Barriers and facilitators to the implementation of digital technologies in mental health systems: a qualitative systematic review to inform a policy framework

Mental Health Professionals' Perspectives on Digital Remote Monitoring in Services for People with Psychosis

BACKGROUND AND HYPOTHESIS

Digital remote monitoring (DRM) captures service users' health-related data remotely using devices such as smartphones and wearables. Data can be analyzed using advanced statistical methods (eg, machine learning) and shared with clinicians to aid assessment of people with psychosis' mental health, enabling timely intervention. Such methods show promise in detecting early signs of psychosis relapse. However, little is known about clinicians' views on the use of DRM for psychosis. This study explores multi-disciplinary staff perspectives on using DRM in practice.

STUDY DESIGN

Fifty-nine mental health professionals were interviewed about their views on DRM in psychosis care. Interviews were analyzed using reflexive thematic analysis. Study Results: Five overarching themes were developed, each with subthemes: (1) the perceived value of digital remote monitoring; (2) clinicians' trust in digital remote monitoring (3 subthemes); (3) service user factors (2 subthemes); (4) the technology-service user-clinician interface (2 subthemes); and (5) organizational context (2 subthemes).

CONCLUSIONS

Participants saw the value of using DRM to detect early signs of relapse and to encourage service user self-reflection on symptoms. However, the accuracy of data collected, the impact of remote monitoring on therapeutic relationships, data privacy, and workload, responsibility and resource implications were key concerns. Policies and guidelines outlining clinicians' roles in relation to DRM and comprehensive training on its use are essential to support its implementation in practice. Further evaluation regarding the impact of digital remote monitoring on service user outcomes, therapeutic relationships, clinical workflows, and service costs is needed.

Users' positive attitudes, perceived usefulness, and intentions to use digital mental health interventions: A systematic literature review and meta-analysis

BACKGROUND

Digital Mental Health Interventions (DMHIs) hold significant potential in addressing gaps in mental health treatment, enhancing mental health literacy, and mitigating associated stigma. However, DMHIs have not been systematically evaluated in terms of potential users' attitudes, perceived usefulness, and intentions to use. Thus, this study aims to consolidate evidence to ascertain users' attitudes, perceived usefulness, and intentions to utilize DMHIs.

METHODS

The meta-analysis reports adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search of databases: Medline, CINHAL, PsycINFO, SCOPUS, and Web of Science, was conducted. As part of the screening process, Covidence database management software was used. Metaprop command was used to calculate the outcome using a random-effects model. Heterogeneity was assessed using Cochrane chi-square (χ2) and the index of heterogeneity (I2 statistics) test. Sensitivity test and subgroup analysis were performed. Publication bias was examined by funnel plots and Egger's test.

RESULTS

In total, 26 studies were analyzed, including data from 13,923 participants. The overall percentage of users' positive attitudes, perceived usefulness, and intentions to use DHMIs was 0.66 (95 % CI; 0.52, 0.79), 0.73 (95 % CI; 0.64, 0.81), and 0.67 (95 % CI; 0.6, 0.74), respectively. Significant heterogeneity was observed; nonetheless, sensitivity analyses indicated that none of the included individual studies exerted undue influence on the overall pooled prevalence. Assessment of funnel plots and Egger's test (p ≤ 0.895) showed no evidence of publication bias.

CONCLUSION

The results of this meta-analysis indicate that, overall, two-thirds of participants have a positive attitude toward DMHIs, around three-quarters find DMHIs useful, and around two-thirds intend to use them. The findings suggest the need to target users' positive attitudes, perceived utility, and willingness for the improved adoption and sustained use of DMHIs.

Updates on digital mental health interventions for children and young people: systematic overview of reviews

Digital mental health interventions (DMHIs) are increasingly recommended for children and young people (CYP) as a promising way to prevent and treat mental health problems. Here, we summarised and consolidated findings from existing systematic reviews to provide an overview of what is known, and which areas need further investigation. Systematic searches were conducted until January 2024 using PubMed, PsycINFO, MEDLINE, CINAHL, Scopus and Google Scholar. Records were screened against predefined criteria and quality assessed using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2) and Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Systematic Reviews. A study protocol was co-developed with key stakeholders and registered on the Open Science Framework. From 941 records, 51 systematic reviews published between 2000 and 2023 of generally moderate quality, targeting CYP 0 to 25 years, were included in our narrative summary. DMHIs were delivered in a variety of ways, including online video calls, apps and various combinations, underpinned mostly by cognitive behaviour therapy. DMHIs supported different mental health problems, but mostly symptoms of anxiety and/or depression. Although generally effective, some studies reported mixed results with limited evidence when focusing on longer-term outcomes. Other benefits of DMHIs included reduced costs and time investments for families, and increased accessibility and acceptability of support. Practitioner preparedness and unclear ethics/safety measures were identified as factors impacting engagement and potential effectiveness. The findings suggest that DMHIs can be a valuable tool for supporting CYP. However, realising the full potential of DMHIs for all CYP may require more high-quality research utilising DMHIs that are diverse in theoretical underpinnings and target audiences.

Barriers and Facilitators of Digital Mental Health Use in Regional, Rural, and Remote Australia: A Comparison of Clinician and Consumer Perspectives

INTRODUCTION

Consumers living in regional, rural, and remote areas of Australia face significant barriers to accessing mental healthcare. Digital mental health interventions (DMHIs) are a promising avenue to improve access to mental health treatment in these areas, but uptake has yet to reach its full potential.

OBJECTIVE

This study evaluated the perceived barriers and facilitators of engagement with DMHIs for clinicians and consumers in regional, rural, and remote Australia.

METHODS, DESIGN, AND PARTICIPANTS

We surveyed consumers (n = 896) and clinicians (n = 104) using cross-sectional surveys to examine perceived barriers and facilitators of DMHI use.

SETTING

This study was conducted within the context of an established digital mental health service, THIS WAY UP.

MAIN OUTCOME MEASURES

Survey responses were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model, and quantitative analyses of response frequencies partitioned the influence of each factor on engagement with DMHIs.

RESULTS

Clinicians and consumers familiar with DMHIs reported barriers that spanned capability, opportunity, and motivation domains. Lack of consumer motivation was the most frequent barrier perceived by clinicians (51%) and reported by consumers (27%). Consumers valued many accessibility benefits of DMHIs and frequently endorsed the importance of clinicians in facilitating their use of DMHIs by supporting knowledge and motivation.

CONCLUSIONS

DMHIs have the potential to alleviate service-related barriers to mental healthcare in regional/remote areas, and successful implementation must consider both clinician and consumer perspectives. Our findings underscore several capability, opportunity, and motivational targets for improving consumer and clinician engagement with DMHI in these areas.

Virtual Service Delivery in Mental Health and Substance Use Care: A Systematic Review of Preference Elicitation Studies

Mental health and substance use disorders affect the lives of many people worldwide. Prevention and treatment of these conditions is important for optimal health and wellbeing, yet service access barriers are common. Virtual models of care may help to reduce barriers to receiving care. However, to facilitate uptake and use of virtual services, they need to appeal to patients and clinicians. This systematic review aimed to synthesise preference elicitation studies to determine what features of virtual mental health and substance use care are preferred by service users and service providers. Following the PRISMA guidelines for systematic reviews, we searched PubMed, PsycINFO, EconLit, MEDLINE, CINAHL, Academic Search Ultimate, and ProQuest Central for all available studies from database inception until May 2023. The Mixed Methods Appraisal Tool was used to assess the methodological quality of included studies. Nineteen studies met the eligibility criteria. However, none examined preferences for elements of different models of virtual care. Across the included studies, we identified 41 unique features that mapped to four themes of mental health and substance use care ('service', 'treatment', 'clinician' and 'additional supports'). Participant preferences were for individual, in-person, effective, flexible, and low-cost treatment. These preferences varied based on demographic factors, such as culture, gender, and participant type (e.g., patients, clinicians, general population). A user-centred approach should be adopted when designing and implementing mental health and substance use services. While preferences for features of mental health and substance use services more broadly are known, preferences for different models of virtual care remain unexplored. Future research should examine what features of virtual services would lead to optimal uptake and use across different users and stakeholders.

Facilitators and Barriers to the Implementation of Digital Health Technologies in Hospital Settings in Lower- and Middle-Income Countries Since the Onset of the COVID-19 Pandemic: Scoping Review

BACKGROUND

Although the implementation process of digital health technologies (DHTs) has been extensively documented in high-income countries, the factors that facilitate and prevent their implementation in lower- and middle-income countries (LMICs) may differ for various reasons.

OBJECTIVE

To address this gap in research, this scoping review aims to determine the facilitators and barriers to implementing DHTs in LMIC hospital settings following the onset of the COVID-19 pandemic. Additionally, the review outlined the types of DHTs that have been implemented in LMICs' hospitals during this pandemic and finally developed a classification framework to categorize the landscape of DHTs.

METHODS

Systematic searches were conducted on PubMed, Scopus, Web of Science, and Google Scholar for studies published from March 2020 to December 2023. We extracted data on authors, publication years, study objectives, study countries, disease conditions, types of DHTs, fields of clinical medicine where the DHTs are applied, study designs, sample sizes, characteristics of the study population, study location, and data collection methods of the included studies. Both quantitative and qualitative data were utilized to conduct a thematic analysis, using a deductive method based on the Practical, Robust Implementation and Sustainability Model (PRISM), to identify facilitators and barriers to DHT implementation. Finally, all accessible DHTs were identified and organized to create a novel classification framework.

RESULTS

Twelve studies were included from 292 retrieved articles. Telemedicine (n=5) was the most commonly used DHT in LMICs' hospitals, followed by hospital information systems (n=4), electronic medical records (n=2), and mobile health (n=1). These 4 DHTs, among the other existing DHTs, allowed us to develop a novel classification framework for DHTs. The included studies used qualitative methods (n=4), which included interviews and focus groups, quantitative methods (n=5), or a combination of both (n=2). Among the 64 facilitators of DHT implementation, the availability of continuous on-the-job training (n=3), the ability of DHTs to prevent cross-infection (n=2), and positive previous experiences using DHTs (n=2) were the top 3 reported facilitators. However, of the 44 barriers to DHT implementation, patients with poor digital literacy and skills in DHTs (n=3), inadequate awareness regarding DHTs among health care professionals and stakeholders (n=2), and concerns regarding the accuracy of disease diagnosis and treatment through DHTs (n=2) were commonly reported.

CONCLUSIONS

In the postpandemic era, telemedicine, along with other DHTs, has seen increased implementation in hospitals within LMICs. All facilitators and barriers can be categorized into 6 themes, namely, (1) Aspects of the Health Care System; (2) Perspectives of Patients; (3) External Environment; (4) Implementation of Sustainable Infrastructure; (5) Characteristics of Health Care Organization; and (6) Characteristics of Patients.

The Impact of Virtual Consultations on Quality of Care for Patients With Type 2 Diabetes: A Systematic Review and Meta-Analysis

BACKGROUND

Virtual consultations (VC) have transformed healthcare delivery, offering a convenient and effective way to manage chronic conditions such as Type 2 Diabetes (T2D). This systematic review and meta-analysis evaluated the impact of VC on the quality of care provided to patients with T2D, mapping it across the six domains of the US National Academy of Medicine (NAM) quality-of-care framework (ie, effectiveness, efficiency, patient-centeredness, timeliness, safety, and equity).

METHODS

A systematic search was conducted in PubMed/MEDLINE, Cochrane, Embase, CINAHL, and Web of Science for the period between January 2010 and December 2024. Eligible studies involved adult T2D patients, evaluated synchronous VCs, and reported outcomes relevant to NAM quality domains. Two independent reviewers performed screening, and studies were assessed using the Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted for each quality domain, and a meta-analysis of HbA1c levels was performed using random-effects models.

RESULTS

In total, 15 studies involving 821 014 participants were included. VCs were comparable with face-to-face care in effectiveness, efficiency, patient-centeredness, and timeliness, with improvements in accessibility and patient satisfaction. Mixed results were found for safety due to limitations in physical assessments, and for equity, with older adults and those with lower digital literacy facing more challenges. The meta-analysis showed no significant difference in HbA1c reduction between VCs and face-to-face (standardized mean difference [SMD] = -0.31, 95% confidence interval [CI]: -0.71 to 0.09, P = 0.12).

CONCLUSION

VCs offer a promising alternative to in-person care, but addressing digital disparities and improving access for older adults are essential for maximizing VC potential.

Individual differences in treatment effects of internet-based cognitive behavioral therapy in primary care: a moderation analysis of a randomized clinical trial

BACKGROUND AND AIMS

Little is known regarding predictors of outcome in treatment of alcohol dependence via the internet and in primary care. The aim of the present study was to investigate the role of socio-demographic and clinical factors for outcomes in internet-based cognitive behavioral treatment (ICBT) added to treatment as usual (TAU) for alcohol dependence in primary care.

DESIGN

Secondary analyses based on data from a randomized controlled trial in which participants were randomized to ICBT + TAU or to TAU only.

SETTING

The study was conducted in collaboration with 14 primary care centers in Stockholm, Sweden.

PARTICIPANTS

The randomized trial included 264 adult primary care patients with alcohol dependence enrolled between September 2017 and November 2019.

INTERVENTIONS

Patients in the parent trial were randomized to ICBT that was added to TAU (n = 132) or to TAU only (n = 132). ICBT was a 12-week intervention based on motivational interviewing, relapse prevention and behavioral self-control training.

MEASURES

Primary outcome was number of standard drinks last 30 days. Sociodemographic and clinical predictors were tested in separate models using linear mixed effects models.

FINDINGS

Severity of dependence, assessed by ICD-10 criteria for alcohol dependence, was the only predictor for changes in alcohol consumption and the only moderator of the effect of treatment. Participants with severe dependence showed a larger reduction in alcohol consumption between baseline and 3-months follow-up compared to participants with moderate dependence. The patients with moderate dependence continued to reduce their alcohol consumption between 3- and 12-months follow-up, while patients with severe dependence did not.

CONCLUSIONS

Dependence severity predicted changes in alcohol consumption following treatment of alcohol dependence in primary care, with or without added ICBT. Dependence severity was also found to moderate the effect of treatment. The results suggest that treatment for both moderate and severe alcohol dependence is viable in primary care.

CLINICAL TRIAL REGISTRATION

The study was approved by the Regional Ethics Board in Stockholm, no. 2016/1367-31/2. The study protocol was published in Trials 30 December 2019. The trial identifier is ISRCTN69957414, available at http://www.isrctn.com , assigned 7 June 2018, retrospectively registered.

Understanding Individual Differences in Happiness Sources and Implications for Health Technology Design: Exploratory Analysis of an Open Dataset

BACKGROUND

Psychologists have developed frameworks to understand many constructs, which have subsequently informed the design of digital mental health interventions (DMHIs) aimed at improving mental health outcomes. The science of happiness is one such domain that holds significant applied importance due to its links to well-being and evidence that happiness can be cultivated through interventions. However, as with many constructs, the unique ways in which individuals experience happiness present major challenges for designing personalized DMHIs.

OBJECTIVE

This paper aims to (1) present an analysis of how sex may interact with age, marital status, and parental status to predict individual differences in sources of happiness, and (2) to present a preliminary discussion of how open datasets may contribute to the process of designing health-related technology innovations.

METHODS

The HappyDB is an open database of 100,535 statements of what people consider to have made them happy, with some people asking to consider the past 24 hours (49,831 statements) and some considering the last 3 months (50,704 statements). Demographic information is also provided. Binary logistic regression analyses are used to determine whether various groups differed in their likelihood of selecting or not selecting a category as a source of their happiness.

RESULTS

Sex and age interacted to influence what was selected as sources of happiness, with patterns being less consistent among female individuals in comparison with male individuals. For marital status, differences in sources of happiness were predominantly between married individuals and those who are divorced or separated, but these were the same for both sexes. Married, single, and widowed individuals were all largely similar in their likelihood of selecting each of the categories as a source of their happiness. However, there were some anomalies, and sex appeared to be important in these anomalies. Sex and parental status also interacted to influence what was selected as sources of happiness.

CONCLUSIONS

Sex interacts with age, marital status, and parental status in the likelihood of reporting affection, bonding, leisure, achievement, or enjoying the moment as sources of happiness. The contribution of an open dataset to understanding individual differences in sources of happiness is discussed in terms of its potential role in addressing the challenges of designing DMHIs that are ethical, responsible, evidence based, acceptable, engaging, inclusive, and effective for users. The discussion considers how the content design of DMHIs in general may benefit from exploring new methods informed by diverse data sources. It is proposed that examining the extent to which insights from nondigital settings can inform requirements gathering for DMHIs is warranted.

Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data

BACKGROUND

With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users' lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data.

OBJECTIVE

This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health.

METHODS

This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes.

RESULTS

A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively.

CONCLUSIONS

This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app's effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research.

Pharmacist-Led Digital Health Interventions for Patients with Diabetes: A Systematic Review

Digital health interventions have emerged as a promising approach for patient care. The aim of this study was to conduct a systematic review of pharmacist-led digital health interventions for patients with diabetes. The PubMed database was used to select randomized controlled trials that assess the effectiveness of digital health interventions on clinical outcomes among patients with type 1 and 2 diabetes from January 2005 to May 2024. We included randomized controlled trial (RCT) studies on type 1 and 2 diabetes mellitus, analyzing the effects of all digital health interventions by pharmacists, including telephone-based intervention, web-based intervention, and mobile health application, as compared to usual care. The outcomes were a reduction in HbA1c, changes in medication adherence, and reduction of adverse effects. We used the PRISMA reporting standard to implement and report the results. A total of 19 studies were included. Among these, the included digital health interventions were telephone monitoring (n = 15), web-based intervention (n = 2), mobile health application (n = 1), and text-message reminder (n = 1). The findings showed variability: around half of the studies (n = 10, 52.63%) indicated that patients receiving digital health interventions had reduced HbA1c levels compared to those receiving usual care, while five studies (26.31%) found no difference between the intervention and usual care. Five studies (26.31%) showed that such interventions increased medication adherence, while two studies (10.53%) found no difference when compared to standard care. Effectiveness of the intervention is related to several factors, including practicability and patient engagement, frequency of the intervention, and the provision of personalized communication. Tailoring interventions to individual patient profiles and providing adequate support for enhancing practicability of these tools may improve their effectiveness. Further research assessing the cost-effectiveness of such intervention is necessary to inform healthcare policy.

Towards a consensus roadmap for a new diagnostic framework for mental disorders

Current nosology claims to separate mental disorders into distinct categories that do not overlap with each other. This nosological separation is not based on underlying pathophysiology but on convention-based clustering of qualitative symptoms of disorders which are typically measured subjectively. Yet, clinical heterogeneity and diagnostic overlap in disease symptoms and dimensions within and across different diagnostic categories of mental disorders is huge. While diagnostic categories provide the basis for general clinical management, they do not describe the underlying neurobiology that gives rise to individual symptomatic presentations. The ability to incorporate neurobiology into the diagnostic framework and to stratify patients accordingly will be a critical step forward for the development of new treatments for mental disorders. Furthermore, it will also allow physicians to provide patients with a better understanding of their illness's complexities and management. To realize this ambition, a paradigm shift is needed to build an understanding of how neuropsychiatric conditions can be defined more precisely using quantitative (multimodal) biological processes and markers and thus to significantly improve treatment success. The ECNP New Frontiers Meeting 2024 set out to develop a consensus roadmap for building a new diagnostic framework for mental disorders by discussing its rationale, outlook, and consequences with all stakeholders involved. This framework would instantiate a set of principles and procedures by which research could continuously improve precision diagnostics while moving away from traditional nosology. In this meeting report, the speakers' summaries from their presentations are combined to address three key elements for generating such a roadmap, namely, the application of innovative technologies, understanding the biology of mental illness, and translating biological understanding into new approaches. In general, the meeting indicated a crucial need for a biology-informed framework to establish more precise diagnosis and treatment for mental disorders to facilitate bringing the right treatment to the right patient at the right time.

Psychiatric Considerations of Infertility

OBJECTIVE

Infertility, the inability to achieve pregnancy within a year despite normal attempts to conceive without contraception, causes psychosocial burden for individuals and couples. This review summarized the interrelationship between infertility and psychological stress and suggested various forms of psychological intervention for infertility.

METHODS

The PubMed, Google Scholar, and Korean Studies Information Service System databases were searched for English- and Korean-language articles published from 1990 to 2024.

RESULTS

Infertility leads to emotional distress from diagnosis to treatment. Also, psychological stress affects the trajectory of infertility. This distress may cause psychiatric illnesses, negatively affecting pregnancy. Psychotherapies, psychopharmacotherapies, and biological treatments can be used for the management of psychiatric illnesses in infertile patients. Digital therapeutics also have the potential to be a competitive treatment option.

CONCLUSION

Regular assessment and management of psychological stress in infertile couples are essential during the course of infertility treatment. Psychological intervention of infertile patients should be implemented according to a personalized plan that completely reflects the individual clinical characteristics.

Engagement of medication users in the development and implementation of digital medication adherence technologies: a multi-stakeholder study

BACKGROUND

This study aims to create a comprehensive framework for the development and implementation of digital medication adherence technologies (DMATech), focusing on critical stages where engagement of medication users (MU) is considered meaningful, i.e. adds significant value, as agreed upon by participating stakeholders.

METHODS

Through a literature review and expert consensus, a framework was outlined covering key DMATech development and implementation phases and steps. An in-person workshop with MU representatives and adherence experts, using the Nominal Group Technique, further refined these stages for MU engagement.

RESULTS

The DMATech framework included three phases: 'Innovation,' 'Research and Development,' and 'Launch and Implementation,' each encompassing multiple steps. The workshop, attended by five MU representatives and nine adherence experts, identified critical stages for MU input including context analysis, ideation, proof of concept, prototype creation, DMATech's iteration, critical evaluation, healthcare implementation, real-world assessment, and improvement. Nevertheless, there was a divergence of consensus regarding the importance of MUs engagement in regulatory, financial, and marketing aspects.

CONCLUSIONS

This study provides a holistic framework for DMATech development and implementation and underscores the necessity of MU engagement at various stages. Modes of MU engagement cannot be generalized; a case-by-case evaluation of engagement strategies is essential.

Implementation of a digital health intervention for young people exposed to Technology Assisted Sexual Abuse

BACKGROUND

The internet has become a place of increased risk of abuse, including sexual abuse, for young people (YP). One potential risk factor to online abuse and exploitation is the ability to mentalise. We developed the i-Minds app, a mentalisation-based digital health intervention (DHI) for YP who have experienced technology assisted sexual abuse (TASA), which we tested in a clinical feasibility trial. Nested within the trial was a qualitative implementation study with clinicians who referred to the trial.

OBJECTIVE

To explore the barriers and enablers to the future integration of i-Minds into clinical practice.

PARTICIPANTS AND SETTING

Twelve HCPs were recruited from across two trial recruitment sites (Manchester and Edinburgh).

METHODS

Semi-structured interviews were informed by Normalisation Process Theory (NPT). Framework analysis was used; transcripts were coded deductively to NPT constructs.

RESULTS

Practitioners were positive about the need for, and added value of, the i-Minds app over existing interventions, including other DHIs. While they felt confident with the app, concerns remained around the safety of using the app without practitioner support. i-Minds promoted changes in practitioners' work and impacted online behaviour of YP. There was an identified need for further training and organisational support.

CONCLUSIONS

Practitioners are aware of TASA but have limited knowledge, skills and tools to work with TASA in clinical practice with YP. There is a need for awareness raising and education about TASA and DHI. i-Minds offers a theory-informed DHI for working with YP exposed to TASA that is acceptable to practitioners and YP.

From the mathematical model to the patient: The scientific and human aspects of artificial intelligence in gastrointestinal surgery

Recent medical literature shows that the application of artificial intelligence (AI) models in gastrointestinal pathology is an exponentially growing field, with promising models that show very high performances. Regarding inflammatory bowel disease (IBD), recent reviews demonstrate promising diagnostic and prognostic AI models. However, studies are generally at high risk of bias (especially in AI models that are image-based). The creation of specific AI models that improve diagnostic performance and allow the establishment of a general prognostic forecast in IBD is of great interest, as it may allow the stratification of patients into subgroups and, in turn, allow the creation of different diagnostic and therapeutic protocols for these patients. Regarding surgical models, predictive models of postoperative complications have shown great potential in large-scale studies. In this work, the authors present the development of a predictive algorithm for early post-surgical complications in Crohn's disease based on a Random Forest model with exceptional predictive ability for complications within the cohort. The present work, based on logical and reasoned, clinical, and applicable aspects, lays a solid foundation for future prospective work to further develop post-surgical prognostic tools for IBD. The next step is to develop in a prospective and multicenter way, a collaborative path to optimize this line of research and make it applicable to our patients.

Digitalization in the Emergency Department-An Interview Study of Nurses' Experiences in Norway

Emergency departments (EDs) are overcrowded and linked to an increased risk of mortality and morbidity. Digitalization in EDs has been shown to increase effectiveness, reduce wait times, and improve performance and patient experience. The purpose of this study was to explore ED nurses' experiences with digitalization in the ED. Interviews were conducted with eight ED nurses in a Norwegian hospital. Data were analyzed using Braun and Clarke's six-step thematic analysis. Through analysis, three themes were identified, namely (1) consequences for patient safety, (2) influencing communication in the ED, and (3) impacting acute nursing. ED nurses experienced that the digital tools had increased patient safety through accurate documentation and providing a quick overview of the patient. However, digital tools were also seen as a threat to patient safety due to taking focus away from the patient. Digital tools were experienced to have negatively changed the communication both between personnel and between personnel and patients. Also, digital tools impacted the ED nurses' professional role to a more digitalization-focused approach rather than a patient-oriented approach. These aspects must be included when planning the implementation of new digital tools in EDs in the future.

Healthcare providers perspectives on digital, self-guided mental health programs for LGBTQIA+ individuals: A cross-sectional online survey

Digital, self-guided mental health programs are a promising avenue for mental health support for LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual plus additional sexuality, gender, and romantic identities) people - however, healthcare providers (HCPs) perspectives on programs are largely unknown. The aim of this study was to explore these perspectives. A cross-sectional online survey was distributed across Australia, with a final sample of 540 HCPs from a range of disciplines. Most respondents (419, 81.2 %), reported that digital, self-guided mental health programs would be useful, but 74.5 % (n = 380) also reported that they had concerns. Thematic analysis of open-text responses showed that HCPs believe programs may help overcome access barriers and could be useful as part of a wider care journey. Others were concerned about patient safety, and whether programs could be appropriately tailored to LGBTQIA+ experiences. Content analysis of open-text responses showed affirming language and imagery, content on LGBTQIA+ people's unique challenges, wider health information, and connections to community were important to include in programs. HCPs advocated for programs that offered broad and sub-population specific information. These findings show that HCPs are enthusiastic about digital, self-guided mental health programs, but care should be taken to address key concerns to facilitate future implementation.