Towards Meaningful Engagement with Clinician Advisors: Lessons Learned Co-Creating a Digital Mental Health Tool

In partnership with clinician advisors, a text-based program, BeWell, was co-created to support clinician well-being at a Canadian mental health hospital. This paper briefly describes the process of designing BeWell with clinician advisors and highlights key lessons learned in engaging clinicians as advisors in the design and development of a digital health intervention. The lessons learned can serve as best practices for health systems, organizations, and researchers to consider when engaging clinicians in the design, development, and implementation of digital health interventions.

Exploring contextual factors impacting the implementation of and engagement with a digital platform supporting psychosis recovery: A brief report

Individuals with schizophrenia often demonstrate poor engagement in treatment and challenges with illness self-management. App4independence (A4i) is a digital health platform that was developed with the purpose of addressing the aforementioned challenges. While digital interventions can support patient care, there is a paucity of research on implementing such interventions in clinical settings. To describe the contextual factors that impacted the implementation of and engagement with A4i across three different clinical implementation sites, a descriptive approach, guided by implementation science frameworks, was employed to understand how people, culture, process, and technology impacted the implementation of A4i. Descriptive statistics were used to present user engagement data across each site implementation. Additionally, the lessons learned from each implementation were described narratively. Overall, 53 patients were onboarded to A4i in Context 1, 8 in Context 2, and 65 within Context 3, with retention rates over 90 days of 100%, 100%, and 96%, respectively. The adoption, engagement, and sustained use of the A4i platform varied across each implementation site and were affected by implementation strategies within the sociotechnical domains of people, culture, process, and technology. Despite differences in implementation processes, engagement with A4i remained consistently high. Customized educational materials, digital navigators, and technical support served as facilitators in the adoption of A4i.

Pre-implementation perceptions of clinicians regarding a patient portal in inpatient addictions settings: A qualitative descriptive study

BACKGROUND

Patient portals have been implemented in many organizations to support patient engagement and empowerment. However, their use in inpatient mental health and addiction settings is relatively new and has not been extensively studied. To address this gap, this study explored clinician perspectives of implementing a patient portal in inpatient addiction settings.

METHODS

The study followed qualitative descriptive methodology and used the Consolidated Framework for Implementation Research (CFIR) to guide the research. Interviews were conducted with clinicians working in an inpatient addictions service at a large mental health and addictions teaching hospital in Toronto, Canada. Data analysis was performed using directed content analysis and the CFIR domains.

RESULTS

Twelve clinicians participated in semi-structured interviews. Participants included prescribers (such as physicians and nurse practitioners), registered nurses, allied health clinicians, and leadership. Participants had positive attitudes toward the patient portal, believing it would benefit patients and support consistency in healthcare. However, they also expressed reservations about its relevance and value during short inpatient admissions. Clinicians perceived the patient portal as compatible with existing workflows, enhancing patient empowerment and facilitating access to medical documentation. Concerns were raised about potential negative impacts on therapeutic rapport, particularly if patients disagreed with or were upset by the contents of their notes. Adaptations to the portal, such as improving documentation templates and providing detailed medication information, were suggested. Participants also highlighted advantages of the portal, including secure communication and access to laboratory results.

CONCLUSIONS

Clinicians generally had positive attitudes toward implementing a patient portal. However, concerns about maintaining therapeutic rapport and the relevance of information to patients were identified, and adaptations were suggested to improve the utility of a portal in the context of short inpatient stays. The findings provide insights into clinician perspectives and can inform the implementation of patient portals in inpatient addiction settings.

Planning for the Future of Digital Mental Health in Canada: Priorities of Canadians Affected by Mental Health Conditions

Digital mental health tools have the potential to support people affected by mental health conditions. A pan-Canadian survey was conducted to understand the current and future digital health needs. The results show that Canadians prioritized tools that support them in navigating the physical and digital mental healthcare systems and that are integrated into their care.

Race and Racialization in Mental Health Research and Implications for Developing and Evaluating Machine Learning Models: A Rapid Review

Machine learning models are often trained on sociodemographic features to predict mental health outcomes. Biases in the collection of race-related data can limit the development of useful and fair models. To assess the current state of this data in mental health research, we conducted a rapid review guided by Critical Race Theory. Findings reveal limitations in the measurement and reporting of race and ethnicity, potentially leading to models that amplify health inequities.

Identifying Implementation Strategies to Enhance the Uptake of OpenNotes in Mental Health Settings: A Study Protocol

Numerous benefits have been shown when OpenNotes functionality is present in a patient portal. Despite the benefits, many mental health providers have demonstrated concern with regards to sharing their clinical documentation with their patients electronically. This poster will describe a mixed-methods study protocol that aims to address the concerns of mental health providers by co-producing and contextualizing resources to support the uptake of OpenNotes by mental health providers in the Canadian context.

Lessons learned developing and deploying a provincial virtual mental health support during the COVID-19 pandemic

Significant efforts have been put into implementing virtual forms of healthcare and supports since the beginning of the pandemic. However, limited information has been shared with health leaders about how this has taken place, and what can be learned from this to move forward into the future. The purpose of this article is to describe lessons learned co-designing and developing a virtual health support during the COVID-19 pandemic in the province of Saskatchewan. In this article, we anchor these lessons learned on a specific virtual health service support, “SaskWell,” which offers a digital service, and aims to connect residents of the province to digital mental health supports and resources.

Ready or Not: Key Insights to Enabling Adolescents' Access to Their Personal Health Information

Granting minors with online access to their personal health information (PHI) is a complex policy and implementation issue, requiring a balance of rapid changes in adolescent maturity and autonomy, adolescent need for privacy and confidentiality and care responsibilities of custodians and providers. There are currently no standard legislation or policies that enable access; however, most implementations use the age of majority or the mature minor doctrine as an approach - each with its own limitations. This paper highlights key legislative and implementation insights for organizations seeking to enable adolescents with online access to their PHI, calling for leadership to address this issue.

Meaningful Digital Consent in Canada: Recommendations from Pan-Canadian Consent Management Workshops

The digital health landscape is rapidly evolving with regard to how society accesses and interacts with digital information and technologies. With a largely commercial marketplace, there are growing concerns that users are not fully informed about how their data are used. Canadian privacy legislation is currently undergoing modernization to improve the transparency of commercial information handling practices through the introduction of meaningful consent. This paper reports on workshops held across Canada, exploring the implications of meaningful consent in a digital health context. Recommendations focus on measures to promote transparency, improve digital literacy and foster public trust in digital health innovations.

Canadian perspectives of digital mental health supports: Findings from a national survey conducted during the COVID-19 pandemic

Objectives

The impact of the COVID-19 pandemic on population mental health has highlighted the potential for digital mental health to support the needs of those requiring care. This study sought to understand the digital mental health experiences and priorities of Canadians affected by mental health conditions (i.e. seekers, patients, and care partners).

Methods

A national cross-sectional electronic survey of Canadians was administered through a market research firm's survey panel. Seekers, patients, and care partners were asked about their digital mental health experiences (e.g. uptake, barriers to access) and priorities. Survey responses were summarized using descriptive statistics.

Results

Overall, 1003 participants completed the survey. 70.2% of participants routinely use digital mental health supports to support themselves or those they care for; however, only 28.6% of participants are satisfied with the available digital mental health supports. Most participants (73.3%) have encountered some barriers when accessing digital mental health supports. Awareness of digital mental health supports was a top barrier identified by participants. The top digital mental health priorities consisted of digital mental health curation, navigation, and a digital mental health passport.

Conclusions

Most participants use digital mental health supports for themselves or others, however, many are unaware of digital mental health supports available. Efforts to improve navigating access to digital and in-person mental health services are seen as a top priority, highlighting the need to enable seekers, patients, and care partners to find the appropriate support and make decisions on how to best improve their mental health.

"I think it's something that we should lean in to": The use of OpenNotes in Canadian psychiatric care contexts by clinicians

BACKGROUND

OpenNotes is the concept of patients having access to their health records and clinical notes in a digital form. In psychiatric settings, clinicians often feel uncomfortable with this concept, and require support during implementation.

OBJECTIVE

This study utilizes an implementation science lens to explore clinicians' perceptions about using OpenNotes in Canadian psychiatric care contexts. The findings are intended to inform the co-design of implementation strategies to support the implementation of OpenNotes in Canadian contexts.

METHOD

This qualitative descriptive study employed semi-structured interviews which were completed among health professionals of varying disciplines working in direct care psychiatric roles. Data analysis consisted of a qualitative directed content analysis using themes outlined from an international Delphi study of mental health clinicians and experts. Ethical approval was obtained from the Centre for Addiction and Mental Health and the University of Toronto.

RESULTS

In total, 23 clinicians from psychiatric settings participated in the interviews. Many of the themes outlined within the Delphi study were voiced. Benefits included enhancements to patient recall, and empowerment, improvements to care quality, strengthened relational effects and effects on professional autonomy and efficiencies. Despite the anticipated benefits of OpenNotes, identified challenges pertained to clarity surrounding exemption policies, training on patient facing notes, managing disagreements, and educating patients on reading clinical notes.

CONCLUSION

Many benefits and challenges were identified for adopting OpenNotes in Canadian psychiatric settings. Future work should focus on applying implementation frameworks to develop interventions that address the identified challenges.

Sharing Clinical Notes in a Canadian Mental Health Setting: Recommendations from Applying the Consolidated Framework for Intervention Research

During the COVID-19 pandemic, the OpenNotes movement presents an optimal solution for virtual engagement through the sharing of clinical notes within mental health care settings. Therefore, we conducted interviews to discover how mental health clinicians interact with patients using OpenNotes. We integrated The Consolidated Framework for Intervention Research to establish implementation recommendations. As both challenges and opportunities were identified, future research should address challenges to foster patient and clinician engagement in sharing clinical notes.

Supporting population mental health and wellness during the COVID-19 pandemic in Canada: protocol for a sequential mixed-method study

INTRODUCTION

The global COVID-19 pandemic has reported to have a negative impact on the mental health and well-being of individuals around the world. Mental health system infrastructure, primarily developed to support individuals through in-person care, struggled to meet rising demand for services even prior to COVID-19. With public health guidelines requiring the use of physical distancing during the pandemic, digital mental health supports may be one way to address the needs of the population. Despite this, barriers exist in promoting and supporting access to existing and emerging digital resources. Text messaging may address some of these barriers, extending the potential reach of these digital interventions across divides that may separate some vulnerable or disadvantaged groups from essential mental health supports. Building on an existing knowledge synthesis project identifying key digital resources for improved mental health, this research will establish low-tech connections to assess need and better match access to services for those who need it most. The aim of this study is to codesign a customised two-way texting service to explore need and better align access to mental health supports for Canadians located in Saskatchewan during the COVID-19 pandemic.

METHODS AND ANALYSIS

This study will be completed in Saskatchewan, Canada. For this project, the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework will be used to support three phases of a sequential mixed-method study. An advisory committee of Saskatchewan residents will guide this work with the study team. A 10-week service will be launched to connect individuals with appropriately suited digital mental health interventions through the use of text messaging. In phase 1, implementation and prototyping will be conducted with collaborative codesign for key elements related to features of an enrolment survey and initial messaging content. Phase 2 will focus on advancing the effectiveness of the service using quantitative user data. In phase 3, an embedding approach will be used to integrate both qualitative and quantitative data collected to understand the overall acceptability, satisfaction and perceived benefit of the text messaging service. Thematic analysis and descriptive statistics will be used as analytic methods.

ETHICS AND DISSEMINATION

This study has received approval from the Research Ethics Board at the University of Saskatchewan. A knowledge dissemination plan has been developed that includes traditional academic approaches such as conference presentations, and academic publications, as well as mainstream approaches such as social media, radio and dissemination through the advisory committee.

Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study

Background

The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada.

Objective

A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector.

Methods

The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content.

Results

A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care.

Conclusions

As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth.

Supporting the Mental Health of Nurses through Digital Tools

Absenteeism rates among nurses have increased across Canada over the last several years, with work environment challenges and staffing shortages being possible contributors. With the onset of the COVID-19 pandemic, nurses have worked under increasingly stressful conditions. Unsurprisingly, many nurses are facing mental health challenges. Digital tools to support and enhance access to mental health services are one strategy to support the mental health of nurses. This paper outlines the digital tools and virtual programs available to support the mental health of nurses, recognizing that there is no single solution to address the mental health challenges faced by Canadian nurses during these difficult times.

Digital Interventions to Support Population Mental Health in Canada During the COVID-19 Pandemic: Rapid Review

BACKGROUND

The COVID-19 pandemic has resulted in a number of negative health related consequences, including impacts on mental health. More than 22% of Canadians reported that they had felt depressed in the last week, in response to a December 2020 national survey. Given the need to physically distance during the pandemic, and the increase in demand for mental health services, digital interventions that support mental health and wellness may be beneficial.

OBJECTIVE

The purpose of this research was to identify digital interventions that could be used to support the mental health of the Canadian general population during the COVID-19 pandemic. The objectives were to identify (1) the populations these interventions were developed for, inclusive of exploring areas of equity such as socioeconomic status, sex/gender, race/ethnicity and culture, and relevance to Indigenous peoples and communities; (2) the effect of the interventions; and (3) any barriers or facilitators to the use of the intervention.

METHODS

This study was completed using a Cochrane Rapid Review methodology. A search of Embase, PsycInfo, Medline, and Web of Science, along with Google, Million Short, and popular mobile app libraries, was conducted. Two screeners were involved in applying inclusion criteria using Covidence software. Academic articles and mobile apps identified were screened using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields resource, the American Psychiatric Association App Evaluation Framework, and the Mental Health Commission of Canada's guidance on app assessment and selection.

RESULTS

A total of 31 mobile apps and 114 web-based resources (eg, telemedicine, virtual peer support groups, discussion forums, etc) that could be used to support the mental health of the Canadian population during the pandemic were identified. These resources have been listed on a publicly available website along with search tags that may help an individual make a suitable selection. Variability exists in the populations that the interventions were developed for, and little assessment has been done with regard to areas of equity. The effect of the interventions was not reported for all those identified in this synthesis; however, for those that did report the effect, it was shown that they were effective in the context that they were used. A number of barriers and facilitators to using these interventions were identified, such as access, cost, and connectivity.

CONCLUSIONS

A number of digital interventions that could support population mental health in Canada during the global COVID-19 pandemic were identified, indicating that individuals have several options to choose from. These interventions vary in their purpose, approach, design, cost, and targeted user group. While some research and digital interventions addressed equity-related considerations, more research and focused attention should be given to this area.

Informatics competencies for nurse leaders: protocol for a scoping review

INTRODUCTION

Globally, health information technologies are now being used by nurses in a variety of settings. However, nurse leaders often do not have the necessary strategic and tactical informatics competencies to adequately ensure their effective adoption and use. Although informatics competencies and competency frameworks have been identified and developed, to date there has not been review or consolidation of the work completed in this area. In order to address this gap, a scoping review is being conducted. The objectives of this scoping review are to: (1) identify informatics competencies of relevance to nurse leaders, (2) identify frameworks or theories that have been used to develop informatics competencies for nurse leaders, (3) identify instruments used to assess the informatics competencies of nurse leaders and (4) examine the psychometric properties of identified instruments.

METHODS

Using the Arksey and O'Malley five-step framework, a literature review will be conducted using a scoping review methodology. The search will encompass academic and grey literature and include two primary databases and five secondary databases. Identified studies and documents will be independently screened for eligibility by two reviewers. Data from the studies and documents will be extracted and compiled into a chart. Qualitative data will be subject to a thematic analysis and descriptive statistics applied to the quantitative data.

ETHICS AND DISSEMINATION

Ethical approval was not required for this study. Results will be used to inform a future study designed to validate an instrument used to evaluate informatics competencies for nurse leaders within a Canadian context.

Genetic determinants of tissue factor pathway inhibitor plasma levels

Tissue factor pathway inhibitor (TFPI) impedes early stages of the blood coagulation response, and low TFPI plasma levels increase the risk of thrombosis. TFPI plasma levels are heritable, but specific genetic determinants are unclear. We conducted a comprehensive review of genetic risk factors for TFPI plasma levels and identified 26 studies. We included 16 studies, as well as results from two unpublished genome-wide studies, in random effects meta-analyses of four commonly reported genetic variants in TFPI and its promoter (rs5940, rs7586970/rs8176592, rs10931292, and rs10153820) and 10 studies were summarised narratively. rs5940 was associated with all measures of TFPI (free, total, and activity), and rs7586970 was associated with total TFPI. Neither rs10931292 nor rs10153820 showed evidence of association. The narrative summary included 6 genes and genetic variants (P151L mutation in TFPI, PROS1, F5, APOE, GLA, and V617F mutation in JAK2) as well as a genome-wide linkage study, and suggested future research directions. A limitation of the systematic review was the heterogeneous measurement of TFPI. Nonetheless, our review found robust evidence that rs5940 and rs7586970 moderate TFPI plasma levels and are candidate risk factors for thrombosis, and that the regulation of TFPI plasma levels involves genetic factors beyond the TFPI gene.