Development of a framework for the implementation of synchronous digital mental health: a realist synthesis of systematic reviews (Preprint)

2021 ◽  
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
GJ Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Alba Navarro-Flores ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Realist Synthesis ◽  
Health Interventions ◽  
Theory Approach ◽  
Access To Treatment ◽  
Mental Health Interventions

BACKGROUND The use of technologies has served to reduce gaps in access to treatment and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it's imperative to document the aspects related to their challenging implementation. OBJECTIVE To determine what evidence is available for synchronous digital mental health implementation and develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS The SPIDER framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020 were searched with no language restriction. AMSTAR-2 was used to assess the risk of bias, and CERQual was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded theory approach with an emergent approach. RESULTS 21 systematic reviews were included in the study. Ninety percent of the studies presented a critically low confidence level assessed with the AMSTAR-2. The realist synthesis allowed the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: Hypothesis 1: These interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy. Hypothesis 2: These interventions reach populations otherwise unable to have access because they can be successfully delivered by non-specialists, which makes them more cost-effective to implement in health services. Hypothesis 3: These interventions are acceptable and show good results in satisfaction, because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represented essential outcomes in the implementation process. CLINICALTRIAL PROSPERO (CRD420203811). INTERNATIONAL REGISTERED REPORT RR2-10.12688/f1000research.27150.2

scholarly journals Development of a Framework for the Implementation of Synchronous Digital Mental Health: A Realist Synthesis of Systematic Reviews

2021 ◽  
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
GJ Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Alba Navarro-Flores ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Realist Synthesis ◽  
Health Interventions ◽  
Theory Approach ◽  
Access To Treatment ◽  
Mental Health Interventions

Abstract Background: The use of technologies has served to reduce gaps in access to treatment and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it's imperative to document the aspects related to their challenging implementation. Methods: The SPIDER framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020 were searched with no language restriction. AMSTAR-2 was used to assess the risk of bias, and CERQual was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded theory approach with an emergent approach.Results: 21 systematic reviews were included in the study. Ninety percent of the studies presented a critically low confidence level assessed with the AMSTAR-2. The realist synthesis allowed the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: Hypothesis 1: These interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy. Hypothesis 2: These interventions reach populations otherwise unable to have access because they can be successfully delivered by non-specialists, which makes them more cost-effective to implement in health services. Hypothesis 3: These interventions are acceptable and show good results in satisfaction, because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist.Conclusion: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represented essential outcomes in the implementation process.Registration: PROSPERO (CRD420203811).

scholarly journals Development of a Framework for the Implementation of Synchronous Digital Mental Health: A Realist Synthesis of Systematic Reviews

2021 ◽  
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
GJ Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Alba Navarro-Flores ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Realist Synthesis ◽  
Health Interventions ◽  
Theory Approach ◽  
Access To Treatment ◽  
Mental Health Interventions

Abstract Background: The use of technologies has served to reduce gaps in access to treatment and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it's imperative to document the aspects related to their challenging implementation. Objective: To determine what evidence is available for synchronous digital mental health implementation and develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems.Methods: The SPIDER framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020 were searched. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded theory approach with an emergent approach.Results: 21 systematic reviews were included in the study. The realist synthesis allowed the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: Hypothesis 1: These interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy. Hypothesis 2: These interventions reach populations otherwise unable to have access because they can be successfully delivered by non-specialists, which makes them more cost-effective to implement in health services. Hypothesis 3: These interventions are acceptable and show good results in satisfaction, because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist.Conclusion: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represented essential outcomes in the implementation process.Systematic review registration: PROSPERO (CRD420203811).

scholarly journals Preventive digital mental health interventions for children and young people: a review of the design and reporting of research

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Aislinn D. Bergin ◽  
Elvira Perez Vallejos ◽  
E. Bethan Davies ◽  
David Daley ◽  
Tamsin Ford ◽  
...  
Keyword(s):  
Mental Health ◽  
Young People ◽  
Real World ◽  
Mental Health Problems ◽  
Digital Health ◽  
Health Problems ◽  
Poor Mental Health ◽  
Research Literature ◽  
Health Interventions ◽  
Children And Young People

Abstract Digital health interventions (DHIs) have frequently been highlighted as one way to respond to increasing levels of mental health problems in children and young people. Whilst many are developed to address existing mental health problems, there is also potential for DHIs to address prevention and early intervention. However, there are currently limitations in the design and reporting of the development, evaluation and implementation of preventive DHIs that can limit their adoption into real-world practice. This scoping review aimed to examine existing evidence-based DHI interventions and review how well the research literature described factors that researchers need to include in their study designs and reports to support real-world implementation. A search was conducted for relevant publications published from 2013 onwards. Twenty-one different interventions were identified from 30 publications, which took a universal (n = 12), selective (n = 3) and indicative (n = 15) approach to preventing poor mental health. Most interventions targeted adolescents, with only two studies including children aged ≤10 years. There was limited reporting of user co-design involvement in intervention development. Barriers and facilitators to implementation varied across the delivery settings, and only a minority reported financial costs involved in delivering the intervention. This review found that while there are continued attempts to design and evaluate DHIs for children and young people, there are several points of concern. More research is needed with younger children and those from poorer and underserved backgrounds. Co-design processes with children and young people should be recognised and reported as a necessary component within DHI research as they are an important factor in the design and development of interventions, and underpin successful adoption and implementation. Reporting the type and level of human support provided as part of the intervention is also important in enabling the sustained use and implementation of DHIs.

scholarly journals Development of a framework for the implementation of electronic interventions in mental health: a protocol for a meta-synthesis of systematic reviews

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 1282
Author(s):  
David Villarreal-Zegarra ◽  
Christoper A. Alarcon-Ruiz ◽  
G.J. Melendez-Torres ◽  
Roberto Torres-Puente ◽  
Juan Ambrosio-Melgarejo ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Reviews ◽  
Mental Health Problems ◽  
Implementation Process ◽  
Health Problems ◽  
Theory Approach ◽  
Language Restriction ◽  
Overview Of Systematic Reviews ◽  
Common Mental Health Problems ◽  
Electronic Interventions

Background: During the COVID-19 pandemic, it has been necessary to incorporate technologies in the care of mental health problems. But there have been difficulties in the application of technology-based interventions in mental health. Some quantitative systematic reviews don’t allow us to fully identify and properly describe this subject. In order to answer the question "how do electronic interventions apply in mental health and what makes the application of any of these interventions work", this study will carry out an overview of systematic reviews, which will make it possible to develop a theoretical framework on the implementation of electronic care in mental health problems. Methods: We will search MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases from 1st January 2015 to September 2020, with no language restriction. We will follow a qualitative method approach and include systematic reviews that assess primary studies relating to adults with common mental health problems using any type of mobile mental health intervention that includes a synchronic component and communication with a mental health professional. For the analysis, we will make a meta-synthesis of the systematic reviews, using an emergent grounded theory approach to synthesize the information, prioritizing the systematic reviews with the lowest risk of bias in the AMSTAR-2 tool. The meta-synthesis will be based on interpreting, integrating, and inferring the evaluation elements to understand better the e-health implementation process for patients with mental health problems. Finally, we will present the overall assessment in a Summary of Qualitative Findings table. Conclusion: Our results will allow a better understanding of the facilitator and limitations in implementing e-health interventions for mental health problems.

PP71 Long-Term Evaluation Of Broad Mental Health Interventions: A Review

2018 ◽  
Vol 34 (S1) ◽  
pp. 95-96
Author(s):  
Alastair Canaway ◽  
Christopher Sampson ◽  
Rachel Meacock
Keyword(s):  
Mental Health ◽  
Mental Health Problems ◽  
Outcome Measurement ◽  
Health Problems ◽  
Trial Data ◽  
Health Interventions ◽  
Data Availability ◽  
Term Trial ◽  
Mental Health Interventions

Introduction:Interventions and services for people with mental health problems can have broad remits: they are often designed to treat people with a variety of diagnoses. Furthermore, addressing mental health problems can have long-term implications for economic, social, and health outcomes. This represents a challenge for health technology assessment, for which long-term trial data can be lacking. In this review, we sought to identify how analysts have tackled this problem. We reviewed the methods used to extrapolate costs and outcomes for the purpose of economic evaluation where long-term trial data are not available.Methods:We conducted a systematic review of the medical and economic literature evaluating long-term costs and outcomes for mental health interventions and services designed to treat or prevent more than two mental health conditions. We searched key databases including MEDLINE, Embase, PsycINFO, CINAHL, and EconLit. Two authors independently screened citations. Articles were excluded if they reported within-trial analyses or employed a time horizon of less than 5 years.Results:The search identified 829 unique records. No papers could be included in the review.Conclusions:This review highlights the lack of research and understanding available to inform the appraisal of broad mental health interventions. In light of our findings, we consider the reasons for this lack of information and review relevant literature on the subject. Potential barriers to research in this context include: (i) challenges in understanding the value of broad mental health services, such as the mental and physical health nexus, intersectoral costs and benefits, and interpersonal impacts, (ii) methodological difficulties, such as data availability, patient heterogeneity, and the challenge of extrapolation, and (iii) parity of esteem. We make recommendations for resolving this problem with regard to funding, data collection, modelling methods, and outcome measurement.

scholarly journals Health Personnel’s Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study

10.2196/15149 ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. e15149
Author(s):  
Hege Therese Størksen ◽  
Silje Marie Haga ◽  
Kari Slinning ◽  
Filip Drozd
Keyword(s):  
Mental Health ◽  
Child Mental Health ◽  
Mental Health Problems ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Health Problems ◽  
Perceived Usefulness ◽  
Health Interventions ◽  
Child Health Services ◽  
Mental Health Interventions

Background Approximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel’s attitudes to perceived usefulness of internet-based interventions. Objective The purpose of this study was to examine health professionals’ perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. Methods Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: “How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?” The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). Results The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). Conclusions Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support.

Examining interventions to improve young deaf people's mental health: a search for evidence

2021 ◽  
Vol 2 (2) ◽  
pp. 78-84
Author(s):  
Julia Terry
Keyword(s):  
Mental Health ◽  
Literature Review ◽  
Hard Of Hearing ◽  
Web Of Science ◽  
Mental Health Problems ◽  
Population Group ◽  
Health Problems ◽  
Health Interventions ◽  
Social And Emotional ◽  
Mental Health Interventions

Background Young deaf and hard of hearing people have a higher prevalence of mental health problems than their hearing peers. Little is known about mental health interventions that promote positive mental health in this population group. Aim To evaluate evidence of mental health interventions with young deaf and hard of hearing people. Methods A literature review was performed over four databases: CINAHL, Medline, Web of Science and Proquest, for peer reviewed articles written in English that focused on interventions to improve young Deaf people's mental health. Results The search yielded 62 papers, with none eligible for inclusion. Information did not relate directly to mental health interventions that improve young deaf and hard of hearing people's mental health or that support social and emotional behavioural issues. Conclusions Practitioners and researchers need to work closely with deaf and hard of hearing communities and explore what improves young deaf and hard of hearing people's mental health.

scholarly journals The Effectiveness of Individual Mental Health Interventions for Depressive, Anxiety and Conduct Disorder Symptoms in School Environment for Adolescents Aged 12–18—A Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Johanna Karukivi ◽  
Outi Herrala ◽  
Elina Säteri ◽  
Anna Tornivuori ◽  
Sanna Salanterä ◽  
...  
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
School Environment ◽  
Mental Health Problems ◽  
Health Problems ◽  
Health Interventions ◽  
Control Group ◽  
Qualitative Synthesis ◽  
Mental Health Interventions

Background: Mental health problems are a major health issue for children and adolescents around the world. The school environment allows adolescents to be reached comprehensively and on a low threshold, making it a potential environment for mental health interventions. The aim of this review was to describe interventions delivered by health-care workers in school environment for individual adolescents aged 12–18 with mental health problems and to assess the effectiveness of these interventions.Methods: This systematic review was conducted in adherence with the PRISMA guidelines. Altogether 349 studies were screened and 24 of them were included in full text assessment. Eight studies were included in the qualitative synthesis. Only in three studies the intervention was compared to another intervention or the study setting included a control group. Five of the interventions were based on cognitive-behavioral therapy and three on other approaches. In seven studies, one of the main response variables was based on assessment of depressive symptoms and/or a depressive disorder. The quality of the studies was limited with notable risk for bias for some studies.Results: Based on reported symptom reductions, for most of the interventions, the results were good. Symptom reductions were also typically achieved in a rather low number of sessions (12 or less) supporting the feasibility of these type of interventions in school environment. However, the lack of use of control groups and actual comparisons between the interventions, limit the possibility to draw firm conclusions regarding their effectiveness and thus, the results should be interpreted with caution. Confirming the effectiveness of the studied interventions requires more robust evidence and thus, improving the quality of studies in the school environment is encouraged.

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