Editorial: How can We Co-Create Solutions in Health Promotion With Users and Stakeholders?

Something Happened with the Way We Work: Evaluating the Implementation of the Reducing Coercion in Norway (ReCoN) Intervention in Primary Mental Health Care

BACKGROUND

Current policies to reduce the use of involuntary admissions are largely oriented towards specialist mental health care and have had limited success. We co-created, with stakeholders in five Norwegian municipalities, the 'Reducing Coercion in Norway' (ReCoN) intervention that aims to reduce involuntary admissions by improving the way in which primary mental health services work and collaborate. The intervention was implemented in five municipalities and is being tested in a cluster randomized control trial, which is yet to be published. The present study evaluates the implementation process in the five intervention municipalities. To assess how the intervention was executed, we report on how its different elements were implemented, and what helped or hindered implementation.

METHODS

We assessed the process using qualitative methods. Data included detailed notes from quarterly progress interviews with (i) intervention coordinators and representatives from (ii) user organisations and (iii) carer organisations. Finally, an end-of-intervention evaluation seminar included participants from across the sites.

RESULTS

The majority of intervention actions were implemented. We believe this was enabled by the co-creating process, which ensured ownership and a good fit for the local setting. The analysis of facilitators and barriers showed a high degree of interconnectedness between different parts of the intervention so that success (or lack thereof) in one area affected the success in others. Future implementation should pay attention to enhanced planning and training, clarify the role and contribution of service user and carer involvement, and pay close attention to the need for implementation support and whether this should be external or internal to services.

CONCLUSIONS

It is feasible to implement a complex intervention designed to reduce the use of involuntary admissions in general support services, such as the Norwegian primary mental health services. This could have implications for national and international policy aimed at reducing the use of involuntary care.

Using formative research to inform a mental health intervention for adolescents living in Indian slums: the ARTEMIS study

BACKGROUND

Adolescents are vulnerable to stressors because of the rapid physical and mental changes that they go through during this life period. Young people residing in slum communities experience additional stressors due to living conditions, financial stress, and limited access to healthcare and social support services. The Adolescents' Resilience and Treatment nEeds for Mental Health in Indian Slums (ARTEMIS) study, is testing an intervention intended to improve mental health outcomes for adolescents living in urban slums in India combining an anti-stigma campaign with a digital health intervention to identify and manage depression, self-harm/suicide risk or other significant emotional complaints.

METHODS

In the formative phase, we developed tools and processes for the ARTEMIS intervention. The two intervention components (anti-stigma and digital health) were implemented in purposively selected slums from the two study sites of New Delhi and Vijayawada. A mixed methods formative evaluation was undertaken to improve the understanding of site-specific context, assess feasibility and acceptability of the two components and identify required improvements to be made in the intervention. In-depth interviews and focus groups with key stakeholders (adolescents, parents, community health workers, doctors, and peer leaders), along with quantitative data from the digital health platform, were analysed.

RESULTS

The anti-stigma campaign methods and materials were found to be acceptable and received overall positive feedback from adolescents. A total of 2752 adolescents were screened using the PHQ9 embedded into a digital application, 133 (4.8%) of whom were identified as at high-risk of depression and/or suicide. 57% (n = 75) of those at high risk were diagnosed and treated by primary health care (PHC) doctors, who were guided by an electronic decision support tool based on WHO's mhGAP algorithm, built into the digital health application.

CONCLUSION

The formative evaluation of the intervention strategy led to enhanced understanding of the context, acceptability, and feasibility of the intervention. Feedback from stakeholders helped to identify key areas for improvement in the intervention; strategies to improve implementation included engaging with parents, organising health camps in the sites and formation of peer groups.

TRIAL REGISTRATION

The trial has been registered in the Clinical Trial Registry India, which is included in the WHO list of Registries, Reference number: CTRI/2022/02/040307. Registered 18 February 2022.

Exploring views and experiences of the general public's adoption of digital technologies for healthy lifestyle in Singapore: a qualitative study

Objective

Little is known about the general adult population's adoption of digital technology to support healthy lifestyle, especially when they are expected to take greater personal responsibility for managing their health and well-being today. The current qualitative study intended to gain an in-depth understanding of determinants of digital technology adoption for healthy lifestyle among community-dwelling adults in Singapore.

Design

A qualitative study design, with thematic framework analysis was applied to develop themes from the data.

Setting

Semi-structured individual interviews were conducted with participants either face-to-face or online through a videoconferencing platform.

Participants

14 women and 16 men from the general population who were between the ages of 22 and 71 years.

Results

Three major themes were developed: (1) digitally disempowered (2) safety and perceived risks and harm; (3) cultural values and drives. Adoption of technology among the general population is needs-driven, and contingent on individual, technological and other cross-cultural contextual factors.

Conclusion

Our findings highlight there is no one solution which fits all individuals, emphasizing the challenges of catering to diverse groups to reduce barriers to adoption of digital technologies for healthy lifestyle. Digital guidance and training, as well as social influences, can motivate technological adoption in the population. However, technical problems as well as data security and privacy concerns should first be adequately addressed. This study provides rich cross-cultural insights and informs policy-making due to its alignment with government public health initiatives to promote healthy lifestyle.

Empowerment through participation in community-based participatory research-effects of a physical activity promotion project among socially disadvantaged women

Introduction

Community-based participatory research (CBPR) approaches are associated with a range of positive impacts on empowerment. However, only a few studies have investigated the influence of different modes of target group participation on empowerment. The present study examined the empowerment processes and outcomes of women in difficult life situations through their participation as co-researchers in the form of Photovoice in "Stark durch Bewegung" (English: "Strong through Movement"), a CBPR project for physical activity (PA) promotion. The extent to which women's participation as co-researchers leads to empowerment was compared with other forms of participation.

Methods

The Photovoice approach consisted of three components: (1) photo task, (2) focus group interviews, and (3) exhibition of photos. It was then extended through participant observation. A total of 18 women took part in Photovoice. They took photos, were involved in four focus groups, helped in the analysis of data, and supported their exhibition. Two additional short focus group interviews in which four more women participated were conducted at the end of the project. The interview guideline was based on the SHOWeD questions proposed within the framework of Photovoice and enriched with various other questions (e.g., self-efficacy, social contacts, and community involvement). The data were analyzed based on a grounded theory approach.

Results

"Stark durch Bewegung" contributed to women's empowerment in several ways. By participating in the project's PA programs, the women reported numerous empowerment effects, such as improved self-efficacy, perceived competencies like swimming and language skills, and social networks. By participating as co-researchers, they perceived empowering processes on organizational and community levels that are comparable with other forms of participation (e.g., participation in a cooperative planning group) but also differ from them at relevant points (e.g., encouraging them to reflect on their own PA behaviors). The willingness to get involved in Photovoice was estimated to be significantly higher than in other possible forms of participation.

Conclusion

Our findings support the notion that health promotion interventions with marginalized groups can contribute to their empowerment on multiple levels when participants become equal partners in the CBPR project. Involving women as co-researchers has advantages over other forms of participation in terms of their empowerment.

Health education via "empowerment" digital marketing of consumer products and services: Promoting therapeutic benefits of self-care for depression and chronic pain

Increasing health care costs and high economic burden exemplify the impact of chronic diseases on public health. Multifaceted approaches to treating chronic diseases include pharmaceutical drugs, digital therapeutics, and lifestyle medicine. Chronic diseases are largely preventable, and health promotion yields positive outcomes. However, despite positive return on investment (ROI) and cost-to-benefit ratio (CBR) for health promotion (median ROI 2.2, median CBR 14.4), commercial marketing of healthy lifestyles and self-care is limited. The objective of this perspective article is to discuss how digital marketing of consumer goods and services that support therapeutic self-care can also bridge public health and for-profit interests. We describe how "empowerment" marketing campaigns can provide evidence-based associations between products/services and self-care benefits for people living with chronic pain and depression. Such a "health education as marketing" strategy is illustrated by educational ads describing how contact with nature, music, and yoga can improve chronic pain and reduce depressive symptoms. Creating associations between health-related benefits of these activities with products (outdoor and yoga apparel, audio equipment) and services (music streaming services, music mobile apps, eco-tourism, yoga studios) that support them expand their value proposition, thus incentivizing profit-driven companies to engage in public health campaigns. Long-term success of companies that incorporate evidence-based health education as marketing and branding strategies will depend on following ethical considerations and advertising guidelines defined by consumer protection regulatory agencies, such as the Federal Trade Commission (FTC). In conclusion, integration of health education about self-care and commercial marketing can support health care outcomes and disease prevention.

Developing healthy eating promotion mass media campaigns: A qualitative study

Background

Involving consumers in the development and assessment of mass media campaigns has been advocated, though research is still lacking. This study aimed to explore opinions and attitudes of citizens, health professionals, communication professionals, and digital influencers regarding the development and implementation of healthy eating promotion mass media campaigns.

Methods

We conducted five semi-structured focus groups, where participants were exposed to the first nationwide mass media campaign promoting healthy eating in Portugal. Through criteria-based purposive sampling, 19 citizens, five health professionals, two communication professionals, and four digital influencers were included. Transcripts were analyzed using Charmaz's line-to-line open coding process.

Results

Main identified themes were: considerations about informative-centered campaigns, health/nutritional issues to address, campaign formulation, target audiences, dissemination channels, and influencers' involvement. Participants favored campaigns focused on practical, transformative, and useful information with simple, innovative, activating, and exciting messages instead of strictly informative campaigns. Health and communication professionals mentioned the importance of adapting the message and dissemination channels to the target audience, addressing the most vulnerable and hard-to-reach individuals, and highlighted the importance of short video format.

Conclusions

Active involvement of the health promotion target audience is crucial for the development and effectiveness of health campaigns. Campaigns need to convey health messages on simple though exciting communication materials, targeted to the most vulnerable subgroups, including deprived, less educated, younger, and older generations.

A Recommendation System Based on AI for Storing Block Data in the Electronic Health Repository

The proliferation of wearable sensors that record physiological signals has resulted in an exponential growth of data on digital health. To select the appropriate repository for the increasing amount of collected data, intelligent procedures are becoming increasingly necessary. However, allocating storage space is a nuanced process. Generally, patients have some input in choosing which repository to use, although they are not always responsible for this decision. Patients are likely to have idiosyncratic storage preferences based on their unique circumstances. The purpose of the current study is to develop a new predictive model of health data storage to meet the needs of patients while ensuring rapid storage decisions, even when data is streaming from wearable devices. To create the machine learning classifier, we used a training set synthesized from small samples of experts who exhibited correlations between health data and storage features. The results confirm the validity of the machine learning methodology.