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Senachai C, Upakdee N, Dhippayom T, Lueyam W, Dilokthornsakul P. Comparative Efficacy of Telepsychiatry Interventions for Depression in Low- and Middle-Income Countries: A Systematic Review and Network Meta-Analysis. Telemed J E Health 2025. [PMID: 40313204 DOI: 10.1089/tmj.2025.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2025] Open
Abstract
Background: Depression represents a major public health burden, especially in low- and middle-income countries (LMICs). Telepsychiatry provides a promising solution by offering remote mental health services, overcoming barriers such as limited resources, isolation, and cost. This study aimed to evaluate the comparative efficacy of different telepsychiatry interventions in LMICs by network meta-analysis of randomized controlled trials (RCTs). Methods: We searched PubMed, EMBASE, CENTRAL, CINAHL, PsycINFO, and ProQuest Dissertations & Theses from inception to May 2024 to identify all relevant studies. Telepsychiatry interventions were categorized as: (1) CBTAppGuided, a cognitive behavioral therapy (CBT) app with professional guidance; (2) CBTChatBot, a CBT app that uses a chatbot for guidance; (3) CBTApp, a CBT app without professional guidance; (4) Reminder; and (5) Consultation. Study quality was assessed according to the Effective Practice and Organization of Care guideline. Depression severity was calculated using summary standardized mean differences with 95% confidence intervals (CIs). Results: Seven RCTs were included with a total of 1,469 adults (mean age range: 16.0-35.64 years). Compared with face-to-face usual care, the most effective telepsychiatry intervention was CBTAppGuided [-23.04, 95% CI: -26.12 to -19.96], followed by CBTChatBot [-5.27, 95% CI: -6.25 to -4.29]. Other interventions, including CBTApp [-0.83, 95% CI: -1.32 to -0.34], Reminder [-0.44, 95% CI: -0.72 to -0.16], and Consultation [-0.27, 95% CI: -0.78 to 0.26], demonstrated smaller effects. CBTAppGuided, CBTChatBot, CBTApp, and Reminder achieved statistically significant improvement, whereas Consultation did not show statistically significant improvement and was not different from face-to-face treatment. Conclusion: Telepsychiatry interventions, particularly CBTAppGuided, show potential for reducing depression severity in LMICs, with promising outcomes for both guided and unguided app-based formats. Further research is needed to confirm their effectiveness in resource-limited settings.
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Affiliation(s)
- Chanittha Senachai
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Nilawan Upakdee
- Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Teerapon Dhippayom
- The Research Unit of Evidence Synthesis (TRUES), Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Worapong Lueyam
- Department of Pharmacy, Naresuan University Hospital, Phitsanulok, Thailand
| | - Piyameth Dilokthornsakul
- Center for Medical and Health Technology Assessment (CM-HTA), Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
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Viljoen M, Seris N, Shabalala N, Ndlovu M, de Vries PJ, Franz L. Adapting an early autism caregiver coaching intervention for telehealth delivery in low-resource settings: A South African study of the 'what' and the 'why'. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2025; 29:1246-1262. [PMID: 39655488 PMCID: PMC12038070 DOI: 10.1177/13623613241300774] [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] [Indexed: 04/30/2025]
Abstract
The COVID-19 pandemic required in-person interventions to be adapted for remote delivery all over the globe. In South Africa, an in-person cascaded task-sharing naturalistic developmental behavioural intervention was adapted for telehealth delivery in a low-resource context. Here we describe the adaptations made (the 'what') and reasons for adaptations (the 'why'). The Framework for Modification and Adaptations (FRAME) was used to document the 'what', and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to describe the 'why'. Systematic member-checking ensured robustness of results. The 'what' included 10 adaptations: selecting WhatsApp as delivery platform, developing images with simple text to communicate intervention concepts, modifying session structure for hybrid delivery, including a caregiver self-reflection checklist, utilizing online practitioner training, supervision, assessment and consent procedures, developing session recording procedures, distributing session materials electronically, and developing caregiver-child interaction recording and uploading protocols. The 'why' included three outer contextual factors (the digital divide, WhatsApp security/privacy policy, and COVID-19 restrictions), three inner contextual factors (characteristics of caregivers and practitioners, ethics board guidance, and school leadership and organizational characteristics) and one innovation factor (support from intervention co-developers). Adaptations were made in response to unchangeable outer contextual factors and through identification of malleable inner contextual factors.Lay abstractWe were busy with an early autism caregiver-coaching programme in South Africa, when COVID-19 stopped all in-person work. We changed the programme so it could be done using computers and/or phones. Here, we describe programme changes (which we call the 'what') and the reasons for those changes (which we call the 'why'). We used a tool called the Framework for Modification and Adaptations (FRAME) to describe the 'what', and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to describe the 'why' of our programme changes. The team members who helped make these changes checked that the changes described were correct. We made 10 changes in total: we used WhatsApp to deliver the programme, made simple pictures with words as visual tools for the programme, changed some session activities, changed a self-reflection checklist, provided all activities online, changed the way assessment and consent was done, made a session recording guide, sent things needed for sessions by email and WhatsApp, and made a caregiver-child play recording guide. The reasons for changes (the 'why') were about factors outside schools (the types of phones and data people had, WhatsApp security rules, COVID-19 rules), things inside schools/workplace (about the caregivers and nonspecialists themselves, ethics boards, things about the school itself), and support from people who developed the programme. Changes were made by working with things inside schools/workplace that could change. Identifying what could change helped focus and guide which changes were made to a programme.
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Affiliation(s)
- Marisa Viljoen
- Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
| | - Noleen Seris
- Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
| | - Nokuthula Shabalala
- Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
| | - Minkateko Ndlovu
- Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
| | - Lauren Franz
- Division of Child & Adolescent Psychiatry, University of Cape Town, South Africa
- Duke Center for Autism and Brain Development, Department of Psychiatry and Behavioral Sciences, Duke University, Durham, USA
- Duke Global Health Institute, Duke University, Durham, USA
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Muttiah N, Tönsing KM, Blackwell A, Bornman J, Armendariz K, Drager KDR. Speech-language therapists perspectives on tele-augmentative and alternative communication (tele-AAC) across three low-and middle-income countries. Augment Altern Commun 2025:1-12. [PMID: 40164138 DOI: 10.1080/07434618.2025.2476143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 01/30/2025] [Accepted: 02/17/2025] [Indexed: 04/02/2025] Open
Abstract
Most individuals with disabilities live in low-and middle-income countries (LMICs) where healthcare services such as speech-language therapy are limited. The challenge of accessing services was compounded by the COVID-19 global pandemic, leaving many people who use augmentative and alternative communication (AAC) vulnerable. The aim of this study was to investigate the nature of tele-AAC across three LMICs as described by speech-language therapists (SLTs). Although studies have been published about speech-language therapy services provided via telepractice, some specifically on AAC services, none of these have examined the impact of having to rapidly pivot to tele-AAC in LMICs. Semi-structured interviews were conducted with 15 SLTs from three LMICs to explore their experiences. SLTs shared the impact that tele-AAC had on their work, their experiences, benefits and challenges including broader challenges of service provision in LMIC contexts.
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Affiliation(s)
- Nimisha Muttiah
- Department of Disability Studies, The University of Kelaniya, Ragama, Sri Lanka
- Department of Communication Disorders and Sciences, State University of New York, Cortland, NY, USA
| | - Kerstin M Tönsing
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Amanda Blackwell
- Department of Communication Sciences and Disorders, Minot State University, Minot, ND, USA
| | - Juan Bornman
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
- Department of Health and Rehabilitation Sciences, Speech-Language and Hearing Therapy Division, Stellenbosch University, Stellenbosch, South Africa
| | - Karla Armendariz
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA, USA
| | - Kathryn D R Drager
- Department of Communication Sciences and Disorders, The Pennsylvania State University, University Park, PA, USA
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Mohtar L, Badr N, Asmar MK, Bou-Orm I, Maalouf FT, Haddad PE. Adoption of tele health technology in mental and psychiatric services in Lebanon: a quantitative study. DISCOVER MENTAL HEALTH 2025; 5:40. [PMID: 40111657 PMCID: PMC11925833 DOI: 10.1007/s44192-025-00169-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 03/11/2025] [Indexed: 03/22/2025]
Abstract
BACKGROUND The rapid adoption of telemedicine during the COVID-19 pandemic showcased its capacity to revolutionize healthcare by augmenting accessibility, decreasing expenses, and improving patient outcomes. This study evaluated Lebanon's preparedness for the implementation of tele-mental health, concentrating on identifying critical factors affecting its adoption by mental health experts. METHODS A self-administered questionnaire was created and disseminated through email to mental health practitioners in Lebanon. The study employed the Extended Technology Acceptance Model (TAM2) and utilized the Partial Least Squares- Structural Equation Modeling (PLS-SEM) to provide a quantitative analysis of the determinants influencing the adoption of tele-mental health in psychiatric services. RESULTS Among the 138 respondents including psychiatrists, psychologists, and mental health nurses, 20% indicated they had never utilized telehealth for mental health services, whereas 54% had employed telehealth prior to the COVID-19 shutdown and expressed a desire to persist with its use. Furthermore, 19% utilized telehealth throughout the lockdown and continued its application, while 8% ceased its usage after the lockdown. The research revealed five primary factors affecting tele-mental health adoption: perceived usefulness, perceived ease of use, perceived risk, subjective norms, and job relevance. CONCLUSION This study highlights the significance of perceived usefulness, ease of use, perceived risk, subjective norm, and job relevance as essential factors influencing the uptake of tele-mental health services. Policymakers, healthcare administrators, and technology developers must concentrate on these criteria to optimize the introduction and sustainability of tele-mental health services in clinical practice, thereby ensuring enhanced mental health care delivery in Lebanon.
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Affiliation(s)
- Layal Mohtar
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Damascus RoadRiad El Solh Beirut, PO Box 11-5076, Beirut, 11072180, Lebanon.
| | - Nabil Badr
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Damascus RoadRiad El Solh Beirut, PO Box 11-5076, Beirut, 11072180, Lebanon
| | - Michèle Kosremelli Asmar
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Damascus RoadRiad El Solh Beirut, PO Box 11-5076, Beirut, 11072180, Lebanon
| | - Ibrahim Bou-Orm
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Damascus RoadRiad El Solh Beirut, PO Box 11-5076, Beirut, 11072180, Lebanon
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Fadi T Maalouf
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Pierre El Haddad
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Damascus RoadRiad El Solh Beirut, PO Box 11-5076, Beirut, 11072180, Lebanon
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Chakrabarti S. Digital psychiatry in low-and-middle-income countries: New developments and the way forward. World J Psychiatry 2024; 14:350-361. [PMID: 38617977 PMCID: PMC11008387 DOI: 10.5498/wjp.v14.i3.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 01/28/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Low- and middle-income countries (LMICs) bear the greater share of the global mental health burden but are ill-equipped to deal with it because of severe resource constraints leading to a large treatment gap. The remote provision of mental health services by digital means can effectively augment conventional services in LMICs to reduce the treatment gap. Digital psychiatry in LMICs has always lagged behind high-income countries, but there have been encouraging developments in the last decade. There is increasing research on the efficacy of digital psychiatric interventions. However, the evidence is not adequate to conclude that digital psychiatric interventions are invariably effective in LMICs. A striking development has been the rise in mobile and smartphone ownership in LMICs, which has driven the increasing use of mobile technologies to deliver mental health services. An innovative use of mobile technologies has been to optimize task-shifting, which involves delivering mental healthcare services in community settings using non-specialist health professionals. Emerging evidence from LMICs shows that it is possible to use digital tools to train non-specialist workers effectively and ensure that the psychosocial interventions they deliver are efficacious. Despite these promising developments, many barriers such as service costs, underdeveloped infrastructure, lack of trained professionals, and significant disparities in access to digital services impede the progress of digital psychiatry in LMICs. To overcome these barriers, digital psychiatric services in LMICs should address contextual factors influencing the delivery of digital services, ensure collaboration between different stakeholders, and focus on reducing the digital divide.
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Affiliation(s)
- Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, UT, India
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Koly KN, Saba J, Rao M, Rasheed S, Reidpath DD, Armstrong S, Gnani S. Stakeholder perspectives of mental healthcare services in Bangladesh, its challenges and opportunities: a qualitative study. Glob Ment Health (Camb) 2024; 11:e37. [PMID: 38572252 PMCID: PMC10988148 DOI: 10.1017/gmh.2024.30] [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: 09/17/2023] [Revised: 01/20/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024] Open
Abstract
This study explores Bangladesh's mental health services from an individual- and system-level perspective and provides insights and recommendations for strengthening it's mental health system. We conducted 13 in-depth interviews and 2 focus group discussions. Thirty-one participants were recruited using a combination of purposive and snowball sampling methods. All interviews and group discussions were audio-recorded and transcribed, and key findings were translated from Bengali to English. Data were coded manually and analysed using a thematic and narrative analysis approach. Stakeholders perceived scarcity of service availability at the peripheral level, shortage of professionals, weak referral systems, lack of policy implementation and regulatory mechanisms were significant challenges to the mental health system in Bangladesh. At the population level, low levels of mental health literacy, high societal stigma, and treatment costs were barriers to accessing mental healthcare. Key recommendations included increasing the number of mental health workers and capacity building, strengthening regulatory mechanisms to enhance the quality of care within the health systems, and raising awareness about mental health. Introducing measures that relate to tackling stigma, mental health literacy as well as building the capacity of the health workforce and governance systems will help ensure universal mental health coverage.
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Affiliation(s)
- Kamrun Nahar Koly
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jobaida Saba
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mala Rao
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Sabrina Rasheed
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Daniel D. Reidpath
- Health System & Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Stephanie Armstrong
- School of Health and Social Care, College of Health and Science, University of Lincoln, Lincoln, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
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Iliyasu Z, Garba RM, Bashir HA, Saleh NS, Jibo AM, Amole TG, Umar AA, Tsiga-Ahmed FI, Abdullahi HM, Kwaku AA, Salihu HM, Aliyu MH. Telemedicine Service Adoption During the COVID-19 Pandemic: Physicians' Experience from Nigeria. Telemed J E Health 2024; 30:805-815. [PMID: 37651192 DOI: 10.1089/tmj.2023.0262] [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] [Indexed: 09/02/2023] Open
Abstract
Introduction: Telemedicine practice experiences during the COVID-19 pandemic have not been well documented in resource-constrained settings, such as Nigeria. We set out to assess knowledge, attitude, and factors associated with telemedicine practice during the COVID-19 lockdown, as well as physician experiences in Kano, Nigeria. Methods: We employed a mixed-methods approach, utilizing structured questionnaires administered to 246 physicians, followed by in-depth interviews with a purposive subsample of 20 individuals. The data were analyzed using logistic regression and the framework approach. Results: Overall, 65.0% of the respondents demonstrated moderate to good knowledge of telemedicine. Before COVID, only 47.6% (n = 117) reported practicing telemedicine, compared with 77.2% (n = 190) during the COVID lockdown (p < 0.05). Factors associated with telemedicine practice included having at least 5 years of work experience, working in pediatrics, undergoing senior residency training, receiving formal telemedicine training, possessing good knowledge of telemedicine, and having a positive attitude toward it. The odds of engaging in telemedicine practice were four times higher (adjusted odds ratio = 4.10, 95% confidence interval: 1.79-9.40) for those who practiced it before the pandemic. Challenges identified included knowledge and skill gaps, slow internet connectivity, unstable electricity, and inadequate equipment. Conclusion: To enhance telemedicine practice in resource-limited settings, it is important to focus on strengthening information and communication infrastructure, providing comprehensive clinician training, implementing careful patient selection processes, and improving practice guidelines.
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Affiliation(s)
- Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Rayyan M Garba
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Humayra A Bashir
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | - Nabila S Saleh
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Abubakar M Jibo
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Taiwo G Amole
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | - Amina A Umar
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | | | - Aminatu A Kwaku
- Department of Community Medicine, Bayero University, Kano, Nigeria
| | | | - Muktar H Aliyu
- Department of Health Policy, Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Khalid OB, Qazi M, Khattak AF, Khattak M, Wazir MNK, Gilani H. COVID-19 Pandemic Lessons for Creating Effective Mental Health Safety Nets in Lower Middle-Income Countries. Cureus 2023; 15:e45980. [PMID: 37900459 PMCID: PMC10600952 DOI: 10.7759/cureus.45980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to mental health globally, particularly in low- and middle-income countries (LMICs) such as Pakistan. This narrative review aims to synthesize the literature on the impact of the pandemic on mental health in LMICs, the challenges and opportunities for mental health system reform, and the role of safety nets in promoting mental health. A comprehensive search was conducted in several electronic databases, resulting in 35 articles being included for review. Data were extracted and analyzed to identify key themes and trends. The COVID-19 pandemic has led to a significant increase in the prevalence of mental health problems in LMICs, particularly anxiety and depression. This burden is disproportionately borne by vulnerable populations, including women, front-line workers, and those living in poverty. The pandemic has highlighted pre-existing weaknesses in mental health systems in LMICs, including inadequate funding, lack of trained mental health professionals, and stigmatization of mental illness. However, it has also presented opportunities for reform, such as increased awareness and political will, and the use of technology to expand access to mental health services. Building effective safety nets, including social protection programs and community-based interventions, can promote mental health and address social determinants of mental illness. The COVID-19 pandemic has underscored the urgent need for mental health system reform and the development of effective safety nets in LMICs. Policymakers should prioritize investment in mental health and address the social determinants of mental illness to build more resilient societies.
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Affiliation(s)
- Osama Bin Khalid
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
| | - Mustafa Qazi
- Medicine and Surgery, Northwest School of Medicine, Peshawar, PAK
- Medicine and Surgery, Northwest General Hospital and Research Center, Peshawar, PAK
| | - Almas F Khattak
- Community Medicine and Research, Northwest School of Medicine, Peshawar, PAK
| | | | | | - Humaira Gilani
- Dermatology, Northwest General Hospital and Research Center, Peshawar, PAK
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Adem JB, Zeleke T, Walle AD, Atinafu WT, Tilahun KN, Melaku MS, Kebede SD. Awareness and readiness of mental healthcare providers to implement telemental health services and associated factors at public referral hospitals in Addis Ababa City, Ethiopia. BMJ Open 2023; 13:e069671. [PMID: 37524552 PMCID: PMC10391830 DOI: 10.1136/bmjopen-2022-069671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE To assess the awareness and readiness of mental healthcare providers to implement telemental health services and the associated factors at public referral hospitals in Addis Ababa City, Ethiopia. STUDY DESIGN A cross-sectional study was conducted among mental health professionals working at public referral hospitals in Addis Ababa City from 4 May to 10 June 2022. PARTICIPANTS A total of 413 (55.7% male and 44.3% female) health professionals participated in the study. The study participants were selected using a simple random sampling technique. All mental healthcare providers working at public referral hospitals in Addis Ababa City were considered as the source population. Mental healthcare providers who meet the inclusion criteria were considered the study population. Having a minimum diploma qualification and 6 months or more of work experience and giving written consent were considered the inclusion criteria. OUTCOME MEASURE The main outcome measure was awareness and readiness to implement telemental health services. RESULT A total of 413 participants were enrolled, with a response rate of 90.6%. The prevalence of good awareness towards telemental health services was 41% (95% CI 37%, 47%). Being female (adjusted OR (AOR)=0.34; 95% CI 0.15, 0.76), having poor information technology support (AOR=0.32; 95% CI 0.11, 0.99) and having electronic health technology experience (AOR=1.21; 95% CI 1.1, 2.44) were significantly associated with awareness of telemental health services, whereas computer access at the workplace (AOR=0.04; 95% CI 0.003, 0.55) and awareness (AOR=4.34; 95% CI 1.02, 18.48) and attitude (AOR=1.01; 95% CI 1.03, 2.19) towards telemental health services were the variables that showed statistically significant association with readiness of mental healthcare providers for telemental health services. CONCLUSION Although majority of healthcare providers in this survey were prepared to implement telemental health services, there was typically little awareness among mental healthcare providers.
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Affiliation(s)
| | - Tirualem Zeleke
- Department of Health Informatics, University of Gondar, Gondar, Ethiopia
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Åhs JW, Ranheim A, Eriksson H, Mazaheri M. Encountering suffering in digital care: a qualitative study of providers' experiences in telemental health care. BMC Health Serv Res 2023; 23:418. [PMID: 37127655 PMCID: PMC10150682 DOI: 10.1186/s12913-023-09367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/04/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Encountering patients who are suffering is common in health care, and particularly when providing mental health care. Telehealth technologies are increasingly used to provide mental health care, yet little is known about the experiences of providers when encountering patients who are suffering within remote care. The present study explored health care providers' lived experiences of encountering patient suffering during telemental health care. METHODS A qualitative phenomenological approach was used to uncover participants' experiences. In-depth interviews were conducted with a purposive sample of physicians, psychologists, and therapists who used telemental health in varied clinical practices in Sweden. Data were analyzed using descriptive phenomenology. RESULTS Telehealth care with patients who were suffering was experienced by providers as loose connections, both literally in compromised functioning of the technology and figuratively in a compromised ability connecting emotionally with patients. Providers' lived experiences were explicated into the following aspects: insecurity in digital practice, inaccessibility of the armamentarium, and conviction in the value of telehealth care. Interpersonal connection between patient and provider is necessary. Worry and guilt arose for providers with fears that technology would not work, patient status was deteriorated, or the care needed could not be delivered. Providers overcame barriers in telehealth encounters, and expressed they perceived that patients appreciated the care received, and through it found relief. CONCLUSIONS This study brings an understanding of experiences in providing telemental care for patients who are suffering. Providers experience challenges in connecting with patients, and in accessing tools needed to enable reaching the goals of the caring encounter. Efforts to ensure functioning of technology, comfort with its use, and accessibility of tools might be some accommodations to support providers for successful and rewarding telehealth care encounters.
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Affiliation(s)
- Jill W Åhs
- Department of Health Sciences, Swedish Red Cross University, P.O. Box 1059, Huddinge, 141 21, Sweden.
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden.
| | - Albertine Ranheim
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden
| | - Henrik Eriksson
- Section for Health Promotion and Care Sciences, University West, Trollhättan, Sweden
| | - Monir Mazaheri
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institute, Huddinge, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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Bertram JE, Kryah R, Vandermause R, Ean N, Paul R, Carrico A, Sophal C, Bruce S, Gregory K, Stein E, Mannarino J. "No matter what, we just work with the trauma…": Mental Health Therapists' Care of Diverse Sexual and Gender Identity Citizens in Cambodia. RESEARCH SQUARE 2023:rs.3.rs-2584144. [PMID: 36865179 PMCID: PMC9980277 DOI: 10.21203/rs.3.rs-2584144/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
The convergence of trauma symptomatology, mental health symptoms, family and social difficulties, and intersectionality of diverse sexual and gender minority (SGM) individual issues is complex, multi-faceted, and challenging for the individuals in Cambodia who suffer them and for the therapists in Cambodia who meet individuals in treatment. We documented and analyzed the perspectives of mental health therapists in the context of a randomized control trial (RCT) intervention within the Mekong Project in Cambodia. The research questions explored perceptions of therapists' care of mental health clients, therapist wellbeing, and experiences of navigating within a research environment in which SGM citizens with mental health concerns receive treatment. The larger study enrolled 150 Cambodian adults, among which 69 identified as SGM. Three key patterns emerged across our interpretations. Clients seek help when symptoms interfere with daily life, therapists care for clients and themselves, and integrated research and practice is integral yet sometimes paradoxical. Therapists did not identify differences in terms of how they work with SGM clients compared with non-SGM clients. Future studies are warranted to examine a reciprocal academic-research partnership in which we examine therapists' work alongside rural community members, evaluate the process of embedding and fortifying peer supports within educational systems, and study the wisdom of traditional and Buddhist healers to address the discrimination and violence that citizens who identify as SGM disproportionately suffer. National Library of Medicine (U.S.). (2020). Trauma Informed Treatment Algorithms for Novel Outcomes (TITAN). Identifier NCT04304378.
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Kathiravan S, Chakrabarti S. Development of a protocol for videoconferencing-based exposure and response prevention treatment of obsessive-compulsive disorder during the COVID-19 pandemic. World J Psychiatry 2023; 13:60-74. [PMID: 36925949 PMCID: PMC10011942 DOI: 10.5498/wjp.v13.i2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND The existing literature indicates that psychotherapeutic treatment, especially exposure and response prevention (ERP) is efficacious in treating obsessive-compulsive disorder (OCD). The coronavirus disease 2019 pandemic adversely impacted many patients with OCD and disrupted their usual treatment. Moreover, the pandemic forced a global switch to telemental health (TMH) services to maintain the standards and continuity of care. Consequently, clinicians are increasingly using TMH-based psychotherapeutic treatments to treat OCD. However, several challenges have made it difficult for them to implement these treatments in the changed circumstances imposed by the pandemic. AIM To describe the formulation, implementation, feasibility, and usefulness of videoconferencing-based ERP (VC-ERP) treatment for OCD during the coronavirus disease 2019 pandemic. METHODS This prospective, observational study was conducted in the psychiatric unit of a multi-specialty hospital in north India over 12 mo (July 2020-June 2021). All patients with OCD were assessed using the home-based TMH services of the department. The VC-ERP protocol for OCD was the outcome of weekly Zoom meetings with a group of clinicians involved in administering the treatment. After a systematic evaluation of the available treatment options, an initial protocol for delivering VC-ERP was developed. Guidelines for clinicians and educational materials for patients and their families were prepared. The protocol was implemented among patients with OCD attending the TMH services, and their progress was monitored. The weekly meetings were used to upgrade the protocol to meet the needs of all stakeholders. Feasibility and efficacy outcomes were examined. RESULTS All patients were diagnosed with OCD as a primary or a comorbid condition according to the International Classification of Diseases, 10th version criteria. Out of 115 patients who attended the services during the study period, 37 were excluded from the final analysis. Of the remaining 78 patients, VC-ERP was initiated in 43 patients. Six patients dropped out, and three were hospitalized for inpatient ERP. Eleven patients have completed the full VC-ERP treatment. One patient completed the psychoeducation part of the protocol. VC-ERP is ongoing in 22 patients. The protocol for VC-ERP treatment was developed and upgraded online. A large proportion of the eligible patients (n = 34/43; 79%) actively engaged in the VC-ERP treatment. Drop-out rates were low (n = 6/43; 14%). Satisfaction with the treatment was adequate among patients, caregivers, and clinicians. Apart from hospitalization in 3 patients, there were no other adverse events. Hybrid care and stepped care approaches could be incorporated into the VC-ERP protocol. Therefore, the feasibility of VC-ERP treatment in terms of operational viability, service utilization, service engagement, need for additional in-person services, frequency of adverse events, and user satisfaction was adequate. The VC-ERP treatment was found to be efficacious in the 11 patients who had completed the full treatment. Significant reductions in symptoms and maintenance of treatment gains on follow-up were observed. CONCLUSION This study provided preliminary evidence for the feasibility and usefulness of VC-ERP in the treatment of OCD. The results suggest that VC-ERP can be a useful option in resource-constrained settings.
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Affiliation(s)
- Sanjana Kathiravan
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
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Leung T, Ranheim A, Mattelin E, Eriksson H, Mazaheri M. Distance in Distant Care: Qualitative Content Analysis of Providers' Experiences in Tele-Mental Care. J Med Internet Res 2023; 25:e38568. [PMID: 36800225 PMCID: PMC9984997 DOI: 10.2196/38568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 12/21/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
| | - Albertine Ranheim
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Huddinge, Sweden
| | - Erica Mattelin
- Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Barnafrid, Swedish National Center on Violence Against Children, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Henrik Eriksson
- Section for Health Promotion and Care Sciences, University West, Trollhättan, Sweden
| | - Monir Mazaheri
- Division of Nursing, Department of Neurobiology, Care Sciences, and Society, Karolinska Institute, Huddinge, Sweden.,Department of Nursing Sciences, Sophiahemmet University, Stockholm, Sweden
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Kapadia SV. Adapting AVATAR Therapy: Using Available Digital Technology for People Living with Auditory Verbal Hallucinations in Low- and Middle-Income Countries. Indian J Psychol Med 2022; 44:405-408. [PMID: 35949640 PMCID: PMC9301740 DOI: 10.1177/02537176221090106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Daly K, Isdell E, Moynihan L, O'Callaghan K, O'Leary S, Pepper A, Pennisi Y. An exploration of service users’ experience of telehealth occupational therapy interventions in adult mental health services, Ireland, during COVID-19. IRISH JOURNAL OF OCCUPATIONAL THERAPY 2022. [DOI: 10.1108/ijot-02-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The COVID-19 pandemic transformed the delivery of occupational therapy (OT) community mental health services nationally, resulting in the rapid expansion and delivery of services through telehealth. While telehealth technology and its use are not new, widespread adoption was precipitated by the cessation of face-to-face services due to the COVID-19 pandemic. Research in this field has been conducted previously; however, it is not specific to OT in the Irish context. This study aims to explore service users’ experience of telehealth OT interventions in adult mental health services during the COVID-19 pandemic.
Design/methodology/approach
A descriptive qualitative approach was used to explore service users’ experience of mental health telehealth OT services. Five service users were recruited to participate in a focus group to explore their experience of OT via telehealth. The themes identified from this focus group were then further explored via individual interviews. Four of the service users who participated in the focus group chose to complete in-depth interviews. Reflexive thematic analysis was then completed.
Findings
Two key themes emerged from the data. The theme of positive telehealth experiences included subthemes of gratitude for the option of telehealth and accessibility. The second theme of learning from experience, included subthemes of human connection, preferred platforms of telehealth methods and future considerations for telehealth interventions.
Originality/value
These findings provide a unique insight into the importance of continuing OT services via telehealth, from the service users’ perspective.
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Figge CJ, Kane JC, Skavenski S, Haroz E, Mwenge M, Mulemba S, Aldridge LR, Vinikoor MJ, Sharma A, Inoue S, Paul R, Simenda F, Metz K, Bolton C, Kemp C, Bosomprah S, Sikazwe I, Murray LK. Comparative effectiveness of in-person vs. remote delivery of the Common Elements Treatment Approach for addressing mental and behavioral health problems among adolescents and young adults in Zambia: protocol of a three-arm randomized controlled trial. Trials 2022; 23:417. [PMID: 35590348 PMCID: PMC9117594 DOI: 10.1186/s13063-022-06319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/19/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND In low- and middle-income countries (LMIC), there is a substantial gap in the treatment of mental and behavioral health problems, which is particularly detrimental to adolescents and young adults (AYA). The Common Elements Treatment Approach (CETA) is an evidence-based, flexible, transdiagnostic intervention delivered by lay counselors to address comorbid mental and behavioral health conditions, though its effectiveness has not yet been tested among AYA. This paper describes the protocol for a randomized controlled trial that will test the effectiveness of traditional in-person delivered CETA and a telehealth-adapted version of CETA (T-CETA) in reducing mental and behavioral health problems among AYA in Zambia. Non-inferiority of T-CETA will also be assessed. METHODS This study is a hybrid type 1 three-arm randomized trial to be conducted in Lusaka, Zambia. Following an apprenticeship model, experienced non-professional counselors in Zambia will be trained as CETA trainers using a remote, technology-delivered training method. The new CETA trainers will subsequently facilitate technology-delivered trainings for a new cohort of counselors recruited from community-based partner organizations throughout Lusaka. AYA with mental and behavioral health problems seeking services at these same organizations will then be identified and randomized to (1) in-person CETA delivery, (2) telehealth-delivered CETA (T-CETA), or (3) treatment as usual (TAU). In the superiority design, CETA and T-CETA will be compared to TAU, and using a non-inferiority design, T-CETA will be compared to CETA, which is already evidence-based in other populations. At baseline, post-treatment (approximately 3-4 months post-baseline), and 6 months post-treatment (approximately 9 months post-baseline), we will assess the primary outcomes such as client trauma symptoms, internalizing symptoms, and externalizing behaviors and secondary outcomes such as client substance use, aggression, violence, and health utility. CETA trainer and counselor competency and cost-effectiveness will also be measured as secondary outcomes. Mixed methods interviews will be conducted with trainers, counselors, and AYA participants to explore the feasibility, acceptability, and sustainability of technology-delivered training and T-CETA provision in the Zambian context. DISCUSSION Adolescents and young adults in LMIC are a priority population for the treatment of mental and behavioral health problems. Technology-delivered approaches to training and intervention delivery can expand the reach of evidence-based interventions. If found effective, CETA and T-CETA would help address a major barrier to the scale-up and sustainability of mental and behavioral treatments among AYA in LMIC. TRIAL REGISTRATION ClinicalTrials.gov NCT03458039 . Prospectively registered on May 10, 2021.
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Affiliation(s)
- Caleb J. Figge
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Jeremy C. Kane
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York City, NY 10032 USA
| | - Stephanie Skavenski
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Emily Haroz
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Mwamba Mwenge
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
| | - Saphira Mulemba
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
| | - Luke R. Aldridge
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Michael J. Vinikoor
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, Birmingham, AL 35294 USA
- Department of Medicine, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Anjali Sharma
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
| | - Sachi Inoue
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 655 Huntington Ave, Boston, MA 02115 USA
| | - Ravi Paul
- Department of Psychiatry, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Francis Simenda
- Ministry of Health Zambia, Haille Selassie Avenue, Ndeke House, P.O. Box 30205, Lusaka, Zambia
| | - Kristina Metz
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Carolyn Bolton
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
| | - Christopher Kemp
- Department of Global Health, Hans Rosling Center, University of Washington School of Public Health, 3980 15th Ave. NE, Seattle, WA 98105 USA
| | - Samuel Bosomprah
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
| | - Izukanji Sikazwe
- The Centre for Infectious Disease Research (CIDRZ) Zambia, Plot 34620, Lusaka, Zambia
| | - Laura K. Murray
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
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Ibragimov K, Palma M, Keane G, Ousley J, Crowe M, Carreño C, Casas G, Mills C, Llosa A. Shifting to Tele-Mental Health in humanitarian and crisis settings: an evaluation of Médecins Sans Frontières experience during the COVID-19 pandemic. Confl Health 2022; 16:6. [PMID: 35164807 PMCID: PMC8845383 DOI: 10.1186/s13031-022-00437-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/01/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND 'Tele-Mental Health (MH) services,' are an increasingly important way to expand care to underserved groups in low-resource settings. In order to continue providing psychiatric, psychotherapeutic and counselling care during COVID-19-related movement restrictions, Médecins Sans Frontières (MSF), a humanitarian medical organization, abruptly transitioned part of its MH activities across humanitarian and resource-constrained settings to remote format. METHODS From June-July of 2020, investigators used a mixed method, sequential explanatory study design to assess MSF staff perceptions of tele-MH services. Preliminary quantitative results influenced qualitative question guide design. Eighty-one quantitative online questionnaires were collected and a subset of 13 qualitative follow-up in-depth interviews occurred. RESULTS Respondents in 44 countries (6 geographic regions), mostly from Sub-Saharan Africa (39.5%), the Middle East and North Africa (18.5%) and Asia (13.6%) participated. Most tele-MH interventions depended on audio-only platforms (80%). 30% of respondents reported that more than half of their patients were unreachable using these interventions, usually because of poor network coverage (73.8%), a lack of communication devices (72.1%), or a lack of a private space at home (67.2%). Nearly half (47.5%) of respondents felt their staff had a decreased ability to provide comprehensive MH care using telecommunication platforms. Most respondents thought MH staff had a negative (46%) or mixed (42%) impression of remote care. Nevertheless, almost all respondents (96.7%) thought tele-MH services had some degree of usefulness, notably improved access to care (37.7%) and time efficiency (32.8%). Qualitative results outlined a myriad of challenges, notably in establishing therapeutic alliance, providing care for vulnerable populations and those inherent to the communications infrastructure. CONCLUSION Tele-MH services were perceived to be a feasible alternative solution to in-person therapeutic interventions in humanitarian settings during the COVID-19 pandemic. However, they were not considered suitable for all patients in the contexts studied, especially survivors of sexual or interpersonal violence, pediatric and geriatric cases, and patients with severe MH conditions. Audio-only technologies that lacked non-verbal cues were particularly challenging and made risk assessment and emergency care more difficult. Prior to considering tele-MH services, communications infrastructure should be assessed, and comprehensive, context-specific protocols should be developed.
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Affiliation(s)
| | - Miguel Palma
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France.
| | - Gregory Keane
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | - Janet Ousley
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
| | | | | | - German Casas
- Fundación Santa Fe University Hospital, Universidad de Los Andes, Bogotá, Colombia
| | - Clair Mills
- Médecins Sans Frontières, 34 Avenue Jean Jaurès, 75019, Paris, France
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Garg A, Agrawal R, Velleman R, Rane A, Costa S, Gupta D, Dsouza E, Jambhale A, Sabnis A, Fernandes G, Bhatia U, Nadkarni A. Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study. Glob Ment Health (Camb) 2022; 9:26-36. [PMID: 36618733 PMCID: PMC9806979 DOI: 10.1017/gmh.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 11/13/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
Background Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. Methods Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. Results The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92-39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61-25.57, p = 0.008)]. Conclusion Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings.
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Affiliation(s)
| | - Ravindra Agrawal
- Sangath, Porvorim, Goa, India
- Antarman Centre for Psychosocial Wellbeing, Panjim, Goa, India
- Manipal Hospital, Panaji, Goa, India
| | | | - Anil Rane
- Institute of Psychiatry & Human Behaviour, Bambolim, Goa, India
| | - Sheina Costa
- Sangath, Porvorim, Goa, India
- Manovikas English Medium School, Margao, Goa, India
| | - Devika Gupta
- Sangath, Porvorim, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
| | | | | | - Akshada Sabnis
- Institute of Psychiatry & Human Behaviour, Bambolim, Goa, India
| | | | - Urvita Bhatia
- Sangath, Porvorim, Goa, India
- Department of Psychology, Health and Professional Development, Oxford Brookes University, Headington Rd, Headington, Oxford OX3 0BP, UK
| | - Abhijit Nadkarni
- Sangath, Porvorim, Goa, India
- Department of Population Health, London School of Hygiene & Tropical Medicine, Centre for Global Mental Health, London, UK
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A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya. AIDS Behav 2022; 26:232-242. [PMID: 34292429 PMCID: PMC8295454 DOI: 10.1007/s10461-021-03376-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/13/2022]
Abstract
Mobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.
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Abraham A, Jithesh A, Doraiswamy S, Al-Khawaga N, Mamtani R, Cheema S. Telemental Health Use in the COVID-19 Pandemic: A Scoping Review and Evidence Gap Mapping. Front Psychiatry 2021; 12:748069. [PMID: 34819885 PMCID: PMC8606591 DOI: 10.3389/fpsyt.2021.748069] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/15/2021] [Indexed: 01/07/2023] Open
Abstract
Background: The COVID-19 pandemic has highlighted telemedicine use for mental illness (telemental health). Objective: In the scoping review, we describe the scope and domains of telemental health during the COVID-19 pandemic from the published literature and discuss associated challenges. Methods: PubMed, EMBASE, and the World Health Organization's Global COVID-19 Database were searched up to August 23, 2020 with no restrictions on study design, language, or geographical, following an a priori protocol (https://osf.io/4dxms/). Data were synthesized using descriptive statistics from the peer-reviewed literature and the National Quality Forum's (NQF) framework for telemental health. Sentiment analysis was also used to gauge patient and healthcare provider opinion toward telemental health. Results: After screening, we identified 196 articles, predominantly from high-income countries (36.22%). Most articles were classified as commentaries (51.53%) and discussed telemental health from a management standpoint (86.22%). Conditions commonly treated with telemental health were depression, anxiety, and eating disorders. Where data were available, most articles described telemental health in a home-based setting (use of telemental health at home by patients). Overall sentiment was neutral-to-positive for the individual domains of the NQF framework. Conclusions: Our findings suggest that there was a marked growth in the uptake of telemental health during the pandemic and that telemental health is effective, safe, and will remain in use for the foreseeable future. However, more needs to be done to better understand these findings. Greater investment into human and financial resources, and research should be made by governments, global funding agencies, academia, and other stakeholders, especially in low- and middle- income countries. Uniform guidelines for licensing and credentialing, payment and insurance, and standards of care need to be developed to ensure safe and optimal telemental health delivery. Telemental health education should be incorporated into health professions curricula globally. With rapidly advancing technology and increasing acceptance of interactive online platforms amongst patients and healthcare providers, telemental health can provide sustainable mental healthcare across patient populations. Systematic Review Registration: https://osf.io/4dxms/.
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Affiliation(s)
- Amit Abraham
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Anupama Jithesh
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | | | | | - Ravinder Mamtani
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
| | - Sohaila Cheema
- Institute for Population Health, Weill Cornell Medicine-Qatar, Ar-Rayyan, Qatar
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Levey EJ, Onyeaka H, Bartles SM, Sanchez Calderon E, Sanchez SE, Prom MC, Fesseha EM, Gelaye B. Mobile Technology Access and Use Among Adolescent Mothers in Lima, Peru: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e30240. [PMID: 34533473 PMCID: PMC8486997 DOI: 10.2196/30240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research shows promise for the use of mobile health interventions to improve access to care for mothers and infants. Although adolescent mothers in particular are comfortable with technology and often face barriers to accessing care, data on the use of digital interventions with young mothers are limited. OBJECTIVE This study aims to examine technology access and use behavior among adolescent mothers in Lima, Peru, to inform the development of technology-mediated perinatal interventions for high-risk mothers and infants in low- and middle-income countries and other areas with limited access to care. METHODS This mixed methods study consisted of a phone survey about technology access (N=29), focus group discussions with clinicians (N=25), and semistructured in-depth interviews with adolescent mothers (N=10) and their family members (N=8) in Lima. RESULTS All adolescent mothers surveyed had access to a smartphone, and nearly half had access to a computer or tablet. However, participants reported a number of obstacles to consistent smartphone access related to the financial precarity of their situations. Examples of this included difficulty affording phone services, using shared plans, and losing smartphones because of theft. CONCLUSIONS These findings indicate that adolescent mothers are connected to technology, highlighting the potential scalability of technology-based health interventions for adolescent mothers in low- and middle-income countries while identifying barriers that need to be addressed.
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Affiliation(s)
- Elizabeth J Levey
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Henry Onyeaka
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Sophia M Bartles
- Gilling School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
| | | | - Sixto E Sanchez
- AC PROESA, Lima, Peru
- Instituto de Investigaciòn, Facultad de Medicina Humana, Universidad de San Martìn de Porres, Lima, Peru
| | - Maria C Prom
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | | | - Bizu Gelaye
- Chester M. Pierce Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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Myers B, van der Westhuizen C, Pool M, Hornsby N, Sorsdahl KR. Responding to COVID-19 threats to trial conduct: lessons learned from a feasibility trial of a psychological intervention for South African adolescents. Trials 2021; 22:440. [PMID: 34243806 PMCID: PMC8267766 DOI: 10.1186/s13063-021-05400-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/21/2021] [Indexed: 02/08/2023] Open
Abstract
The COVID-19 pandemic has posed challenges to the conduct of clinical trials. Strategies for overcoming common challenges to non-COVID-19 trial continuation have been reported, but this literature is limited to pharmacological intervention trials from high-income settings. The purpose of this paper is to expand the literature to include a low- and middle-income country perspective. We describe the challenges posed by COVID-19 for a randomised feasibility trial of a psychological intervention for adolescents in Cape Town, South Africa, and lessons learned when implementing strategies to facilitate trial continuation in this context. We used a Plan-Do-Study-Act cycle method to explore whether our adaptations were having the desired effect on trial accrual and retention. We found that stakeholder engagement, trial coordination and team communication need to be intensified while testing these procedural changes. We learned that strategies found to be effective in high-income countries required significant adaptation to our resource-constrained setting. The detailed documentation of extraneous influences, procedural changes and trial process information was essential to guiding decisions about which adaptations to retain. This information will be used to examine the potential impact of these changes on study outcomes. We hope that these reflections will be helpful to other trialists from low- and middle-income countries grappling with how to minimise the impact of public health emergencies on their research. TRIAL REGISTRATION: The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795 .
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Affiliation(s)
- Bronwyn Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa. .,Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia. .,Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Claire van der Westhuizen
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Megan Pool
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Nancy Hornsby
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg, 7505, South Africa
| | - Katherine R Sorsdahl
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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23
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Winders WT, Garbern SC, Bills CB, Relan P, Schultz ML, Trehan I, Kivlehan SM, Becker TK, McQuillan R. The effects of mobile health on emergency care in low- and middle-income countries: A systematic review and narrative synthesis. J Glob Health 2021; 11:04023. [PMID: 33828846 PMCID: PMC8021077 DOI: 10.7189/jogh.11.04023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In resource-constrained settings, mobile health (mHealth) has varied applications. While there is strong evidence for its use in chronic disease management, the applications of mHealth for management of acute illness in low- and middle-income countries (LMICs) are not as well described. This review systematically explores current available evidence on the effectiveness of mHealth interventions at improving health outcomes in emergency care settings in LMICs. METHODS A systematic search of the literature was performed in accordance with PRISMA guidelines, utilizing seven electronic databases and manual searches to identify peer-reviewed literature containing each of three search elements: mHealth, emergency care (EC), and LMICs. Articles quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS After removing duplicates, 6498 studies met initial search criteria; 108 were eligible for full text review and 46 met criteria for inclusion. Thirty-six pertained to routine emergency care, and 10 involved complex humanitarian emergencies. Based on the GRADE criteria, 15 studies were rated as "Very Low" quality, 24 as "Low" quality, 6 as "Moderate" quality, and 1 as "High" quality. Eight studied data collection, 9 studied decision support, 15 studied direct patient care, and 14 studied health training. All 46 studies reported positive impacts of mHealth on EC in LMICs. CONCLUSIONS Mobile health interventions can be effective in improving provider-focused and patient-centered outcomes in both routine and complex EC settings. Future investigations focusing on patient-centered outcomes are needed to further validate these findings.
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Affiliation(s)
- W Tyler Winders
- School of Public Health, University of Edinburgh, Edinburgh, UK
| | - Stephanie C Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Pryanka Relan
- Department of Emergency Medicine, Emory Healthcare Network, Atlanta, Georgia, USA
| | - Megan L Schultz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Indi Trehan
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Ruth McQuillan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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24
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Naal H, Whaibeh E, Mahmoud H. Guidelines for primary health care-based telemental health in a low-to middle-income country: the case of Lebanon. Int Rev Psychiatry 2021; 33:170-178. [PMID: 32462955 DOI: 10.1080/09540261.2020.1766867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Significant efforts have been conducted to improve access to Mental Health Services (MHS) and reduce the burden of Mental Health Disorders (MHD) in Low-to Middle-Income Countries (LMIC). However, important challenges to accessing MHS still exist and limit improvements. Telemental Health (TMH), a modality that delivers remote MHS provides an ideal solution to complement existing efforts; however, there are limited reports on its implementation in developing countries such as Lebanon. This study presents the first roadmap for TMH applicability in Lebanon, with a focus on the Primary Health Care (PHC) setting, which has international relevance. We review existing guidelines and contextualise them to the Lebanese setting by addressing essential components for implementation. In specific, we shed light on 6 aspects: (1) patient population, (2) technological guidelines, (3) clinical guidelines, (4) administrative guidelines, (5) workforce, and (6) monitoring and evaluation. In addition, we acknowledge the important role of governmental efforts in setting the infrastructural and regulatory aspects for TMH practice. We provide guidance for public health professionals, government officials, and clinicians looking to adopt TMH practice in Lebanon or other countries with similar development and cultural landscapes.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Emile Whaibeh
- Department of Public Health, Faculty of Health Sciences, University of Balamand, Beirut, Lebanon
| | - Hossam Mahmoud
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA, USA
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25
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Sunder P, Vincent AS, Saju MK, Moorthy AS, Paulose G, Robins R, Prabhu AV, Arun M, Rajah A, Venkateswaran C. Reimagining Community Mental Health Care Services: Case Study of a Need Based Biopsychosocial Response Initiated During Pandemic. Front Psychiatry 2021; 12:731321. [PMID: 34690838 PMCID: PMC8528954 DOI: 10.3389/fpsyt.2021.731321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 08/30/2021] [Indexed: 12/16/2022] Open
Abstract
Community mental health systems worldwide have undergone transformation in order to accommodate enormous demands of the pandemic and its mitigation efforts. The pandemic created unprecedented challenges that required Mehac Foundation (further referred as Mehac), a not for profit organization based in Kerala, to reassess our care delivery model. The aim of this report is to present a flexible, need-based biopsychosocial response; a case study effectuated by the Non-Governmental Organization (NGO) with a focus on minimizing the impact of COVID 19 on vulnerable communities, while adhering to timely regulations issued by the government. The key aspect of our biopsychosocial response was implementation of a phased approach that was rooted in real time need identification. The strategies will be described under broad headings of (i) adaptations for maintaining continuity of care, (ii) identifying vulnerable subgroups and need based psychological response, (iii) exploring social dimensions of the pandemic and implementing strategies to address them, (iv) ensuring team well-being and enhancing skills to effectively respond to the challenges.
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Affiliation(s)
| | | | | | | | | | | | | | - M Arun
- Mehac Foundation, Kochi, India
| | | | - Chitra Venkateswaran
- Mehac Foundation, Kochi, India.,Department of Psychiatry, Believers Church Medical College Hospital, Tiruvalla, India
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26
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Senbekov M, Saliev T, Bukeyeva Z, Almabayeva A, Zhanaliyeva M, Aitenova N, Toishibekov Y, Fakhradiyev I. The Recent Progress and Applications of Digital Technologies in Healthcare: A Review. Int J Telemed Appl 2020; 2020:8830200. [PMID: 33343657 PMCID: PMC7732404 DOI: 10.1155/2020/8830200] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The implementation of medical digital technologies can provide better accessibility and flexibility of healthcare for the public. It encompasses the availability of open information on the health, treatment, complications, and recent progress on biomedical research. At present, even in low-income countries, diagnostic and medical services are becoming more accessible and available. However, many issues related to digital health technologies remain unmet, including the reliability, safety, testing, and ethical aspects. PURPOSE The aim of the review is to discuss and analyze the recent progress on the application of big data, artificial intelligence, telemedicine, block-chain platforms, smart devices in healthcare, and medical education. Basic Design. The publication search was carried out using Google Scholar, PubMed, Web of Sciences, Medline, Wiley Online Library, and CrossRef databases. The review highlights the applications of artificial intelligence, "big data," telemedicine and block-chain technologies, and smart devices (internet of things) for solving the real problems in healthcare and medical education. Major Findings. We identified 252 papers related to the digital health area. However, the number of papers discussed in the review was limited to 152 due to the exclusion criteria. The literature search demonstrated that digital health technologies became highly sought due to recent pandemics, including COVID-19. The disastrous dissemination of COVID-19 through all continents triggered the need for fast and effective solutions to localize, manage, and treat the viral infection. In this regard, the use of telemedicine and other e-health technologies might help to lessen the pressure on healthcare systems. Summary. Digital platforms can help optimize diagnosis, consulting, and treatment of patients. However, due to the lack of official regulations and recommendations, the stakeholders, including private and governmental organizations, are facing the problem with adequate validation and approbation of novel digital health technologies. In this regard, proper scientific research is required before a digital product is deployed for the healthcare sector.
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Affiliation(s)
- Maksut Senbekov
- S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Timur Saliev
- S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | | | | | | | - Nazym Aitenova
- NJSC “Astana Medical University”, Nur-Sultan, Kazakhstan
| | | | - Ildar Fakhradiyev
- S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
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27
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Narla NP, Surmeli A, Kivlehan SM. Agile Application of Digital Health Interventions during the COVID-19 Refugee Response. Ann Glob Health 2020; 86:135. [PMID: 33117656 PMCID: PMC7566526 DOI: 10.5334/aogh.2995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The intersection of digital health platforms and refugee health in the context of the novel 2019 coronavirus disease (COVID-19) has not yet been explored. We discuss the ability of a novel mobile health (mhealth) platform to be effectively adapted to improve health access for vulnerable displaced populations. In a preliminary analysis of 200 Syrian refugee women, we found positive user feedback and uptake of an mhealth application to increase access to preventive maternal and child health services for Syrian refugees under temporary protection in Turkey. Rapid adaptation of this application was successfully implemented during a global pandemic state to perform symptomatic assessment, disseminate health education, and bolster national prevention efforts. We propose that mhealth interventions can provide an innovative, cost-effective, and user-friendly approach to access the dynamic needs of refugees and other displaced populations, particularly during an emerging infectious disease outbreak.
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Affiliation(s)
- Nirmala P. Narla
- Division of Medical Critical Care, Boston Children’s Hospital and Harvard Medical School, MA, US
| | - Aral Surmeli
- Medical Rescue Association of Turkey (MEDAK), Istanbul, TR
| | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, US
- Harvard Humanitarian Initiative, Cambridge, MA, US
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28
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Gupta PP, Jyotsana P, Larrison C, Rodrigues S, Lam C, Dowrick C. Effectiveness of mental health community training on depression and anxiety to the health care profession working in rural centers of eastern Nepal. J Family Med Prim Care 2020; 9:2416-2419. [PMID: 32754512 PMCID: PMC7380740 DOI: 10.4103/jfmpc.jfmpc_6_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/11/2020] [Accepted: 03/15/2020] [Indexed: 01/15/2023] Open
Abstract
Background: Depression and anxiety is the leading cause of disease burden in low- and middle-income countries. It is associated with a worse clinical course over the lifespan. This study aims the post-effect on the approach of managing depression and anxiety after the training on diagnosis and management of depression and anxiety. Methods: This is a prospective observational study done in the health care professionals who had done training on diagnosis and management of depression and anxiety from me. The participants were evaluated with the questionnaire. Results: The training was given in three parts in three different places of eastern Nepal with the health care professionals working near to those centers. There were total of 49 participants from 17 different primary health care centers. The referral rate of patients with depression and anxiety was decreased by 27% as stated by the participants as they can give psychoeducation and counseling in a very well manner after training which was lacking before training. Conclusions: Overall, the findings from the current data suggest that there is merit in continuing to evaluate and deliver community health training programs for depression and anxiety. While prevention type and personnel delivering the intervention account for aspects of the heterogeneity observed, more research is needed to identify how program completion and fidelity impact outcomes.
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Affiliation(s)
- Pramendra P Gupta
- Associate Professor, Department of General Practice and Emergency Medicine B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Chris Larrison
- Project Facilitators and Consultant, California Academy of Family Physicians, California, United states of America
| | - Shelly Rodrigues
- Project Facilitators and Consultant, California Academy of Family Physicians, California, United states of America
| | - Cindy Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China
| | - Chris Dowrick
- Professor of Primary Medical Care, University of Liverpool, United Kingdom
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29
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Special Issue on E-Health Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082885. [PMID: 32331273 PMCID: PMC7215852 DOI: 10.3390/ijerph17082885] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
The importance of e-health to citizens, patients, health providers, governments, and other stakeholders is rapidly increasing. E-health services have a range of advantages. For instance, e-health may improve access to services, reduce costs, and improve self-management. E-health may allow previously underserved populations to gain access to services. Services utilizing apps, social media, or online video are rapidly gaining ground in most countries. In this special issue, we present a range of up-to-date studies from around the world, providing important insights into central topics relating to e-health services.
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30
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Dolan SB, Alao ME, Mwansa FD, Lymo DC, Bulula N, Carnahan E, Beylerian E, Werner L, Shearer JC. Perceptions of factors influencing the introduction and adoption of electronic immunization registries in Tanzania and Zambia: a mixed methods study. Implement Sci Commun 2020; 1:38. [PMID: 32885195 PMCID: PMC7427960 DOI: 10.1186/s43058-020-00022-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As technology has become cheaper and more accessible, health programs are adopting digital health interventions (DHI) to improve the provision of and demand for health services. These interventions are complex and require strong coordination and support across different health system levels and government departments, and they need significant capacities in technology and information to be properly implemented. Electronic immunization registries (EIRs) are types of DHI used to capture, store, access, and share individual-level, longitudinal health information in digitized records. The BID Initiative worked in partnership with the governments of Tanzania and Zambia to introduce an EIR at the sub-national level in both countries within 5 years as part of a multi-component complex intervention package focusing on data use capacity-building. METHODS We aimed to gather and describe learnings from the BID experience by conducting a framework-based mixed methods study to describe perceptions of factors that influenced scale-up of the EIR. Data were collected through key informant interviews, a desk review, EIRs, and health management information systems. We described how implementation of the EIRs fulfilled domains described in our conceptual framework and used cases to illustrate the relationships and relative influence of domains for scale-up and adoption of the EIR. RESULTS We found that there was no single factor that seemed to influence the introduction or sustained adoption of the EIR as many of the factors were interrelated. For EIR introduction, strong strategic engagement among partners was important, while EIR adoption was influenced by adequate staffing at facilities, training, use of data for supervision, internet and electricity connectivity, and community sensitization. CONCLUSIONS Organizations deploying DHIs in the future should consider how best to adapt their intervention to the existing ecosystem, including human resources and organizational capacity, as well as the changing technological landscape during planning and implementation.
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Affiliation(s)
- Samantha B. Dolan
- Dolan Consulting LLC, PATH, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Mary E. Alao
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Dafrossa C. Lymo
- Immunisation and Vaccines Development, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Ngwegwe Bulula
- Immunisation and Vaccines Development, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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31
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Wynn R, Oyeyemi SO, Budrionis A, Marco-Ruiz L, Yigzaw KY, Bellika JG. Electronic Health Use in a Representative Sample of 18,497 Respondents in Norway (The Seventh Tromsø Study - Part 1): Population-Based Questionnaire Study. JMIR Med Inform 2020; 8:e13106. [PMID: 32134395 PMCID: PMC7082740 DOI: 10.2196/13106] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 06/13/2019] [Accepted: 10/22/2019] [Indexed: 01/09/2023] Open
Abstract
Background Electronic health (eHealth) services may help people obtain information and manage their health, and they are gaining attention as technology improves, and as traditional health services are placed under increasing strain. We present findings from the first representative, large-scale, population-based study of eHealth use in Norway. Objective The objectives of this study were to examine the use of eHealth in a population above 40 years of age, the predictors of eHealth use, and the predictors of taking action following the use of these eHealth services. Methods Data were collected through a questionnaire given to participants in the seventh survey of the Tromsø Study (Tromsø 7). The study involved a representative sample of the Norwegian population aged above 40 years old. A subset of the more extensive questionnaire was explicitly related to eHealth use. Data were analyzed using logistic regression analyses. Results Approximately half (52.7%; 9752/18,497) of the respondents had used some form of eHealth services during the last year. About 58% (5624/9698) of the participants who had responded to a question about taking some type of action based on information gained from using eHealth services had done so. The variables of being a woman (OR 1.58; 95% CI 1.47-1.68), of younger age (40-49 year age group: OR 4.28, 95% CI 3.63-5.04), with a higher education (tertiary/long: OR 3.77, 95% CI 3.40-4.19), and a higher income (>1 million kr [US $100,000]: OR 2.19, 95% CI 1.77-2.70) all positively predicted the use of eHealth services. Not living with a spouse (OR 1.14, 95% CI 1.04-1.25), having seen a general practitioner (GP) in the last year (OR 1.66, 95% CI 1.53-1.80), and having had some disease (such as heart disease, cancer, asthma, etc; OR 1.29, 95% CI 1.18-1.41) also positively predicted eHealth use. Self-rated health status did not significantly influence eHealth use. Taking some action following eHealth use was predicted with the variables of being a woman (OR 1.16, 95% CI 1.07-1.27), being younger (40-49 year age group: OR 1.72, 95% CI 1.34-2.22), having a higher education (tertiary/long: OR 1.65, 95% CI 1.42-1.92), having seen a GP in the last year (OR 1.58, 95% CI 1.41-1.77), and having ever had a disease (such as heart disease, cancer or asthma; OR 1.26, 95% CI 1.14-1.39). Conclusions eHealth appears to be an essential supplement to traditional health services for those aged above 40 years old, and especially so for the more resourceful. Being a woman, being younger, having higher education, having had a disease, and having seen a GP in the last year all positively predicted using the internet to get health information and taking some action based on this information.
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Affiliation(s)
- Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway
| | - Sunday Oluwafemi Oyeyemi
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Andrius Budrionis
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Luis Marco-Ruiz
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Johan Gustav Bellika
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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32
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Budrionis A, Wynn R, Marco-Ruiz L, Yigzaw KY, Bergvik S, Oyeyemi SO, Bellika JG. Impact of the Use of Electronic Health Tools on the Psychological and Emotional Well-Being of Electronic Health Service Users (The Seventh Tromsø Study - Part 3): Population-Based Questionnaire Study. J Med Internet Res 2020; 22:e13118. [PMID: 32134396 PMCID: PMC7082736 DOI: 10.2196/13118] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/24/2019] [Accepted: 08/31/2019] [Indexed: 01/18/2023] Open
Abstract
Background Electronic health (eHealth) has been described as a silver bullet for addressing how challenges of the current health care system may be solved by technological solutions in future strategies and visions for modern health care. However, the evidence of its effects on service quality and cost effectiveness remains unclear. In addition, patients’ psychological and emotional reactions to using eHealth tools are rarely addressed by the scientific literature. Objective This study aimed to assess how the psychological and emotional well-being of eHealth service users is affected by the use of eHealth tools. Methods We analyzed data from a population-based survey in Norway, conducted in the years 2015-2016 and representing 10,604 eHealth users aged over 40 years, to identify how the use of eHealth tools was associated with feeling anxious, confused, knowledgeable, or reassured. Associations between these four emotional outcomes and the use of four types of eHealth services (Web search engines, video search engines, health apps, and social media) were analyzed using logistic regression models. Results The use of eHealth tools made 72.41% (6740/9308) of the participants feel more knowledgeable and 47.49% (4421/9308) of the participants feel more reassured about their health status. However, 25.69% (2392/9308) reported feeling more anxious and 27.88% (2595/9308) reported feeling more confused using eHealth tools. A high level of education and not having a full-time job were associated with positive reactions and emotions (feeling more knowledgeable and reassured), whereas low self-reported health status and not having enough friends who could provide help and support predicted negative reactions and emotions (ie, feeling anxious and confused). Overall, the positive emotional effects of eHealth use (feeling knowledgeable and reassured) were relatively more prevalent among users aged over 40 years than the negative emotional effects (ie, feeling anxious and confused). About one-fourth of eHealth users reported being more confused and anxious after using eHealth services. Conclusions The search for health information on the internet can be motivated by a range of factors and needs (not studied in this study), and people may experience a range of reactions and feelings following health information searching on the Web. Drawing on prior studies, we categorized reactions as positive and negative reactions. Some participants had negative reactions, which is challenging to resolve and should be taken into consideration by eHealth service providers when designing services (ie, including concrete information about how users can get more help and support). There is a need for more studies examining a greater range of reactions to online health information and factors that might predict negative reactions to health information on the Web.
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Affiliation(s)
- Andrius Budrionis
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Division of Mental Health and Addictions, University Hospital of North Norway, Tromsø, Norway
| | - Luis Marco-Ruiz
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Svein Bergvik
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Sunday Oluwafemi Oyeyemi
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Johan Gustav Bellika
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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