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Hynie M, Oda A, Calaresu M, Kuo BCH, Ives N, Jaimes A, Bokore N, Beukeboom C, Ahmad F, Arya N, Samuel R, Farooqui S, Palmer-Dyer JL, McKenzie K. Access to Virtual Mental Healthcare and Support for Refugee and Immigrant Groups: A Scoping Review. J Immigr Minor Health 2023; 25:1171-1195. [PMID: 37407884 PMCID: PMC10509103 DOI: 10.1007/s10903-023-01521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Immigrant and refugee populations face multiple barriers to accessing mental health services. This scoping review applies the (Levesque et al. in Int J Equity Health 12:18, 2013) Patient-Centred Access to Healthcare model in exploring the potential of increased access through virtual mental healthcare services VMHS for these populations by examining the affordability, availability/accommodation, and appropriateness and acceptability of virtual mental health interventions and assessments. A search in CINAHL, MEDLINE, PSYCINFO, EMBASE, SOCINDEX and SCOPUS following (Arksey and O'Malley in Int J Soc Res Methodol 8:19-32, 2005) guidelines found 44 papers and 41 unique interventions/assessment tools. Accessibility depended on individual (e.g., literacy), program (e.g., computer required) and contextual/social factors (e.g., housing characteristics, internet bandwidth). Participation often required financial and technical support, raising important questions about the generalizability and sustainability of VMHS' accessibility for immigrant and refugee populations. Given limitations in current research (i.e., frequent exclusion of patients with severe mental health issues; limited examination of cultural dimensions; de facto exclusion of those without access to technology), further research appears warranted.
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Affiliation(s)
- Michaela Hynie
- Department of Psychology, York University, Toronto, Canada.
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada.
| | - Anna Oda
- Centre for Refugee Studies, York University, 4700 Keele St., Toronto, ON, M3J1P3, Canada
| | - Michael Calaresu
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Ben C H Kuo
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Nicole Ives
- School of Social Work, McGill University, Montreal, Canada
| | - Annie Jaimes
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
| | - Nimo Bokore
- School of Social Work, Carleton University, Ottawa, Canada
| | | | - Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Canada
| | - Neil Arya
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Rachel Samuel
- Counseling Psychology, Yorkville University, Fredericton, Canada
| | | | | | - Kwame McKenzie
- Wellesley Institute, Toronto, Canada
- Division of Health Equity, CAMH, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Ahmad F, Wang J, Wong B, Fung WLA. Interactive mental health assessments for Chinese Canadians: A pilot randomized controlled trial in nurse practitioner-led primary care clinic. Asia Pac Psychiatry 2022; 14:e12400. [PMID: 32608131 DOI: 10.1111/appy.12400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Mental health conditions like depression and anxiety are on the rise, but access to care remains a challenge. Immigrants and racialized communities including Chinese Canadians experience high level of access barriers including communication with clinicians. With the aim to facilitate mental health communications, we tested an Interactive Computer-assisted Client Assessment Survey (iCCAS) in Cantonese/Mandarin and English at a nurse practitioner-led primary care clinic in Toronto. The iCCAS offers a touch-screen, pre-consultation survey with questions on depression, anxiety, post-traumatic stress, alcohol abuse, and social context. The program generates point-of-care reports for the clinician and patient. METHODS A pilot randomized controlled trial examined the intervention impact on mental health discussion and symptom detection, compared with the usual care, followed by clinicians' qualitative interviews. RESULTS Fifty self-identified Chinese adult patients participated (iCCAS = 26, Usual Care = 24), response rate 79.4%. Participant mean age was 44.8 years and 92% were immigrants. There was an increase of 19% and 15% in the mental health discussion and detection of symptoms in the iCCAS group compared with the usual care. More participants in the iCCAS group were referred to a social worker or psychiatrist. Patients found the use of iCCAS easy and clinicians identified its benefits for themselves (eg, early identification and comfort) and patients (eg, self-awareness and anonymity) and proposed practice-integration. DISCUSSION The studied tool holds promise for enhancing clinician-patient mental health communications in primary care settings for overseas Chinese. Implications are discussed for in-person and virtual healthcare which could also inform responses to mental health crisis related to COVID-19.
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Affiliation(s)
- Farah Ahmad
- School of Health Policy and Management, York University, Toronto, Ontario, Canada.,North York General Hospital, Toronto, Ontario, Canada
| | - Jamie Wang
- Office of Research and Innovations, North York General Hospital, Toronto, Ontario, Canada
| | - Bonnie Wong
- Hong Fook Mental Health Association, Toronto, Ontario, Canada.,HF Connecting Health Nurse Practitioner-Led Clinic, Toronto, Ontario, Canada
| | - Wai Lun Alan Fung
- HF Connecting Health Nurse Practitioner-Led Clinic, Toronto, Ontario, Canada.,Tyndale University, Toronto, Ontario, Canada.,North York General Hospital and Mount Sinai Hospital, Toronto, Ontario, Canada.,Faculty Member, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Liem A, Natari RB, Jimmy, Hall BJ. Digital Health Applications in Mental Health Care for Immigrants and Refugees: A Rapid Review. Telemed J E Health 2021; 27:3-16. [DOI: 10.1089/tmj.2020.0012] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Andrian Liem
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
- School of Psychology and The University of Queensland, Brisbane, Australia
| | - Rifani B. Natari
- School of Pharmacy, The University of Queensland, Brisbane, Australia
- Department of Pharmacy, Jambi Regional Psychiatric Hospital, Jambi City, Indonesia
| | - Jimmy
- School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
- Department of Computer Science, The University of Surabaya, Surabaya, Indonesia
| | - Brian J. Hall
- Global and Community Mental Health Research Group, Department of Psychology, University of Macau, Macao (SAR), China
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Global Mental Health and Services for Migrants in Primary Care Settings in High-Income Countries: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228627. [PMID: 33233666 PMCID: PMC7699722 DOI: 10.3390/ijerph17228627] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/22/2022]
Abstract
Migrants are at a higher risk for common mental health problems than the general population but are less likely to seek care. To improve access, the World Health Organization (WHO) recommends the integration of mental health services into primary care. This scoping review aims to provide an overview of the types and characteristics of mental health services provided to migrants in primary care following resettlement in high-income countries. We systematically searched MEDLINE, EMBASE, PsycInfo, Global Health, and other databases from 1 January 2000 to 15 April 2020. The inclusion criteria consisted of all studies published in English, reporting mental health services and practices for refugee, asylum seeker, or undocumented migrant populations, and were conducted in primary care following resettlement in high-income countries. The search identified 1627 citations and we included 19 studies. The majority of the included studies were conducted in North America. Two randomized controlled trials (RCTs) assessed technology-assisted mental health screening, and one assessed integrating intensive psychotherapy and case management in primary care. There was a paucity of studies considering gender, children, seniors, and in European settings. More equity-focused research is required to improve primary mental health care in the context of global mental health.
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Holt JM, Cusatis R, Winn A, Asan O, Spanbauer C, Williams JS, Flynn KE, Somai M, Laud P, Crotty BH. The Impact of Previsit Contextual Data Collection on Patient-Provider Communication and Patient Activation: Study Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e20309. [PMID: 32965223 PMCID: PMC7542405 DOI: 10.2196/20309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patient-centered care is respectful of and responsive to individual patient preferences, needs, and values. To provide patient-centered care, clinicians need to know and incorporate patients' context into their communication and care with patients. Patient contextual data (PCD) encompass social determinants of health and patients' needs, values, goals, and preferences relevant to their care. PCD can be challenging to collect as a routine component of the time-limited primary care visit. OBJECTIVE This study aims to determine if patient-provider communication and patient activation are different for patient users and patient nonusers of an electronic health record (EHR)-integrated PCD tool and assess if the impact of using PCD on patient-provider communication and patient activation differs for Black and White patients. METHODS We describe a randomized controlled trial of a prospective cohort of non-Hispanic White and Black patients who receive primary care services at a midwestern academic health care system in the United States. We will evaluate whether providing PCD through a consumer informatics tool enhances patient-provider communication, as measured by the Communication Assessment Tool, and we will evaluate patient activation, as measured by the Patient Activation Measure for PCD tool users and nonusers. Furthermore, owing to racial disparities in care and communication, we seek to determine if the adoption and use of the tool might narrow the differences between patient groups. RESULTS The trial was funded in November 2017 and received local ethics review approval in February 2019. The study began recruitment in April 2019 and enrollment concluded in October 2019 with 301 participants. The analysis was completed in May 2020, and trial results are expected to be published in winter 2020. CONCLUSIONS Recently, there has been increased attention to the role of health information technology tools to enable patients to collaborate with providers through the sharing of PCD. The adoption of such tools may overcome the barriers of current EHRs by directly engaging patients to submit their contextual data. Effectively, these tools would support the EHR in providing a more holistic understanding of the patient. Research further supports that individuals who have robust digital engagement using consumer informatics tools have higher participation in treatment follow-up and self-care across populations. Therefore, it is critical to investigate interventions that elicit and share patients' social risks and care preferences with the health care team as a mechanism to improve individualized care and reduce the gap in health outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03766841; https://clinicaltrials.gov/ct2/show/NCT03766841. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/20309.
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Affiliation(s)
- Jeana M Holt
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
- Department of Family & Community Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Rachel Cusatis
- Hematology and Oncology Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Aaron Winn
- School of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Onur Asan
- School of Systems and Enterprises, Stevens Institute of Technology, Hoboken, NJ, United States
| | - Charles Spanbauer
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joni S Williams
- Department of Medicine, Medical College of Wisconsin, Center for Advancing Population Science, Milwaukee, WI, United States
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Melek Somai
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Purushottam Laud
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bradley H Crotty
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Abstract
Despite the increasing presence of Chinese communities in the West, their experiences of depression and the variations in symptoms or presentation are not well understood. Using Arksey and O'Malley's methodical framework, we conducted a scoping review of the published literature, using electronic databases MEDLINE and PsycINFO, and searched for articles published since 1999. Out of 1177 articles identified, 21 met the inclusion criteria. Thematic synthesis revealed valuable scholarly work on (1) depression rates, migration, and contextual determinants, (2) causation beliefs and help seeking, (3) acculturation and symptoms, (4) presenting symptoms and somatization, and (5) culturally sensitive assessment and care. Overall, this review has identified the importance of contextual determinants in the development of depression, low rates of seeking of professional help, subtle variations in somatization, and knowledge gaps in culturally sensitive care. The findings suggest that, rather than treating migration as a cause of mental distress, the accompanying conditions and events need to be further examined and addressed as potential risk or protective factors. Subtle variations in somatization are also evident, and future scholarly work should examine the notion of cultural scripts-namely, that people attend and react to particular experiences in culturally based ways. For this reason (among others), practice models need to develop strategies for culturally sensitive care, such as co-construction of illness narratives and finding common ground. Given the stigma of mental illness and the low level of seeking professional help, the role of primary care should be expanded. Further studies investigating mental health issues beyond depression are also warranted in the studied community.
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Brinker TJ, Brieske CM, Esser S, Klode J, Mons U, Batra A, Rüther T, Seeger W, Enk AH, von Kalle C, Berking C, Heppt MV, Gatzka MV, Bernardes-Souza B, Schlenk RF, Schadendorf D. A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic. J Med Internet Res 2018; 20:e10976. [PMID: 30111525 PMCID: PMC6115598 DOI: 10.2196/10976] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 06/22/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. OBJECTIVE The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. METHODS We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. RESULTS During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). CONCLUSIONS A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking.
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Affiliation(s)
- Titus Josef Brinker
- National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Christian Martin Brieske
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
- German Cancer Consortium, University of Heidelberg, Heidelberg, Germany
| | - Stefan Esser
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Ute Mons
- Cancer Prevention Unit, German Cancer Research Center, Heidelberg, Germany
| | - Anil Batra
- Section for Addiction Medicine and Addiction Research, University Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Rüther
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Werner Seeger
- Universities of Giessen and Marburg Lung Center, Department of Internal Medicine, Justus-Liebig-University, Gießen, Germany
| | - Alexander H Enk
- Department of Dermatology, Heidelberg University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Carola Berking
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Markus V Heppt
- Department of Dermatology, University Medical Center Munich, University of Munich, Munich, Germany
| | - Martina V Gatzka
- Department of Dermatology and Allergic Diseases, University of Ulm, Ulm, Germany
| | | | - Richard F Schlenk
- Trial Center, National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
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Ferrari M, Shakya Y, Ledwos C, McKenzie K, Ahmad F. Patients' Mental Health Journeys: A Qualitative Case Study with Interactive Computer-Assisted Client Assessment Survey (iCASS). J Immigr Minor Health 2017; 20:1173-1181. [PMID: 28831628 DOI: 10.1007/s10903-017-0643-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite growing concerns about common mental disorders (CMDs), challenges persist in accessing timely and appropriate care, especially for immigrant, refugee, racialized and low-income groups. Partnering with a community health centre serving these populations in Toronto, we examined the Interactive Computer-assisted Client Assessment Survey (iCCAS) that screens for CMDs (depression, generalized anxiety, post-traumatic stress, and alcohol overuse) and related social factors. In this case study design with embedded units, we explored the mental health care journeys of patients who screened positive for a CMD. The analysis identified three major pathways of care: (1) early detection of previously unidentified CMDs; (2) detection of comorbid mental health conditions; and (3) prevention of possible relapse and/or management of existing previously recognized mental health condition. These cases indicate iCCAS holds potential to facilitate more open, tailored, and informed collaborations between patients and clinicians regarding mental health care plans.
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Affiliation(s)
- Manuela Ferrari
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON, M3J1P3, Canada
| | - Yogendra Shakya
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON, M5T3A9, Canada
| | - Cliff Ledwos
- Access Alliance Multicultural Health and Community Services, 340 College Street, Suite 500, Toronto, ON, M5T3A9, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J1H4, Canada
| | - Farah Ahmad
- School of Health Policy and Management, York University, 4700 Keele Street, HNES Building, Rm 414, Toronto, ON, M3J1P3, Canada.
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