1
|
Bear HA, Ayala Nunes L, Ramos G, Manchanda T, Fernandes B, Chabursky S, Walper S, Watkins E, Fazel M. The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study. J Med Internet Res 2024; 26:e48964. [PMID: 39078699 PMCID: PMC11322694 DOI: 10.2196/48964] [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: 05/13/2023] [Revised: 09/26/2023] [Accepted: 06/10/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. OBJECTIVE This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. METHODS We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. RESULTS The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users' objective engagement. CONCLUSIONS Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in "real-world" settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. TRIAL REGISTRATION PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241.
Collapse
Affiliation(s)
- Holly Alice Bear
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Lara Ayala Nunes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Giovanni Ramos
- Department of Psychological Science, University of California, Irvine, CA, United States
| | - Tanya Manchanda
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Blossom Fernandes
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | | | | | - Edward Watkins
- School of Psychology, University of Exeter, Exeter, United Kingdom
| | - Mina Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Chen T, Ou J, Li G, Luo H. Promoting mental health in children and adolescents through digital technology: a systematic review and meta-analysis. Front Psychol 2024; 15:1356554. [PMID: 38533221 PMCID: PMC10963393 DOI: 10.3389/fpsyg.2024.1356554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Background The increasing prevalence of mental health issues among children and adolescents has prompted a growing number of researchers and practitioners to explore digital technology interventions, which offer convenience, diversity, and proven effectiveness in addressing such problems. However, the existing literature reveals a significant gap in comprehensive reviews that consolidate findings and discuss the potential of digital technologies in enhancing mental health. Methods To clarify the latest research progress on digital technology to promote mental health in the past decade (2013-2023), we conducted two studies: a systematic review and meta-analysis. The systematic review is based on 59 empirical studies identified from three screening phases, with basic information, types of technologies, types of mental health issues as key points of analysis for synthesis and comparison. The meta-analysis is conducted with 10 qualified experimental studies to determine the overall effect size of digital technology interventions and possible moderating factors. Results The results revealed that (1) there is an upward trend in relevant research, comprising mostly experimental and quasi-experimental designs; (2) the common mental health issues include depression, anxiety, bullying, lack of social emotional competence, and mental issues related to COVID-19; (3) among the various technological interventions, mobile applications (apps) have been used most frequently in the diagnosis and treatment of mental issues, followed by virtual reality, serious games, and telemedicine services; and (4) the meta-analysis results indicated that digital technology interventions have a moderate and significant effect size (g = 0.43) for promoting mental health. Conclusion Based on these findings, this study provides guidance for future practice and research on the promotion of adolescent mental health through digital technology. Systematic review registration https://inplasy.com/inplasy-2023-12-0004/, doi: 10.37766/inplasy2023.12.0004.
Collapse
Affiliation(s)
| | | | | | - Heng Luo
- Faculty of Artificial Intelligence in Education, Central China Normal University, Wuhan, China
| |
Collapse
|
3
|
Klingberg S, Adhikari B, Draper CE, Bosire E, Nyirenda D, Tiigah P, Mukumbang FC. Enhanced or hindered research benefits? A realist review of community engagement and participatory research practices for non-communicable disease prevention in low- and middle-income countries. BMJ Glob Health 2024; 9:e013712. [PMID: 38341191 PMCID: PMC10862340 DOI: 10.1136/bmjgh-2023-013712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Community engagement and participatory research are widely used and considered important for ethical health research and interventions. Based on calls to unpack their complexity and observed biases in their favour, we conducted a realist review with a focus on non-communicable disease prevention. The aim was to generate an understanding of how and why engagement or participatory practices enhance or hinder the benefits of non-communicable disease research and interventions in low- and middle-income countries. METHODS We retroductively formulated theories based on existing literature and realist interviews. After initial searches, preliminary theories and a search strategy were developed. We searched three databases and screened records with a focus on theoretical and empirical relevance. Insights about contexts, strategies, mechanisms and outcomes were extracted and synthesised into six theories. Five realist interviews were conducted to complement literature-based theorising. The final synthesis included 17 quality-appraised articles describing 15 studies. RESULTS We developed six theories explaining how community engagement or participatory research practices either enhance or hinder the benefits of non-communicable disease research or interventions. Benefit-enhancing mechanisms include community members' agency being realised, a shared understanding of the benefits of health promotion, communities feeling empowered, and community members feeling solidarity and unity. Benefit-hindering mechanisms include community members' agency remaining unrealised and participation being driven by financial motives or reputational expectations. CONCLUSION Our review challenges assumptions about community engagement and participatory research being solely beneficial in the context of non-communicable disease prevention in low- and middle-income countries. We present both helpful and harmful pathways through which health and research outcomes are affected. Our practical recommendations relate to maximising benefits and minimising harm by addressing institutional inflexibility and researcher capabilities, managing expectations on research, promoting solidarity in solving public health challenges and sharing decision-making power.
Collapse
Affiliation(s)
- Sonja Klingberg
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Bipin Adhikari
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Edna Bosire
- SAMRC/Wits Developmental Pathways for Health Research Unit (DPHRU), University of the Witwatersrand, Johannesburg, Gauteng, South Africa
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Deborah Nyirenda
- Community Engagement & Bioethics, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | | |
Collapse
|
4
|
Alsaqqa HH, Alwawi A. Digital intervention for public health: searching for implementing characteristics, concepts and recommendations: scoping review. Front Public Health 2023; 11:1142443. [PMID: 37790710 PMCID: PMC10544338 DOI: 10.3389/fpubh.2023.1142443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Studying the impact of digital interventions on public health can help ensure that the offered services produce the desired results. In order to address these factors, the subsequent study uses a scope review to evaluate the state of the field while concentrating on ideas and suggestions that represent factors that have been crucial in the management of digital intervention for public health. To shed light on the traits, ideas and suggestions related to public health digital intervention, a scoping review was carried out. Five electronic databases were used to locate pertinent research that were published before February 2022. All texts were examined, and study abstracts were scrutinized to determine their eligibility. The last analysis of this study included fifteen publications; five reviews, four qualitative studies, two quantitative studies, one viewpoint study, one mixed-method study, one perspective study, and one interventional study. The key ideas for digital interventions in population management and health studies are presented in this overview. Many concepts, implementation characteristics and recommendations have been raised which highlight the future role of these interventions to enhance public engagement and health equity.
Collapse
Affiliation(s)
- Hatem H. Alsaqqa
- Deanship of Scientific Research, Al-Quds University, Jerusalem, Palestine
- Ministry of Health, Gaza Strip, Palestine
| | - Abdallah Alwawi
- Anesthesia and Resuscitation Technology, Health Professions Faculty, Al Quds University, Jerusalem, Palestine
| |
Collapse
|
5
|
Black CJ, Berent JM, Joshi U, Khan A, Chamlagai L, Shrivastava R, Gautam B, Negeye A, Iftin AN, Ali H, Desrosiers A, Bhan A, Bhattacharya S, Naslund JA, Betancourt TS. Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00312. [PMID: 36853639 PMCID: PMC9972370 DOI: 10.9745/ghsp-d-22-00312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/24/2023] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Human-centered design (HCD) refers to a diverse suite of interactive processes that engage end users in the development of a desired outcome. We showcase how 2 global mental health research teams applied HCD to develop mobile health tools, each directed at reducing treatment gaps in underserved populations. CASE STUDY 1: Refugees face higher risks for mental health problems, yet these communities face structural and cultural barriers that reduce access to and use of services. To address these challenges, the Research Program on Children and Adversity at the Boston College School of Social Work, in partnership with resettled refugee communities in the northeastern United States, used codesign methodology to digitally adapt delivery of the Family Strengthening Intervention for Refugees-a program designed to improve mental health and family functioning among resettled families. We describe how codesign methods support the development of more feasible, acceptable, and sustainable interventions. CASE STUDY 2: Sangath, an NGO in India focused on mental health services research, in partnership with Harvard Medical School, designed and evaluated a digital training program for community health workers to deliver an evidence-based, brief psychological treatment for depression as part of primary care in Madhya Pradesh, India. We describe how HCD was applied to program development and discuss our approach to scaling up training and capacity-building to deliver evidence-based treatment for depression in primary care. IMPLICATIONS HCD involves a variety of techniques that can be flexibly adapted to engage end users in the conceptualization, implementation, scale-up, and sustainment of global mental health interventions. Community solutions generated using HCD offer important benefits for key stakeholders. We encourage widespread adoption of HCD within global mental health policy, research, and practice, especially for addressing mental health disparities with underserved populations.
Collapse
Affiliation(s)
- Candace J. Black
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA.,Correspondence to Candace J. Black ()
| | - Jenna M. Berent
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA
| | - Udita Joshi
- Bangalore Hospice Trust – Karunashraya Institute for Palliative Care Education and Research, Bangalore, India.,Sangath, Bhopal, India
| | | | - Lila Chamlagai
- Community member from the resettled Bhutanese community, Springfield, MA, USA
| | | | - Bhuwan Gautam
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA.,Community member from the resettled Bhutanese community, Springfield, MA, USA
| | - Abdikadir Negeye
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Abdi Nor Iftin
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Halimo Ali
- Community member from the resettled Somali Bantu community, Lewiston, ME, USA
| | - Alethea Desrosiers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | | | | | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Cambridge, MA, USA
| | - Theresa S. Betancourt
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA, USA
| |
Collapse
|
6
|
Goodyear T, Richardson C, Aziz B, Slemon A, Gadermann A, Daly Z, McAuliffe C, Pumarino J, Thomson KC, Jenkins EK. Mental distress and virtual mental health resource use amid the COVID-19 pandemic: Findings from a cross-sectional study in Canada. Digit Health 2023; 9:20552076231173528. [PMID: 37163172 PMCID: PMC10164262 DOI: 10.1177/20552076231173528] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/14/2023] [Indexed: 05/11/2023] Open
Abstract
Objective This paper characterizes levels of mental distress among adults living in Canada amid the COVID-19 pandemic and examines the extent of virtual mental health resource use, including reasons for non-use, among adults with moderate to severe distress. Methods Data are drawn from a cross-sectional monitoring survey (29 November to 7 December 2021) on the mental health of adults (N = 3030) in Canada during the pandemic. Levels of mental distress were assessed using the Kessler Psychological Distress Scale. Descriptive statistics were used to examine virtual mental health resource use among participants with moderate to severe distress, including self-reported reasons for non-use. Results Levels of mental distress were classified as none to low (48.8% of participants), moderate (36.6%), and severe (14.6%). Virtual mental health resource use was endorsed by 14.2% of participants with moderate distress and 32% of those with severe distress. Participants with moderate to severe distress reported a range of reasons for not using virtual mental health resources, including not feeling as though they needed help (37.4%), not thinking the supports would be helpful (26.2%), and preferring in-person supports (23.4%), among other reasons. Conclusions This study identified a high burden of mental distress among adults in Canada during the COVID-19 pandemic alongside an apparent mismatch between actual and perceived need for support, including through virtual mental health resources. Findings on virtual mental health resource use, and reasons for non-use, offer directions for mental health promotion and health communication related to mental health literacy and the awareness and appropriateness of virtual mental health resources.
Collapse
Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Chris Richardson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
| | - Bilal Aziz
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Allie Slemon
- School of Nursing, University of Victoria, Victoria, Canada
| | - Anne Gadermann
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Zachary Daly
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Corey McAuliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Javiera Pumarino
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Kimberly C Thomson
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, Canada
- Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Emily K Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
| |
Collapse
|
7
|
Gonsalves PP, Bhat B, Sharma R, Jambhale A, Chodankar B, Verma M, Hodgson E, Weiss HA, Leurent B, Cavanagh K, Fairburn CG, Cuijpers P, Michelson D, Patel V. Pilot randomised controlled trial of a remotely delivered online intervention for adolescent mental health problems in India: lessons learned about low acceptability and feasibility during the COVID-19 pandemic. BJPsych Open 2022; 9:e7. [PMID: 36573376 PMCID: PMC9798210 DOI: 10.1192/bjo.2022.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND 'POD Adventures' is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic. AIMS To evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors. METHOD We conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation. RESULTS Seventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants (n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team. CONCLUSIONS Despite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.
Collapse
Affiliation(s)
- Pattie P Gonsalves
- PRIDE, Sangath, India; and School of Psychology, University of Sussex, UK
| | | | | | | | | | | | | | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | - Baptiste Leurent
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
| | | | | | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, The Netherlands
| | - Daniel Michelson
- School of Psychology, University of Sussex, UK; and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Vikram Patel
- Department of Clinical Psychology, Vrije Universiteit, The Netherlands; and Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA
| |
Collapse
|
8
|
Michelson D, Hodgson E, Bernstein A, Chorpita BF, Patel V. Problem Solving as an Active Ingredient in Indicated Prevention and Treatment of Youth Depression and Anxiety: An Integrative Review. J Adolesc Health 2022; 71:390-405. [PMID: 35803863 DOI: 10.1016/j.jadohealth.2022.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/09/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
Problem solving is a common focus of psychological interventions for young people. However, existing evidence syntheses are relatively limited in their scope and conclusions. Taking a transdiagnostic approach and incorporating diverse sources of evidence, we examined the role of problem solving as an active ingredient for the indicated prevention and treatment of depression and anxiety in 14-24-year-olds. Three information sources were integrated using framework synthesis: (1) a systematic review of randomized controlled trials of problem solving; (2) a metasynthesis of qualitative evidence on the therapeutic experience of problem solving; and (3) consultations with a Youth Advisory Group. Intervention protocols that included problem solving and no more than one other specific component appeared to be effective for depression but not anxiety. Larger multicomponent interventions with a problem-solving element achieved moderate effect sizes for both conditions. There was no clear evidence that effectiveness varied by population characteristics, intervention formats, or contextual factors. Qualitative evidence and youth consultations highlighted positive views about the practicality, simplicity, and flexibility of problem solving. Converging sources also suggested changes in problem orientation as a key transdiagnostic process contributing to positive outcomes. Problem solving is a widely applicable therapeutic approach that can help young people with emotional problems to resolve specific stressors and lead to a more hopeful mindset about managing future challenges. Implications for practice are discussed.
Collapse
Affiliation(s)
- Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom.
| | - Eleanor Hodgson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, California
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
9
|
Willmot RA, Sharp RA, Amir Kassim A, Parkinson JA. A scoping review of community-based mental health intervention for children and adolescents in South Asia. Glob Ment Health (Camb) 2022; 10:e1. [PMID: 36843878 PMCID: PMC9947630 DOI: 10.1017/gmh.2022.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022] Open
Abstract
Children and adolescents in South Asia are exposed to significant mental health risks. Yet, policy to prevent or treat youth mental health problems in this context is underdeveloped, and services are difficult to access. Community-based mental health treatment may offer a potential solution, by increasing resource capacity in deprived settings. However, little is known about the current community-based mental health provision for South Asian youth. A scoping review was conducted across six scientific databases and hand searching of reference lists to identify relevant studies. Study selection and data extraction were performed by three independent reviewers using predefined criteria, an adapted version of the template for intervention description and replication checklist and the Cochrane Risk of Bias Tool. The search identified 19 relevant studies published from January 2000 to March 2020. Studies most frequently addressed PTSD and autism, were conducted in India and Sri Lanka, used education-based intervention and were based in urban school settings. Community-based mental health provision for the South Asian youth is in its infancy, but holds promise for providing essential resources to treat or prevent mental health disorder. New insights on approaches are discussed, which are valuable for South Asian settings, primarily task-shifting and stigma reduction, with implications for policy, practice and research.
Collapse
Affiliation(s)
| | - Rebecca A. Sharp
- School of Human and Behavioural Sciences, Bangor University, Bangor, UK
| | | | | |
Collapse
|
10
|
Singh S, Sagar R. Time to Have Effective Regulation of the Mental Health Apps Market: Maximize Gains and Minimize Harms. Indian J Psychol Med 2022; 44:399-404. [PMID: 35949633 PMCID: PMC9301749 DOI: 10.1177/02537176221082902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Swarndeep Singh
- Dept. of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Rajesh Sagar
- Dept. of Psychiatry, All India Institute of Medical Sciences, New Delhi, Delhi, India
| |
Collapse
|
11
|
Ferrari M, Sabetti J, McIlwaine SV, Fazeli S, Sadati SMH, Shah JL, Archie S, Boydell KM, Lal S, Henderson J, Alvarez-Jimenez M, Andersson N, Nielsen RKL, Reynolds JA, Iyer SN. Gaming My Way to Recovery: A Systematic Scoping Review of Digital Game Interventions for Young People's Mental Health Treatment and Promotion. Front Digit Health 2022; 4:814248. [PMID: 35465647 PMCID: PMC9021794 DOI: 10.3389/fdgth.2022.814248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/26/2022] [Indexed: 11/13/2022] Open
Abstract
Nearly all young people use the internet daily. Many youth with mental health concerns, especially since the Covid-19 pandemic, are using this route to seek help, whether through digital mental health treatment, illness prevention tools, or supports for mental wellbeing. Videogames also have wide appeal among young people, including those who receive mental health services. This review identifies the literature on videogame interventions for young people, ages 12-29, and maps the data on game use by those with mental health and substance use problems, focusing on evidence for the capacity of games to support treatment in youth mental health services; how stakeholders are involved in developing or evaluating games; and any potential harms and ethical remedies identified. A systematic scoping review methodology was used to identify and assess relevant studies. A search of multiple databases identified a total of 8,733 articles. They were screened, and 49 studies testing 32 digital games retained. An adapted stepped care model, including four levels, or steps, based on illness manifestation and severity, was used as a conceptual framework for organizing target populations, mental health conditions and corresponding digital games, and study results. The 49 selected studies included: 10 studies (20.4%) on mental health promotion/prevention or education for undiagnosed youth (Step 0: 7 games); 6 studies (12.2%) on at-risk groups or suspected mental problems (Step 1: 5 games); 24 studies (49.0%) on mild to moderate mental conditions (Steps 2-3: 16 games); and 9 studies (18.4%) focused on severe and complex mental conditions (Step 4: 7 games). Two interventions were played by youth at more than one level of illness severity: the SPARX game (Steps 1, 2-3, 4) and Dojo (Steps 2-3 and 4), bringing the total game count to 35 with these repetitions. Findings support the potential integration of digital games in youth services based on study outcomes, user satisfaction, relatively high program retention rates and the potential usefulness of most games for mental health treatment or promotion/prevention. Most studies included stakeholder feedback, and involvement ratings were very high for seven games. Potential harms were not addressed in this body of research. This review provides an important initial repository and evaluation of videogames for use in clinical settings concerned with youth mental health.
Collapse
Affiliation(s)
- Manuela Ferrari
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- *Correspondence: Manuela Ferrari
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarah V. McIlwaine
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Sahar Fazeli
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - S. M. Hani Sadati
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Integrated Studies in Education, McGill University, Montreal, QC, Canada
| | - Jai L. Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Suzanne Archie
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Katherine M. Boydell
- Black Dog Institute and School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Shalini Lal
- Douglas Mental Health University Institute, Montreal, QC, Canada
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Health Innovation and Evaluation Hub, Université de Montréal Hospital Research Centre, Montreal, QC, Canada
| | | | - Mario Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Neil Andersson
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | | | | | - Srividya N. Iyer
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| |
Collapse
|
12
|
Mehra D, Lakiang T, Kathuria N, Kumar M, Mehra S, Sharma S. Mental Health Interventions among Adolescents in India: A Scoping Review. Healthcare (Basel) 2022; 10:337. [PMID: 35206951 PMCID: PMC8871588 DOI: 10.3390/healthcare10020337] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Early adolescence is the period of the emergence of most mental disorders contributing significantly to the mental health burden globally, including India. The major challenges in India are early identification of mental health problems, treatment gap, lack of professionals, and interventions that address the same. Our review aimed to assess the effectiveness of mental health interventions among adolescents in India. We systematically searched PubMed, PsycINFO, and Cochrane databases and used cross-referencing to review the interventions published from 2010 to 2020. Eleven interventions were included in this review; nine were school-based, one community, and one digital. Most of the school-based programs used a life skills curriculum. Additionally, coping skills and resilience curricula showed improvement in depressive symptoms, cognitive abilities, academic stress, problem-solving, and overall mental well-being. The multi-component whole-school intervention was quite promising and helped in improving the overall school climate and various other mental health outcomes. Hence, school-based programs should be implemented as an entry point for screening mental health problems. However, there is a need for a more comprehensive mental health program in the country for adolescents. Additionally, there is a need to address the gap by conducting more interventions for early and out-of-school adolescents.
Collapse
Affiliation(s)
- Devika Mehra
- MAMTA Health Institute for Mother and Child, New Delhi 110048, India;
- Public Health Consultant, Medeon Science Park, 205 12 Malmo, Sweden; (T.L.); (N.K.); (M.K.); (S.M.)
| | - Theophilus Lakiang
- Public Health Consultant, Medeon Science Park, 205 12 Malmo, Sweden; (T.L.); (N.K.); (M.K.); (S.M.)
| | - Nishtha Kathuria
- Public Health Consultant, Medeon Science Park, 205 12 Malmo, Sweden; (T.L.); (N.K.); (M.K.); (S.M.)
| | - Manish Kumar
- Public Health Consultant, Medeon Science Park, 205 12 Malmo, Sweden; (T.L.); (N.K.); (M.K.); (S.M.)
| | - Sunil Mehra
- Public Health Consultant, Medeon Science Park, 205 12 Malmo, Sweden; (T.L.); (N.K.); (M.K.); (S.M.)
| | - Shantanu Sharma
- Public Health Consultant, Medeon Science Park, 205 12 Malmo, Sweden; (T.L.); (N.K.); (M.K.); (S.M.)
- Department of Clinical Sciences, Lund University, Skane University Hospital, 205 12 Malmo, Sweden
| |
Collapse
|
13
|
Gonsalves PP, Sharma R, Hodgson E, Bhat B, Jambhale A, Weiss HA, Fairburn CG, Cavanagh K, Cuijpers P, Michelson D, Patel V. A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e30339. [PMID: 34586075 PMCID: PMC8496682 DOI: 10.2196/30339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/20/2023] Open
Abstract
Background “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID) DERR1-10.2196/30339
Collapse
Affiliation(s)
- Pattie P Gonsalves
- Sangath, New Delhi, India.,School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | | | | | | | - Helen A Weiss
- Medical Research Council Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| |
Collapse
|
14
|
Zidaru T, Morrow EM, Stockley R. Ensuring patient and public involvement in the transition to AI-assisted mental health care: A systematic scoping review and agenda for design justice. Health Expect 2021; 24:1072-1124. [PMID: 34118185 PMCID: PMC8369091 DOI: 10.1111/hex.13299] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 04/07/2021] [Accepted: 05/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Machine‐learning algorithms and big data analytics, popularly known as ‘artificial intelligence’ (AI), are being developed and taken up globally. Patient and public involvement (PPI) in the transition to AI‐assisted health care is essential for design justice based on diverse patient needs. Objective To inform the future development of PPI in AI‐assisted health care by exploring public engagement in the conceptualization, design, development, testing, implementation, use and evaluation of AI technologies for mental health. Methods Systematic scoping review drawing on design justice principles, and (i) structured searches of Web of Science (all databases) and Ovid (MEDLINE, PsycINFO, Global Health and Embase); (ii) handsearching (reference and citation tracking); (iii) grey literature; and (iv) inductive thematic analysis, tested at a workshop with health researchers. Results The review identified 144 articles that met inclusion criteria. Three main themes reflect the challenges and opportunities associated with PPI in AI‐assisted mental health care: (a) applications of AI technologies in mental health care; (b) ethics of public engagement in AI‐assisted care; and (c) public engagement in the planning, development, implementation, evaluation and diffusion of AI technologies. Conclusion The new data‐rich health landscape creates multiple ethical issues and opportunities for the development of PPI in relation to AI technologies. Further research is needed to understand effective modes of public engagement in the context of AI technologies, to examine pressing ethical and safety issues and to develop new methods of PPI at every stage, from concept design to the final review of technology in practice. Principles of design justice can guide this agenda.
Collapse
Affiliation(s)
- Teodor Zidaru
- Department of Anthropology, London School of Economics and Political Science (LSE), London, UK
| | | | - Rich Stockley
- Surrey Heartlands Health and Care Partnership, Guildford and Waverley CCG, Guildford, UK.,Insight and Feedback Team, Nursing Directorate, NHS England and NHS Improvement, London, UK.,Surrey County Council, Kingston upon Thames, UK
| |
Collapse
|
15
|
Abstract
Background: Design workshops offer effective methods in eliciting end-user participation from design inception to completion. Workshops unite stakeholders in the utilization of participatory methods, coalescing in the best possible creative solutions. Objective: This systematic review aimed to identify design approaches whilst providing guidance to health information technology designers/researchers in devising and organizing workshops. Methods: A systematic literature search was conducted in five medical/library databases identifying 568 articles. The initial duplication removal resulted in 562 articles. A criteria-based screening of the title field, abstracts, and pre-full-texts reviews resulted in 72 records for full-text review. The final review resulted in 10 article exclusions. Results: 62 publications were included in the review. These studies focused on consumer facing and clinical health information technologies. The studied technologies involved both clinician and patients and encompassed an array of health conditions. Diverse workshop activities and deliverables were reported. Only seven publications reported workshop evaluation data. Discussion: This systematic review focused on workshops as a design and research activity in the health informatics domain. Our review revealed three themes: (1) There are a variety of ways of conducting design workshops; (2) Workshops are effective design and research approaches; (3) Various levels of workshop details were reported.
Collapse
|
16
|
Mental Health and Wellbeing at Schools: Health Promotion in Primary Schools with the Use of Digital Methods. CHILDREN-BASEL 2021; 8:children8050345. [PMID: 33925744 PMCID: PMC8145101 DOI: 10.3390/children8050345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022]
Abstract
Mental health disorders among primary school children remain a crucial issue. Early health promotion interventions can positively affect and prevent the onset of mental disorders. Promising digital mental health methods have been implemented for adolescents and youths with scarce evidence among younger ages. Therefore, the aim of the current systematic review was to identify health promotion interventions on mental health and wellbeing, with the use of digital methods, delivered in primary school settings. Six digital interventions have been identified, three of which were targeting teachers and the others students. Regardless of the limited number of studies, the effectiveness of the web-based interventions upon teachers’ knowledge and attitudes and the positive impact on children’s behavioral improvements has been documented. The lack of adequate evidence highlights the need for further research in the field. The current review provides information for professionals working in primary schools useful for the design and implementation of effective mental health and wellbeing interventions.
Collapse
|
17
|
Borghouts J, Eikey E, Mark G, De Leon C, Schueller SM, Schneider M, Stadnick N, Zheng K, Mukamel D, Sorkin DH. Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review. J Med Internet Res 2021; 23:e24387. [PMID: 33759801 PMCID: PMC8074985 DOI: 10.2196/24387] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/24/2020] [Accepted: 02/08/2021] [Indexed: 01/14/2023] Open
Abstract
Background Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions.
Collapse
Affiliation(s)
| | - Elizabeth Eikey
- University of California San Diego, San Diego, CA, United States
| | - Gloria Mark
- University of California Irvine, Irvine, CA, United States
| | | | | | | | - Nicole Stadnick
- University of California San Diego, San Diego, CA, United States
| | - Kai Zheng
- University of California Irvine, Irvine, CA, United States
| | - Dana Mukamel
- University of California Irvine, Irvine, CA, United States
| | - Dara H Sorkin
- University of California Irvine, Irvine, CA, United States
| |
Collapse
|
18
|
Gonsalves PP, Hodgson ES, Bhat B, Sharma R, Jambhale A, Michelson D, Patel V. App-based guided problem-solving intervention for adolescent mental health: a pilot cohort study in Indian schools. EVIDENCE-BASED MENTAL HEALTH 2020; 24:11-18. [PMID: 33208507 PMCID: PMC7958086 DOI: 10.1136/ebmental-2020-300194] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
Background This paper describes the pilot evaluation of ‘POD Adventures’, a lay counsellor-guided problem-solving intervention delivered via a smartphone app in Indian secondary schools. Objective To test the feasibility and acceptability of POD Adventures for adolescents with a felt need for psychological support, and to explore the intervention’s effects on self-reported mental health symptoms, prioritised problems, stress and well-being. Methods We used a mixed-methods pre-post cohort design. Participants were self-referred from grades 9–12 in two coeducational government-aided secondary schools in Goa, India. The intervention was delivered in two formats, ‘mixed’ (comprising individual and small group sessions) and ‘group’ (small group sessions only). Findings 248 participants enrolled in the study and 230 (92.7%) completed the intervention. Outcomes at 4 weeks showed significant improvements on all measures that were maintained at 12 weeks. Large effects were observed on problem severity scores (4 weeks, d=1.47; 12 weeks, d=1.53) while small to moderate effects were seen on mental health symptoms, stress and well-being. 22 students completed qualitative interviews about their experience of the intervention. Participants found POD Adventures easy to use, engaging and helpful in solving their problems. They were satisfied with the guidance provided by the counsellor irrespective of delivery format. Conclusions POD Adventures was feasible to deliver with guidance from lay counsellors in Indian schools, acceptable to participants and associated with large improvements in problem severity and mental health symptom severity. Clinical implications POD Adventures has promise as an early intervention for adolescents with a felt need for psychological support in low-resource settings.
Collapse
Affiliation(s)
- Pattie P Gonsalves
- Sangath, New Delhi, India .,Psychology, University of Sussex, Brighton, Brighton and Hove, UK
| | | | | | | | | | | | - Vikram Patel
- Sangath, Porvorim, Goa, India.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
19
|
Muke SS, Tugnawat D, Joshi U, Anand A, Khan A, Shrivastava R, Singh A, Restivo JL, Bhan A, Patel V, Naslund JA. Digital Training for Non-Specialist Health Workers to Deliver a Brief Psychological Treatment for Depression in Primary Care in India: Findings from a Randomized Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6368. [PMID: 32883018 PMCID: PMC7503742 DOI: 10.3390/ijerph17176368] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
Introduction: Task sharing holds promise for scaling up depression care in countries such as India, yet requires training large numbers of non-specialist health workers. This pilot trial evaluated the feasibility and acceptability of a digital program for training non-specialist health workers to deliver a brief psychological treatment for depression. Methods: Participants were non-specialist health workers recruited from primary care facilities in Sehore, a rural district in Madhya Pradesh, India. A three-arm randomized controlled trial design was used, comparing digital training alone (DGT) to digital training with remote support (DGT+), and conventional face-to-face training. The primary outcome was the feasibility and acceptability of digital training programs. Preliminary effectiveness was explored as changes in competency outcomes, assessed using a self-reported measure covering the specific knowledge and skills required to deliver the brief psychological treatment for depression. Outcomes were collected at pre-training and post-training. Results: Of 42 non-specialist health workers randomized to the training programs, 36 including 10 (72%) in face-to-face, 12 (86%) in DGT, and 14 (100%) in DGT+ arms started the training. Among these participants, 27 (64%) completed the training, with 8 (57%) in face-to-face, 8 (57%) in DGT, and 11 (79%) in DGT+. The addition of remote telephone support appeared to improve completion rates for DGT+ participants. The competency outcome improved across all groups, with no significant between-group differences. However, face-to-face and DGT+ participants showed greater improvement compared to DGT alone. There were numerous technical challenges with the digital training program such as poor connectivity, smartphone app not loading, and difficulty navigating the course content-issues that were further emphasized in follow-up focus group discussions with participants. Feedback and recommendations collected from participants informed further modifications and refinements to the training programs in preparation for a forthcoming large-scale effectiveness trial. Conclusions: This study adds to mounting efforts aimed at leveraging digital technology to increase the availability of evidence-based mental health services in primary care settings in low-resource settings.
Collapse
Affiliation(s)
- Shital S. Muke
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Deepak Tugnawat
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Udita Joshi
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Aditya Anand
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Azaz Khan
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Ritu Shrivastava
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Abhishek Singh
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Juliana L. Restivo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (J.L.R.); (V.P.)
| | - Anant Bhan
- Sangath, 120 Deepak Society, Chuna Bhatti, Kolar Road, Bhopal 462016, India; (S.S.M.); (D.T.); (U.J.); (A.A.); (A.K.); (R.S.); (A.S.); (A.B.)
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (J.L.R.); (V.P.)
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA 02115, USA
| | - John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; (J.L.R.); (V.P.)
| |
Collapse
|
20
|
Design and Development of a Digital Program for Training Non-Specialist Health Workers to Deliver an Evidence-Based Psychological Treatment for Depression in Primary Care in India. ACTA ACUST UNITED AC 2020; 5:402-415. [PMID: 34150992 DOI: 10.1007/s41347-020-00154-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Digital technologies hold promise for building capacity of non-specialist health workers towards scaling up depression care in low-resource settings. The purpose of this study was to describe the systematic approach to designing a digital program for training non-specialist health workers to deliver an evidence-based brief psychological treatment for depression, called the Healthy Activity Program, in primary care in rural India. Methods The design and development of the training program involved 5 steps: 1) develop program blueprint; 2) create instructional content; 3) digitize content for a smartphone app; 4) develop a platform for uploading and hosting the digital content; and 5) user-testing and refinements to ensure program functioning. This was followed by field-testing and focus group discussions with non-specialist health workers recruited from primary care facilities in Madhya Pradesh, India, to inform further modifications and improvements to the digital training program. Results Training program development occurred over 12-months, and the final digital training consisted of 16 modules with videos, role-plays, and digital content tailored to the local culture and context. Focus group discussions with 19 non-specialist health workers generated three key action items and modifications to the digital training in response to participant feedback: 1) addressing technical challenges by making the digital content available offline; 2) account for low digital literacy by including a comprehensive orientation session about navigating the smartphone app; and 3) addition of remote coaching to support participants in completing the training. Conclusions This study illustrates a step-wise approach to combine evidence-based content with iterative feedback from stakeholders to develop a digital training program tailored to the context in a low-resource setting. Further research is needed to validate this approach and to evaluate the effectiveness of the final modified digital training program, while considering whether this approach can be adopted and replicated in other settings.
Collapse
|
21
|
Peiris-John R, Dizon L, Sutcliffe K, Kang K, Fleming T. Co-creating a large-scale adolescent health survey integrated with access to digital health interventions. Digit Health 2020; 6:2055207620947962. [PMID: 32922828 PMCID: PMC7453446 DOI: 10.1177/2055207620947962] [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: 11/07/2019] [Accepted: 07/13/2020] [Indexed: 11/16/2022] Open
Abstract
Aim This paper describes how we engaged with adolescents and health providers to integrate access to digital health interventions as part of a large-scale secondary school health and wellbeing survey in New Zealand. Methods We conducted nine participatory, iterative co-design sessions involving 29 adolescents, and two workshops with young people (n = 11), digital and health service providers (n = 11) and researchers (n = 9) to gain insights into end-user perspectives on the concept and how best to integrate digital interventions in to the survey. Results Students’ perceived integrating access to digital health interventions into a large-scale youth health survey as acceptable and highly beneficial. They did not want personalized/normative feedback, but thought that every student should be offered all the help options. Participants identified key principles: assurance of confidentiality, usability, participant choice and control, and language. They highlighted wording as important for ease and comfort, and emphasised the importance of user control. Participants expressed that it would be useful and acceptable for survey respondents to receive information about digital help options addressing a range of health and wellbeing topics. Conclusion The methodology of adolescent-practitioner-researcher collaboration and partnership was central to this research and provided useful insights for the development and delivery of adolescent health surveys integrated with digital help options. The results from the ongoing study will provide useful data on the impact of digital health interventions integrated in large-scale surveys, as a novel methodology. Future research on engaging with adolescents once interventions are delivered will be useful to explore benefits over time.
Collapse
Affiliation(s)
- Roshini Peiris-John
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lovely Dizon
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kylie Sutcliffe
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kristy Kang
- Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
| |
Collapse
|
22
|
Abstract
Adolescents living in low-resource settings lack access to adequate psychological care. The barriers to mental health care in low- and middle-income countries (LMIC) include high disease burden, low allocation of resources, lack of national mental health policy and child and adolescent mental health (CAMH) professionals and services, poverty, illiteracy and poor availability of adolescent friendly health services. WHO has recommended a stepped task shifting approach to mental health care in LMIC. Training of non-mental health specialists like peers, teachers, community health workers, paediatricians and primary care physicians by CAMH and framing country-specific evidence-based national mental health policies are vital in overcoming barriers to psychological care in LMIC. Digital technology and telemedicine can be used in providing economical and accessible mental health care services to adolescents.
Collapse
Affiliation(s)
| | - Merrian J Brooks
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, USA
| |
Collapse
|
23
|
Vandekerckhove P, de Mul M, Bramer WM, de Bont AA. Generative Participatory Design Methodology to Develop Electronic Health Interventions: Systematic Literature Review. J Med Internet Res 2020; 22:e13780. [PMID: 32338617 PMCID: PMC7215492 DOI: 10.2196/13780] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Generative participatory design (PD) may help in developing electronic health (eHealth) interventions. PD is characterized by the involvement of all stakeholders in creative activities. This is different from the traditional user-centered design, where users are less involved. When looking at PD from a research through design perspective, it is important to summarize the reasons for choosing a certain form of generative PD to further develop its methodology. However, the scientific literature is currently unclear about which forms of PD are used to develop eHealth and which arguments are used to substantiate the decision to use a certain form of generative PD. OBJECTIVE This study aimed to explore the reporting and substantiation of generative PD methodologies in empirical eHealth studies published in scientific journals to further develop PD methodology in the field of eHealth. METHODS A systematic literature review following the Cochrane guidelines was conducted in several databases (EMBASE, MEDLINE Ovid, Web of Science, and CINAHL EBSCOhost). Data were extracted on the recruitment and management of stakeholders, the use of tools, and the use of outcome measures. RESULTS Of the 3131 studies initially identified, 69 were selected for qualitative synthesis. The reporting was very variable, depending to a large extent on whether the study stated that reporting on the PD process was a major aim. The different levels of reporting and substantiation of the choices of a recruitment strategy, stakeholder management, and tools and outcome measures are presented. Only a few authors explicitly used arguments directly related to PD guiding principles such as democratic, mutual learning, tacit and latent knowledge, and collective creativity. Even though PD principles were not always explicitly discussed in the method descriptions of the studies, they were implicitly present, mostly in the descriptions of the use of PD tools. The arguments used to substantiate the choices made in stakeholder management, PD tools, and the type of outcome measures adopted point to the involvement of PD principles. CONCLUSIONS Studies that have used a PD research methodology to develop eHealth primarily substantiate the choice of tools made and much less the use of stakeholders and outcome measures.
Collapse
Affiliation(s)
| | - Marleen de Mul
- Erasmus School of Health Policy and Management, Rotterdam, Netherlands
| | - Wichor M Bramer
- Medical Library Erasmus MC, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | | |
Collapse
|
24
|
Baghaei N, Naslund JA, Hach S, Liang HN. Editorial: Designing Technologies for Youth Mental Health. Front Public Health 2020; 8:45. [PMID: 32161745 PMCID: PMC7052481 DOI: 10.3389/fpubh.2020.00045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 02/10/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Nilufar Baghaei
- Department of Information Technology, Otago Polytechnic Auckland Campus, Auckland, New Zealand
- School of Natural and Computational Sciences, Massey University, Auckland, New Zealand
| | - John A Naslund
- Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Sylvia Hach
- Clinical Research, Unitec Institute of Technology, Auckland, New Zealand
| | - Hai-Ning Liang
- Department of Computer Science and Software Engineering, Xi'an Jiaotong-Liverpool University, Suzhou, China
| |
Collapse
|
25
|
Naslund JA, Gonsalves PP, Gruebner O, Pendse SR, Smith SL, Sharma A, Raviola G. Digital Innovations for Global Mental Health: Opportunities for Data Science, Task Sharing, and Early Intervention. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2019; 6:337-351. [PMID: 32457823 PMCID: PMC7250369 DOI: 10.1007/s40501-019-00186-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Globally, individuals living with mental disorders are more likely to have access to a mobile phone than mental health care. In this commentary, we highlight opportunities for expanding access to and use of digital technologies to advance research and intervention in mental health, with emphasis on the potential impact in lower resource settings. RECENT FINDINGS Drawing from empirical evidence, largely from higher income settings, we considered three emerging areas where digital technology will potentially play a prominent role: supporting methods in data science to further our understanding of mental health and inform interventions, task sharing for building workforce capacity by training and supervising non-specialist health workers, and facilitating new opportunities for early intervention for young people in lower resource settings. Challenges were identified related to inequities in access, threats of bias in big data analyses, risks to users, and need for user involvement to support engagement and sustained use of digital interventions. SUMMARY For digital technology to achieve its potential to transform the ways we detect, treat, and prevent mental disorders, there is a clear need for continued research involving multiple stakeholders, and rigorous studies showing that these technologies can successfully drive measurable improvements in mental health outcomes.
Collapse
Affiliation(s)
- John A. Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | | | - Oliver Gruebner
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - Sachin R. Pendse
- Microsoft Research India, Bangalore, India
- Georgia Institute of Technology, School of Interactive Computing, Atlanta, GA, USA
| | | | | | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|