Health-North Coast, School of Rural Health, University of Sydney, Lismore, Australia
| | - Darlene Rotumah
- University Centre for Rural Health-North Coast, School of Rural Health, University of Sydney, Lismore, Australia
| | - James Bennett-Levy
- University Centre for Rural Health-North Coast, School of Rural Health, University of Sydney, Lismore, Australia
| | - Judy Singer
- University Centre for Rural Health-North Coast, School of Rural Health, University of Sydney, Lismore, Australia
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Strand M, Gammon D, Ruland CM. Transitions from biomedical to recovery-oriented practices in mental health: a scoping review to explore the role of Internet-based interventions. BMC Health Serv Res 2017; 17:257. [PMID: 28388907 PMCID: PMC5385090 DOI: 10.1186/s12913-017-2176-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/18/2017] [Indexed: 01/21/2023] Open
Abstract
Background The Internet is transforming mental health care services by increasing access to, and potentially improving the quality of, care. Internet-based interventions in mental health can potentially play a role in transitions from biomedical to recovery-oriented research and practices, but an overview of what this may entail, current work, and issues that need addressing, is lacking. The objective of this study is to describe Internet-based recovery-oriented interventions (referred to as e-recovery) and current research, and to identify gaps and issues relevant to advancing recovery research and practices through opportunities provided by the Internet. Methods Five iterative stages of a scoping review framework were followed in searching and analyzing the literature. A recovery framework with four domains and 16 themes was used to deductively code intervention characteristics according to their support for recovery-oriented practices. Only Internet-based interventions used in conjunction with ongoing care were included. Results Twenty studies describing six e-recovery interventions were identified and originated in Australia, Finland, the Netherlands, Norway and USA. The domain supporting personal recovery was most clearly reflected in interventions, whereas the last three domains, i.e., promoting citizenship, organizational commitment and working relationship were less evident. Support for the formulation and follow-up of personal goals and preferences, and in accessing peer-support, were the characteristics shared by most interventions. Three of the six studies that employed a comparison group used randomization, and none presented definitive findings. None used recovery-oriented frameworks or specific recovery outcome measures. Four of the interventions were specific to a diagnosis. Conclusion Research about how technologies might aid in illuminating and shaping recovery processes is in its formative stages. We recommend that future e-recovery research and innovation attend to four dimensions: evidence-supported interventions, new knowledge about personal recovery, values-based approaches and Internet as a facilitator for organizational transformation. The incremental changes facilitated by e-recovery may help propel a shift in mental health care toward recovery-oriented practices.
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Affiliation(s)
- Monica Strand
- Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.O. Box 4950, Nydalen, Oslo, 0424, Norway. .,Department of Psychiatry Blakstad, Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Asker, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Deede Gammon
- Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.O. Box 4950, Nydalen, Oslo, 0424, Norway.,Norwegian Centre for Integrated Care and Telemedicine, University Hospital in North Norway, Tromsø, Norway
| | - Cornelia M Ruland
- Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.O. Box 4950, Nydalen, Oslo, 0424, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
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Hennemann S, Beutel ME, Zwerenz R. Ready for eHealth? Health Professionals' Acceptance and Adoption of eHealth Interventions in Inpatient Routine Care. JOURNAL OF HEALTH COMMUNICATION 2017; 22:274-284. [PMID: 28248626 DOI: 10.1080/10810730.2017.1284286] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
eHealth interventions can be effective in treating health problems. However, adoption in inpatient routine care seems limited. The present study therefore aimed to investigate barriers and facilitators to acceptance of eHealth interventions and of online aftercare in particular in health professionals of inpatient treatment. A total of 152 out of 287 health professionals of various professional groups in four inpatient rehabilitation facilities filled out a self-administered web-based questionnaire (response rate: 53%); 128 individuals were eligible for further data analysis. Acceptance and possible predictors were investigated with a complex research model based on the Unified Theory of Acceptance and Use of Technology. Acceptance of eHealth interventions was rather low (M = 2.47, SD = 0.98); however, acceptance of online aftercare was moderate (M = 3.08, SD = 0.96, t(127) = 8.22, p < .001), and eHealth literacy was elevated. Social influence, performance expectancy, and treatment-related internet and mobile use significantly predicted overall acceptance. No differences were found between professional and age groups. Although acceptance of eHealth interventions was limited in health professionals of inpatient treatment, moderate acceptance of online aftercare for work-related stress implies a basis for future implementation. Tailored eHealth education addressing misconceptions about inferiority and incongruity with conventional treatment considering the systemic aspect of acceptance formation are needed.
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Affiliation(s)
- Severin Hennemann
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center , Mainz , Germany
- b Department of Clinical Psychology , Psychotherapy, and Experimental Psychopathology, Institute of Psychology, University of Mainz , Mainz , Germany
| | - Manfred E Beutel
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center , Mainz , Germany
| | - Rüdiger Zwerenz
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center , Mainz , Germany
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Bennett-Levy J, Singer J, DuBois S, Hyde K. Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals? J Med Internet Res 2017; 19:e1. [PMID: 28077347 PMCID: PMC5266824 DOI: 10.2196/jmir.6269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 12/01/2016] [Accepted: 12/18/2016] [Indexed: 01/10/2023] Open
Abstract
Background With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results Uptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers’ lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH’s health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients.
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Affiliation(s)
- James Bennett-Levy
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Judy Singer
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Simon DuBois
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Kelly Hyde
- University Centre for Rural Health, University of Sydney, Lismore, Australia
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Cano-Vindel A, Muñoz-Navarro R, Wood CM, Limonero JT, Medrano LA, Ruiz-Rodríguez P, Gracia-Gracia I, Dongil-Collado E, Iruarrizaga I, Chacón F, Santolaya F. Transdiagnostic Cognitive Behavioral Therapy Versus Treatment as Usual in Adult Patients With Emotional Disorders in the Primary Care Setting (PsicAP Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2016; 5:e246. [PMID: 28011446 PMCID: PMC5219590 DOI: 10.2196/resprot.6351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/30/2016] [Accepted: 10/22/2016] [Indexed: 12/18/2022] Open
Abstract
Background Demand for primary care (PC) services in Spain exceeds available resources. Part of this strong demand is due to the high prevalence of emotional disorders (EDs)—anxiety, depression, and somatic symptom disorders—and related comorbidities such as pain or chronic illnesses. EDs are often under- or misdiagnosed by general practitioners (GPs) and, consequently, treatment is frequently inadequate. Objective We aim to compare the short- and long-term effectiveness of group-delivered transdiagnostic cognitive behavioral therapy (TD-CBT) versus treatment as usual (TAU) in the treatment of EDs in the PC setting in Spain. We also aim to compare the effect of these treatments on disability, quality of life, cognitive-emotional factors, and treatment satisfaction. Methods Here we present the study design of a two-arm, single-blind, randomized controlled trial (N=1126) to compare TAU to TD-CBT for EDs. TAU will consist primarily of pharmacological treatment and practical advice from the GP while TD-CBT will be administered in seven 90-minute group sessions held over a period ranging from 12 to 14 weeks. Psychological assessments are carried out at baseline (ie, pretreatment); posttreatment; and at 3-, 6-, and 12-month follow-up. The study is conducted in approximately 26 PC centers from the National Health System in Spain. Results This study was initiated in December 2013 and will remain open to new participants until recruitment and follow-up has been completed. We expect all posttreatment evaluations to be completed by December 2017, and follow-up will end in December 2018. Conclusions We expect the TD-CBT group to have better results compared to TAU on all posttreatment measures and that this improvement will be maintained during follow-up. This project could serve as a model for use in other areas or services of the National Health System in Spain and even in other countries. ClinicalTrial International Standard Randomized Controlled Trial Number (ISRCTN): 58437086; http://www.isrctn.com/ISRCTN58437086 (Archived by WebCite at http://www.webcitation.org/6mbYjQSn3)
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Affiliation(s)
- Antonio Cano-Vindel
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Roger Muñoz-Navarro
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, University of Valencia, Valencia, Spain
| | - Cristina Mae Wood
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Joaquín T Limonero
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Leonardo Adrián Medrano
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Universidad Siglo 21, Córdoba, Argentina
| | - Paloma Ruiz-Rodríguez
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Fuenlabrada Primary Care Center, Health Service of Madrid, Madrid, Spain
| | | | - Esperanza Dongil-Collado
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Catholic University of Valencia, Valencia, Spain
| | - Iciar Iruarrizaga
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Social Work, Complutense University of Madrid, Madrid, Spain
| | - Fernando Chacón
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Faculty of Psychology, Complutense University of Madrid, Madrid, Spain.,Spanish Association of Psychologists, Madrid, Spain
| | - Francisco Santolaya
- PsicAP Research Group, Complutense University of Madrid, Madrid, Spain.,Spanish Association of Psychologists, Madrid, Spain.,Malva-Rosa Mental Health Service, Valencia, Spain
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The Interactive Mobile App Review Toolkit (IMART): a Clinical Practice-Oriented System. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s41347-016-0005-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery. BMC Health Serv Res 2016; 16:562. [PMID: 27724951 PMCID: PMC5057226 DOI: 10.1186/s12913-016-1790-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Digital technologies show promise for reversing poor engagement of youth (16-24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. The literature in this field, however, fails to adequately capture the perspectives of the youth mental health workforce regarding utility and acceptability of technology for this purpose. METHODS This paper describes results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff (n = 4 focus groups; n = 8 interviews) and analysed via inductive thematic analysis. RESULTS Results question the acceptability of technology to engage clients within youth mental health services. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. CONCLUSIONS These findings deepen the understanding of risks and challenges faced when adopting new technologies in mental healthcare. Recommendations for technology design and implementation in mental health services are made.
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Puszka S, Dingwall KM, Sweet M, Nagel T. E-Mental Health Innovations for Aboriginal and Torres Strait Islander Australians: A Qualitative Study of Implementation Needs in Health Services. JMIR Ment Health 2016; 3:e43. [PMID: 27644259 PMCID: PMC5048059 DOI: 10.2196/mental.5837] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Electronic mental health (e-mental health) interventions offer effective, easily accessible, and cost effective treatment and support for mental illness and well-being concerns. However, e-mental health approaches have not been well utilized by health services to date and little is known about their implementation in practice, particularly in diverse contexts and communities. OBJECTIVE This study aims to understand stakeholder perspectives on the requirements for implementing e-mental health approaches in regional and remote health services for Indigenous Australians. METHODS Qualitative interviews were conducted with 32 managers, directors, chief executive officers (CEOs), and senior practitioners of mental health, well-being, alcohol and other drug and chronic disease services. RESULTS The implementation of e-mental health approaches in this context is likely to be influenced by characteristics related to the adopter (practitioner skill and knowledge, client characteristics, communication barriers), the innovation (engaging and supportive approach, culturally appropriate design, evidence base, data capture, professional development opportunities), and organizational systems (innovation-systems fit, implementation planning, investment). CONCLUSIONS There is potential for e-mental health approaches to address mental illness and poor social and emotional well-being amongst Indigenous people and to advance their quality of care. Health service stakeholders reported that e-mental health interventions are likely to be most effective when used to support or extend existing health services, including elements of client-driven and practitioner-supported use. Potential solutions to obstacles for integration of e-mental health approaches into practice were proposed including practitioner training, appropriate tool design using a consultative approach, internal organizational directives and support structures, adaptations to existing systems and policies, implementation planning and organizational and government investment.
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Affiliation(s)
- Stefanie Puszka
- Menzies School of Health Research, Charles Darwin University, Casuarina , NT, Australia.
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Brown M, O'Neill N, van Woerden H, Eslambolchilar P, Jones M, John A. Gamification and Adherence to Web-Based Mental Health Interventions: A Systematic Review. JMIR Ment Health 2016; 3:e39. [PMID: 27558893 PMCID: PMC5014987 DOI: 10.2196/mental.5710] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/06/2016] [Accepted: 07/11/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adherence to effective Web-based interventions for common mental disorders (CMDs) and well-being remains a critical issue, with clear potential to increase effectiveness. Continued identification and examination of "active" technological components within Web-based interventions has been called for. Gamification is the use of game design elements and features in nongame contexts. Health and lifestyle interventions have implemented a variety of game features in their design in an effort to encourage engagement and increase program adherence. The potential influence of gamification on program adherence has not been examined in the context of Web-based interventions designed to manage CMDs and well-being. OBJECTIVE This study seeks to review the literature to examine whether gaming features predict or influence reported rates of program adherence in Web-based interventions designed to manage CMDs and well-being. METHODS A systematic review was conducted of peer-reviewed randomized controlled trials (RCTs) designed to manage CMDs or well-being and incorporated gamification features. Seven electronic databases were searched. RESULTS A total of 61 RCTs met the inclusion criteria and 47 different intervention programs were identified. The majority were designed to manage depression using cognitive behavioral therapy. Eight of 10 popular gamification features reviewed were in use. The majority of studies utilized only one gamification feature (n=58) with a maximum of three features. The most commonly used feature was story/theme. Levels and game leaders were not used in this context. No studies explicitly examined the role of gamification features on program adherence. Usage data were not commonly reported. Interventions intended to be 10 weeks in duration had higher mean adherence than those intended to be 6 or 8 weeks in duration. CONCLUSIONS Gamification features have been incorporated into the design of interventions designed to treat CMD and well-being. Further research is needed to improve understanding of gamification features on adherence and engagement in order to inform the design of future Web-based health interventions in which adherence to treatment is of concern. Conclusions were limited by varied reporting of adherence and usage data.
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Affiliation(s)
- Menna Brown
- Swansea University, Medical School, Swansea, United Kingdom.
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35
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Exploring the acceptability of online mental health interventions among university teaching staff: Implications for intervention dissemination and uptake. Internet Interv 2015. [DOI: 10.1016/j.invent.2015.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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