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Schwab-Reese L, Short C, Jacobs L, Fingerman M. Rapport Building in Written Crisis Services: Qualitative Content Analysis. J Med Internet Res 2024; 26:e42049. [PMID: 38748472 PMCID: PMC11137431 DOI: 10.2196/42049] [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: 08/19/2022] [Revised: 08/21/2023] [Accepted: 03/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. OBJECTIVE This study aims to categorize crisis counselors' efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. METHODS The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. RESULTS Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. CONCLUSIONS Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions.
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Affiliation(s)
- Laura Schwab-Reese
- Department of Public Health, Purdue University, West Lafayette, IN, United States
| | - Caitlyn Short
- Department of Public Health, Purdue University, West Lafayette, IN, United States
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Luetke Lanfer H, Reifegerste D, Weber W, Memenga P, Baumann E, Geulen J, Klein S, Müller A, Hahne A, Weg-Remers S. Digital clinical empathy in a live chat: multiple findings from a formative qualitative study and usability tests. BMC Health Serv Res 2024; 24:314. [PMID: 38459522 PMCID: PMC10921626 DOI: 10.1186/s12913-024-10785-8] [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: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Clinical empathy is considered a crucial element in patient-centered care. The advent of digital technology in healthcare has introduced new dynamics to empathy which needs to be explored in the context of the technology, particularly within the context of written live chats. Given the growing prevalence of written live chats, this study aimed to explore and evaluate techniques of digital clinical empathy within a familial cancer-focused live chat, focusing on how health professionals can (a) understand, (b) communicate, and (c) act upon users' perspectives and emotional states. METHODS The study utilized a qualitative approach in two research phases. It examined the expected and implemented techniques and effectiveness of digital clinical empathy in a live chat service, involving semi-structured interviews with health professionals (n = 9), focus group discussions with potential users (n = 42), and two rounds of usability tests between health professionals (n = 9) and users (n = 18). Data were examined using qualitative content analysis. RESULTS Expected techniques of digital clinical empathy, as articulated by both users and health professionals, involve reciprocal engagement, timely responses, genuine authenticity, and a balance between professionalism and informality, all while going beyond immediate queries to facilitate informed decision-making. Usability tests confirm these complexities and introduce new challenges, such as balancing timely, authentic responses with effective, personalized information management and carefully framed referrals. CONCLUSIONS The study reveals that the digital realm adds layers of complexity to the practice of clinical empathy. It underscores the importance of ongoing adaptation and suggests that future developments could benefit from a hybrid model that integrates the strengths of both AI and human health professionals to meet evolving user needs and maintain high-quality, empathetic healthcare interactions.
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Affiliation(s)
- Hanna Luetke Lanfer
- School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany.
| | - Doreen Reifegerste
- School of Public Health, Bielefeld University, Universitaetsstrasse 25, 33615, Bielefeld, Germany
| | - Winja Weber
- German Cancer Research Center (DKFZ), Division Cancer Information Service, Heidelberg, Germany
| | - Paula Memenga
- Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Eva Baumann
- Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Julia Geulen
- German Cancer Research Center (DKFZ), Division Cancer Information Service, Heidelberg, Germany
| | - Stefanie Klein
- German Cancer Research Center (DKFZ), Division Cancer Information Service, Heidelberg, Germany
| | | | | | - Susanne Weg-Remers
- German Cancer Research Center (DKFZ), Division Cancer Information Service, Heidelberg, Germany
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Campagnola M, Burlibasa A, Gutman LM. Barriers and enablers to the delivery of email communication for a helpline service for young people. PEC INNOVATION 2022; 1:100059. [PMID: 37213768 PMCID: PMC10194286 DOI: 10.1016/j.pecinn.2022.100059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 05/23/2023]
Abstract
Objective This qualitative study utilises the Behaviour Change Wheel (BCW) approach to identify barriers and enablers to the delivery of email communication in a mental health helpline service for young people, which are then linked to specific intervention strategies for improvement. Methods Semi-structured interviews were conducted with ten volunteers working for a free online helpline service for young people. Transcripts of the interviews were coded according to deductive then inductive themes. Results Ten core themes were identified. These were barriers or enablers, depending on the volunteers' level of experience with the email service. Enablers included the volunteers' skills, the resources and support offered to them. Barriers related to the asynchronous nature of email communication, need for additional training and volunteers' lack of confidence and motivation in responding to emails. Innovation This study expands current research on online mental health support by showing how the BCW can be a useful tool to identify influences on email helpline provision and offer strategies for its optimisation. Conclusion Offering training targeted to the email service, increasing the level of practice with mock-up emails, and introducing newsletters featuring positive feedback on the email service may improve the delivery of email helpline services for young people.
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Affiliation(s)
| | | | - Leslie Morrison Gutman
- Corresponding author at: 1-19 Torrington Place, University College London, London WC1E 7HB, UK.
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Moylan CA, Carlson ML, Campbell R, Fedewa T. "It's Hard to Show Empathy in a Text": Developing a Web-based Sexual Assault Hotline in a College Setting. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP16037-NP16059. [PMID: 34134570 DOI: 10.1177/08862605211025036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
To increase access to counseling and advocacy services and respond to changes in communication preferences, many victim service programs are expanding their traditional telephone hotlines and adding web chat or text hotlines. However, there is little research available about these web and text-based hotlines. We examined program data collected in the first year of operation of a web-based crisis hotline for sexual assault survivors at a large Midwestern university in the United States as part of a larger evaluation project. We examined how often the web-based chat hotline was used and explored patterns of use by time of day and month, comparing to records from the phone hotline operated by the same campus-based victim service program. We also conducted interviews and two group discussions with volunteers and staff about their experiences with providing crisis intervention in a web-chat medium. Findings suggest that the web-based crisis hotline is being used frequently, nearly as often as the telephone hotline and doubling the total number of crisis contacts the organization had in the year prior to adding the web-based chat hotline. Staff and volunteers identified a number of advantages of a web-based hotline, including increased privacy and accessibility for survivors. Difficulty identifying and conveying emotions in the web-chat context was one of the primary challenges described by staff and volunteers. Operating the web-hotline, therefore, requires additional training for volunteers and staff on how to translate crisis intervention skills into a text-based medium. Suggestions for how to communicate effectively in text-based crisis intervention are discussed, along with other considerations for designing a web or text hotline.
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Affiliation(s)
| | | | | | - Tana Fedewa
- Michigan State University, East Lansing, MI, USA
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Mohammed TF, Nadile EM, Busch CA, Brister D, Brownell SE, Claiborne CT, Edwards BA, Wolf JG, Lunt C, Tran M, Vargas C, Walker KM, Warkina TD, Witt ML, Zheng Y, Cooper KM. Aspects of Large-Enrollment Online College Science Courses That Exacerbate and Alleviate Student Anxiety. CBE LIFE SCIENCES EDUCATION 2021; 20:ar69. [PMID: 34806910 PMCID: PMC8715781 DOI: 10.1187/cbe.21-05-0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/27/2021] [Accepted: 10/01/2021] [Indexed: 05/06/2023]
Abstract
Anxiety is the top mental health concern for undergraduates. While researchers have identified ways that in-person science courses can affect anxiety, little is known about how online science courses affect anxiety. In this study, 2111 undergraduates at a large research-intensive institution completed survey questions about their anxiety in large-enrollment online science courses. Specifically, we assessed students' anxiety in the context of online science courses and asked what aspects of online science courses increase and decrease their anxiety. Students also identified what instructors can do to lessen anxiety in online classrooms. We used open coding and logistic regression to analyze student responses. More than 50% of students reported at least moderate anxiety in the context of online college science courses. Students commonly reported that the potential for personal technology issues (69.8%) and proctored exams (68.0%) increased their anxiety, while being able to access content at a later time (79.0%) and attending class from where they want (74.2%) decreased their anxiety. The most common ways that students suggested that instructors could decrease student anxiety is to increase test-taking flexibility (25.0%) and be understanding (23.1%). This study provides insight into how instructors can create more inclusive online learning environments for students with anxiety.
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Affiliation(s)
| | | | - Carly A. Busch
- Biology Education Research Course, School of Life Sciences
| | | | - Sara E. Brownell
- Research for Inclusive STEM Education Center, Arizona State University, Tempe, AZ 85281
| | | | | | | | - Curtis Lunt
- Biology Education Research Course, School of Life Sciences
| | - Missy Tran
- Biology Education Research Course, School of Life Sciences
| | - Cindy Vargas
- Biology Education Research Course, School of Life Sciences
| | - Kobe M. Walker
- Biology Education Research Course, School of Life Sciences
| | | | | | - Yi Zheng
- Mary Lou Fulton Teachers College, Arizona State University, Tempe, AZ 85281
| | - Katelyn M. Cooper
- Research for Inclusive STEM Education Center, Arizona State University, Tempe, AZ 85281
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Mathieu SL, Uddin R, Brady M, Batchelor S, Ross V, Spence SH, Watling D, Kõlves K. Systematic Review: The State of Research Into Youth Helplines. J Am Acad Child Adolesc Psychiatry 2021; 60:1190-1233. [PMID: 33383161 DOI: 10.1016/j.jaac.2020.12.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/03/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Helplines are generally a population-level resource for providing free, timely, easy-to-access, and anonymous counseling and/or information. Helplines have been developed and widely implemented for specific use by young people. The current study aimed to systematically review the literature to determine the status of research into the use of helplines among young people. METHOD Following the PRISMA checklist, 5 electronic databases were searched using relevant terms for literature published until May 2020. The extracted studies were summarized with the intention of identifying key themes that highlighted common findings, key implications, and important gaps in understanding. RESULTS A total of 52 articles fitting study inclusion criteria were identified. Most studies were quantitative papers from the United States and Australia. The types of helpline interactions studied were a mixture of telephone-based and SMS/text-based interactions. Three major themes were identified: awareness of and engagement with helpline services, nature of problems faced by young people, and service-related factors. Subthemes were use and awareness, barriers to help seeking, psychosocial problems, suicidality, telephone- versus text-based interactions, counselor-caller interaction, and provision of services to historically and systemically marginalized groups. CONCLUSION It appears that helplines may provide a beneficial service to youths, and that myriad psychosocial concerns provide the basis for calling. The literature is limited by a lack of controlled trials, on one hand, and complex methodological/ethical barriers preventing such trials, on the other hand. However, more research is needed before conclusions regarding effectiveness in youths can be made, particularly for services provided to systemically marginalized groups and using online text-based approaches.
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Affiliation(s)
- Sharna L Mathieu
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Riaz Uddin
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia; School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | - Morgan Brady
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | | | - Victoria Ross
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Susan H Spence
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - David Watling
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia
| | - Kairi Kõlves
- Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Australia.
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