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March A, Allen K, Davies K, Harris J, Bethel A, Kennedy L, Malhotra T, Stemp R, Alexandrescu B, Hobbs T, Fonagy P, Pilling S, Berry V. Place-based approaches to improve the mental health and wellbeing of children and young people: a rapid realist review. Syst Rev 2025; 14:115. [PMID: 40390084 PMCID: PMC12090407 DOI: 10.1186/s13643-025-02838-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 04/01/2025] [Indexed: 05/21/2025] Open
Abstract
BACKGROUND Adolescent mental health continues to be a pressing public health concern across the globe, in spite of renewed efforts in recent years to improve mental health and wellbeing outcomes. With many mental health services and systems ill-equipped to meet young people's needs, there is growing evidence that prevention interventions addressing the social and structural determinants of mental health should be prioritised. Consequently, there is a move away from isolated interventions towards 'place-based approaches' that aim to unlock systemic or structural change. However, there is limited evidence on how these approaches create change and the different contextual factors or underlying mechanisms that influence outcomes. This is the first realist review on place-based approaches to improve young people's mental health. METHODS This rapid realist review synthesises relevant literature on place-based approaches to improve the mental health and wellbeing of children and young people. The review involved consultation with programme developers, an expert panel of content specialists and a Young Person's Advisory Group. Online databases were searched for peer-reviewed and grey literature published between January 2000 and August 2023, resulting in 5685 articles. RESULTS Fifteen articles from eight countries were included in the review, from which 11 realist context-mechanism-outcome configurations (CMOCs) were developed to explain the underlying mechanisms present in the place-based approaches. These CMOCs were categorised into three themes: (1) Building relationships and trust, (2) bringing a social determinants lens, and (3) educating and empowering community stakeholders. CONCLUSIONS This review provides valuable insights into the mechanisms underpinning place-based approaches. However, the mechanisms identified primarily address the intermediate outcomes of place-based approaches, such as engaging the right stakeholders and creating opportunities for youth voices to be heard. Articles did not address the challenges around long-term sustainability and there remain crucial questions around the pathway to wider systemic change. Recommendations are included for future development and evaluation of place-based approaches to improve young people's mental health. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023450778.
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Affiliation(s)
- Anna March
- Children and Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Kate Allen
- Children and Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Karuna Davies
- Department of Clinical, Educational, and Health Psychology, UCL, London, UK
| | - Julie Harris
- Dartington Service Design Lab, Buckfastleigh, England, UK
| | - Alison Bethel
- Children and Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | - Laura Kennedy
- Department of Clinical, Educational, and Health Psychology, UCL, London, UK
| | - Tamanna Malhotra
- Children and Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK
| | | | | | - Tim Hobbs
- Dartington Service Design Lab, Buckfastleigh, England, UK
| | - Peter Fonagy
- Department of Clinical, Educational, and Health Psychology, UCL, London, UK
| | - Steve Pilling
- Department of Clinical, Educational, and Health Psychology, UCL, London, UK
| | - Vashti Berry
- Children and Young People's Mental Health Research Collaboration, University of Exeter, Exeter, UK.
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Bahamón MJ, Javela JJ, Ortega-Bechara A, Matar-Khalil S, Ocampo-Flórez E, Uribe-Alvarado JI, Cabezas-Corcione A, Cudris-Torres L. Social Determinants and Developmental Factors Influencing Suicide Risk and Self-Injury in Healthcare Contexts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2025; 22:411. [PMID: 40238575 PMCID: PMC11942370 DOI: 10.3390/ijerph22030411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2025] [Revised: 03/05/2025] [Accepted: 03/07/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Suicide is a global public health issue, particularly in low- and middle-income countries and among vulnerable groups such as adolescents. Despite increasing research efforts, understanding the psychosocial factors associated with suicidal behavior remains a challenge. This study examines family and personal histories of suicidal behavior, exposure to violence, empathy, and perceived social support in adolescents who have received healthcare services in Ecuador. METHODS A cross-sectional study was conducted with 438 adolescents aged 12 to 18 years. Participants were classified into suicide attempt survivors (AS, n = 58) and non-attempters (NAS, n = 380). A characterization questionnaire was applied (prior hospitalization for suicide attempt, family history, and survivor condition), the Alexian Brother Urge to Self-Injure scale, the Plutchik Suicide Risk Scale, the Multidimensional Scale of Perceived Social Support, and the Cognitive and Affective Empathy Test. RESULTS Adolescents with a history of suicide attempts exhibited higher levels of self-injurious behavior impulse (OR = 8.90, CI 95% [4.28-18.52], p < 0.001), Gravity attempt (OR = 8.162, CI 95% [4.34-15.37], p < 0.001), and suicide risk (OR = 2.90, CI 95% [1.42-5.94], p = 0.006). A significant association was found between suicide attempts and exposure to domestic (p = 0.000), school (p = 0.000), and sexual violence (p = 0.000). A family history of suicide attempts increased the likelihood of suicidal behavior in adolescents (OR = 2.40, CI 95% [1.12-5.16], p = 0.022). In contrast, perceived family support acted as a potential protective factor (OR = 0.36, CI 95% [0.15-0.91], p = 0.055). CONCLUSIONS These findings highlight the need for prevention strategies that address social and developmental factors.
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Affiliation(s)
- Marly Johana Bahamón
- Facultad de Ciencias de la Salud Montería, Universidad del Sinú “Elías Bechara Zainúm”, Córdoba 230002, Colombia; (J.J.J.); (A.O.-B.); (S.M.-K.)
| | - José Julián Javela
- Facultad de Ciencias de la Salud Montería, Universidad del Sinú “Elías Bechara Zainúm”, Córdoba 230002, Colombia; (J.J.J.); (A.O.-B.); (S.M.-K.)
| | - Andrea Ortega-Bechara
- Facultad de Ciencias de la Salud Montería, Universidad del Sinú “Elías Bechara Zainúm”, Córdoba 230002, Colombia; (J.J.J.); (A.O.-B.); (S.M.-K.)
| | - Shadye Matar-Khalil
- Facultad de Ciencias de la Salud Montería, Universidad del Sinú “Elías Bechara Zainúm”, Córdoba 230002, Colombia; (J.J.J.); (A.O.-B.); (S.M.-K.)
| | | | | | - Andrés Cabezas-Corcione
- Facultad de Ciencias de la Salud Montería, Universidad del Sinú “Elías Bechara Zainúm”, Córdoba 230002, Colombia; (J.J.J.); (A.O.-B.); (S.M.-K.)
| | - Lorena Cudris-Torres
- Departamento de Ciencias Sociales, Universidad de la Costa, Barranquilla 080002, Colombia;
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Crosland P, Marshall DA, Hosseini SH, Ho N, Vacher C, Skinner A, Nguyen KH, Iorfino F, Rosenberg S, Song YJC, Tsiachristas A, Tran K, Occhipinti JA, Hickie IB. Incorporating Complexity and System Dynamics into Economic Modelling for Mental Health Policy and Planning. PHARMACOECONOMICS 2024; 42:1301-1315. [PMID: 39354214 PMCID: PMC11564312 DOI: 10.1007/s40273-024-01434-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/03/2024]
Abstract
Care as usual has failed to stem the tide of mental health challenges in children and young people. Transformed models of care and prevention are required, including targeting the social determinants of mental health. Robust economic evidence is crucial to guide investment towards prioritised interventions that are effective and cost-effective to optimise health outcomes and ensure value for money. Mental healthcare and prevention exhibit the characteristics of complex dynamic systems, yet dynamic simulation modelling has to date only rarely been used to conduct economic evaluation in this area. This article proposes an integrated decision-making and planning framework for mental health that includes system dynamics modelling, cost-effectiveness analysis, and participatory model-building methods, in a circular process that is constantly reviewed and updated in a 'living model' ecosystem. We describe a case study of this approach for mental health system policy and planning that synergises the unique attributes of a system dynamics approach within the context of economic evaluation. This kind of approach can help decision makers make the most of precious, limited resources in healthcare. The application of modelling to organise and enable better responses to the youth mental health crisis offers positive benefits for individuals and their families, as well as for taxpayers.
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Affiliation(s)
- Paul Crosland
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia.
- Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, NSW, 2050, Australia.
| | - Deborah A Marshall
- Cumming School of Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Seyed Hossein Hosseini
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Nicholas Ho
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Catherine Vacher
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Adam Skinner
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Kim-Huong Nguyen
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Frank Iorfino
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Sebastian Rosenberg
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
- Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Kristen Tran
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Jo-An Occhipinti
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology, Brain and Mind Centre, Faculty of Medicine and Health, Translational Research Collective, University of Sydney, Sydney, Australia
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Iannelli O, Hirvonen T, Robotham J, Song YJC, Occhipinti JA, Lee GY, Troy JF, Vacher C, Bray A, Chang EP, Hickie IB, Dudgeon P. Participatory systems modelling to inform improvements in the social and emotional wellbeing of young Aboriginal and Torres Strait Islander people in Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 52:101213. [PMID: 39664595 PMCID: PMC11632743 DOI: 10.1016/j.lanwpc.2024.101213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 09/02/2024] [Accepted: 09/18/2024] [Indexed: 12/13/2024]
Affiliation(s)
- Olivia Iannelli
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tanja Hirvonen
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Julie Robotham
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | - Yun Ju Christine Song
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW, Australia
| | - Grace Yeeun Lee
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jakelin Fleur Troy
- Faculty of Arts and Social Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Catherine Vacher
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Abigail Bray
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
| | - Ee Pin Chang
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ian Bernard Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Pat Dudgeon
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA, Australia
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Mohd Tohit NF, Haque M. Forbidden Conversations: A Comprehensive Exploration of Taboos in Sexual and Reproductive Health. Cureus 2024; 16:e66723. [PMID: 39139803 PMCID: PMC11319820 DOI: 10.7759/cureus.66723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2024] [Indexed: 08/15/2024] Open
Abstract
This scoping review aims to comprehensively explore the landscape of taboos and their impact on sexual and reproductive health. Titled "Forbidden Conversations," it delves into the intricate web of societal, cultural, and religious norms that have contributed to the elusive and often stigmatized nature of sexual and reproductive health topics. The review navigates through the multifaceted dimensions of these taboos, shedding light on their impact on individuals, communities, and public health while advocating for a paradigm shift toward open, inclusive, and informed dialogue. The analysis within this review spans a decade, capturing the most recent and relevant literature to map the landscape of taboos in sexual and reproductive health. It explores the persistent societal apprehensions and subsequent stigmatization surrounding topics such as menstruation, contraception, fertility, sexual orientation, and gender identity. The review contextualizes the multifaceted challenges presented by these prevailing norms by tracing historically rooted taboos and their evolution across different cultures and contexts. The scoping review identifies the profound implications of these taboos on public health, highlighting how they contribute to disparities in access to healthcare, perpetuate misinformation, and infringe upon the fundamental rights of individuals. It addresses the challenges in sexual education, emphasizing how these taboos impede comprehensive understanding and enforcement of sexual and reproductive health rights among adolescents and young adults. The intersectional approach taken in this review situates these taboos within broader systems of inequality, emphasizing the compounded impact they have on marginalized populations. Through this comprehensive exploration, the review aims to provide actionable insights and identify existing research, policy, and practice gaps. It seeks to lay the foundation for future initiatives that advocate for destigmatization, empowerment, and equity in sexual and reproductive health. Ultimately, "Forbidden Conversations" aims to steer the conversation toward openness and inclusivity while advocating for unbiased, comprehensive sexual and reproductive healthcare with dignity for all individuals.
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Affiliation(s)
- Nor Faiza Mohd Tohit
- Department of Community Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
| | - Mainul Haque
- Department of Research, Karnavati Scientific Research Center (KSRC) School of Dentistry, Karnavati University, Gandhinagar, IND
- Department of Pharmacology and Therapeutics, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, MYS
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Lawal SA, Adedeji IA, Ogunniyi A, Henderson D. Social domains of poor mental health: A qualitative pilot study of community stakeholders' understanding and demarcation of mental illness and its interpretations in rural Nigeria. Health Sci Rep 2024; 7:e1922. [PMID: 38420202 PMCID: PMC10899201 DOI: 10.1002/hsr2.1922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Background and Aims Although previous studies on mental health/illness in Nigeria have explored knowledge and attitude of community members using quantitative approaches, few studies have engaged stakeholders within rural communities on the issue of mental illness using qualitative approaches. Community stakeholders play a critical role in influencing health behaviors. The objective of this pilot study was to explore community stakeholders' understanding and demarcation of mental illness, and its interpretations in a rural Nigerian town. This is with the aim of shaping stakeholders understanding of people when they experience mental distress within the community. Methods The study was conducted in Ijebu-Igbo town of Ogun State in south-west Nigeria. In-depth interviews were conducted among two religious' leaders: a Pastor and an Imam, a traditional healer, a medical doctor, and a registered nurse, and a focus group discussion was held in a church with members of its advisory committee. Results The findings showed that community stakeholders gave multiple interpretations of mental illness and many attribute mental illness to spiritual attack, ancestral curse, anger of the gods, and personal affliction (Ogun-Afowofa). This has been categorized as familial and individual attributes in this study which is part of the main themes derived. The study findings also show that the understanding of community members regarding the root causes of mental illness is somewhat vague based on their poor knowledge of mental illness. This is because of the various interpretations they gave to explain mental health is based on their cultural orientation, socialization, and belief system, and not based on any medical knowledge. Conclusion This pilot study was conducted to justify the main study. There is therefore a need for health education interventions to enlighten and educate community stakeholders with requisite knowledge for better understanding and interpretation of mental illness. Also, through mental health education interventions, community members will gain clarity on what mental health is and what it is not.
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Affiliation(s)
- Saheed A. Lawal
- Department of Public Health, School of Public and Allied HealthBabcock UniversityIlishan‐RemoOgun StateNigeria
| | - Isaac A. Adedeji
- Department of GerontologySimon Fraser UniversityBritish ColumbiaCanada
| | - Adesola Ogunniyi
- Department of Medicine, College of MedicineUniversity of IbadanIbadanNigeria
| | - David Henderson
- Department of Psychiatry, Boston University Medical CenterBoston UniversityBostonMassachusettsUSA
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Lee GY, Robotham J, Song YJC, Occhipinti JA, Troy J, Hirvonen T, Feirer D, Iannelli O, Loblay V, Freebairn L, Agung-Igusti R, Chang EP, Dudgeon P, Hickie IB. Partnering with Aboriginal and Torres Strait Islander Peoples: An Evaluation Study Protocol to Strengthen a Comprehensive Multi-Scale Evaluation Framework for Participatory Systems Modelling through Indigenous Paradigms and Methodologies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:53. [PMID: 36612375 PMCID: PMC9819653 DOI: 10.3390/ijerph20010053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
The social and emotional wellbeing of young Aboriginal and Torres Strait Islander peoples should be supported through an Indigenous-led and community empowering approach. Applying systems thinking via participatory approaches is aligned with Aboriginal and Torres Strait Islander research paradigms and can be an effective method to deliver a decision support tool for mental health systems planning for Indigenous communities. Evaluations are necessary to understand the effectiveness and value of such methods, uncover protective and healing factors of social and emotional wellbeing, as well as to promote Aboriginal and Torres Strait Islander self-determination over allocation of funding and resources. This paper presents modifications to a published evaluation protocol for participatory systems modelling to align with critical Aboriginal and Torres Strait Islander guidelines and recommendations to support the social and emotional wellbeing of young people. This paper also presents a culturally relevant participatory systems modelling evaluation framework. Recognizing the reciprocity, strengths, and expertise Aboriginal and Torres Strait Islander methodologies can offer to broader research and evaluation practices, the amended framework presented in this paper facilitates empowering evaluation practices that should be adopted when working with Aboriginal and Torres Strait Islander peoples as well as when working with other diverse, non-Indigenous communities.
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Affiliation(s)
- Grace Yeeun Lee
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Julie Robotham
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Yun Ju C. Song
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Jo-An Occhipinti
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
- Computer Simulation & Advanced Research Technologies (CSART), Sydney, NSW 2021, Australia
| | - Jakelin Troy
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Tanja Hirvonen
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia
| | - Dakota Feirer
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Olivia Iannelli
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Victoria Loblay
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
| | - Louise Freebairn
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, ACT 2601, Australia
| | - Rama Agung-Igusti
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Ee Pin Chang
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Pat Dudgeon
- Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, School of Indigenous Studies, University of Western Australia, Perth, WA 6009, Australia
| | - Ian Bernard Hickie
- Brain and Mind Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia
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Bui TA, Pohl M, Rosenfelt C, Ogourtsova T, Yousef M, Whitlock K, Majnemer A, Nicholas D, Demmans Epp C, Zaiane O, Bolduc FV. Identifying Potential Gamification Elements for A New Chatbot for Families With Neurodevelopmental Disorders: User-Centered Design Approach. JMIR Hum Factors 2022; 9:e31991. [PMID: 35984679 PMCID: PMC9440405 DOI: 10.2196/31991] [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: 07/13/2021] [Revised: 05/26/2022] [Accepted: 06/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Chatbots have been increasingly considered for applications in the health care field. However, it remains unclear how a chatbot can assist users with complex health needs, such as parents of children with neurodevelopmental disorders (NDDs) who need ongoing support. Often, this population must deal with complex and overwhelming health information, which can make parents less likely to use a software that may be very helpful. An approach to enhance user engagement is incorporating game elements in nongame contexts, known as gamification. Gamification needs to be tailored to users; however, there has been no previous assessment of gamification use in chatbots for NDDs. OBJECTIVE We sought to examine how gamification elements are perceived and whether their implementation in chatbots will be well received among parents of children with NDDs. We have discussed some elements in detail as the initial step of the project. METHODS We performed a narrative literature review of gamification elements, specifically those used in health and education. Among the elements identified in the literature, our health and social science experts in NDDs prioritized five elements for in-depth discussion: goal setting, customization, rewards, social networking, and unlockable content. We used a qualitative approach, which included focus groups and interviews with parents of children with NDDs (N=21), to assess the acceptability of the potential implementation of these elements in an NDD-focused chatbot. Parents were asked about their opinions on the 5 elements and to rate them. Video and audio recordings were transcribed and summarized for emerging themes, using deductive and inductive thematic approaches. RESULTS From the responses obtained from 21 participants, we identified three main themes: parents of children with NDDs were familiar with and had positive experiences with gamification; a specific element (goal setting) was important to all parents, whereas others (customization, rewards, and unlockable content) received mixed opinions; and the social networking element received positive feedback, but concerns about information accuracy were raised. CONCLUSIONS We showed for the first time that parents of children with NDDs support gamification use in a chatbot for NDDs. Our study illustrates the need for a user-centered design in the medical domain and provides a foundation for researchers interested in developing chatbots for populations that are medically vulnerable. Future studies exploring wide range of gamification elements with large number of potential users are needed to understand the impact of gamification elements in enhancing knowledge mobilization.
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Affiliation(s)
- Truong An Bui
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Megan Pohl
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Cory Rosenfelt
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Tatiana Ogourtsova
- Feil & Oberfeld Research Centre of the Jewish Rehabilitation Hospital - Centre intégré de santé et de services sociaux de Laval (CISSS Laval), Centre for Interdisciplinary Research of Greater Montreal (CRIR), Laval, QC, Canada
- School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences, Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - Mahdieh Yousef
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kerri Whitlock
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Annette Majnemer
- School of Physical & Occupational Therapy, Faculty of Medicine and Health Sciences, Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada
| | - David Nicholas
- Central and Northern Alberta Region, Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Carrie Demmans Epp
- EdTeKLA Research Group, Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - Osmar Zaiane
- Department of Computing Science, University of Alberta, Edmonton, AB, Canada
| | - François V Bolduc
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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