Digital Health Interventions in Older Adult Populations Living With Chronic Disease in High-Income Countries: Protocol for a Scoping Review

BACKGROUND

Globally, around 80% percent of adults aged 65 years or older are living with at least 1 chronic disease, and 68% percent have 2 or more chronic diseases. Older adults living with chronic diseases require greater health care services, but these health care services are not always easily accessible. Furthermore, the COVID-19 pandemic has resulted in unprecedented changes in the provision of health care services for older adults. During the COVID-19 pandemic, digital health interventions for chronic disease management were developed out of necessity, but the evidence regarding these and developed interventions is lacking.

OBJECTIVE

In this scoping review, we aim to identify available digital health interventions such as emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms for chronic disease management for older adults in high-income countries.

METHODS

We will follow the Arksey and O'Malley framework to conduct the scoping review. Our full search strategy was developed following a preliminary search on MEDLINE. We will include studies where older adults are at least 65 years of age, living with at least 1 chronic disease (eg, cancer, cardiovascular disease, chronic obstructive pulmonary disease, and diabetes), and residing in high-income countries. Digital health interventions will be broadly defined to include emails, text messages, voice messages, telephone calls, video calls, mobile apps, and web-based platforms.

RESULTS

This scoping review is currently ongoing. As of March 2023, our full search strategy has resulted in a total of 9901 records. We completed the screening of titles and abstracts and obtained 442 abstracts for full-text review. We are aiming to complete our full-text review in October 2024, data extraction in November 2024, and data synthesis in December 2024.

CONCLUSIONS

This scoping review will generate evidence that will contribute to the further development of digital health interventions for future chronic disease management among older adults in high-income countries. More evidence-based research is needed to better understand the feasibility and limitations associated with the use of digital health interventions for this population. These evidence-based findings can then be disseminated to decision-makers and policy makers in other high-income countries.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/49130.

Mental healthcare-seeking behavior of women in Bangladesh: content analysis of a social media platform

BACKGROUND

Mental health remains a highly stigmatized area of healthcare, and people often conceal their concerns rather than seek assistance or treatment. The Women Support Initiative Forum (WSIF) is a social media platform established in 2018 to provide expert and peer-led psychosocial support services to women of all ages in Bangladesh. The anonymous nature of the forum means that mental health concerns can be aired without fear of identification.

METHOD

A content analysis was conducted on the anonymous posts retrieved from the WSIF platform between 8^th March 2020 and 7^th July 2022. Around 1457 posts were initially selected for analysis which was reduced to 1006 after removing duplicates and non-relevant posts, such as queries about the addresses of the doctors and other non-mental health-related issues. A thematic analysis of the data was conducted using an inductive approach.

RESULT

The 1006 posts generated four themes and nine sub-themes. All the women mentioned mental health symptoms (n = 1006; 100%). Most also mentioned reasons for seeking mental healthcare (n = 818; 81.31%), healthcare-seeking behavior (n = 667; 66.30%), and barriers to seeking mental healthcare (n = 552; 54.87%). The majority of women described symptoms of stress, depression, and anxiety-like symptoms, which were aggregated under common mental health conditions. Mental health symptoms were ascribed to various external influences, including marital relationship, intrafamilial abuse, and insecurities related to the COVID-19 pandemic. A large proportion of posts were related to women seeking information about mental healthcare services and service providers (psychologists or psychiatrists). The analysis found that most women did not obtain mental healthcare services despite their externalized mental health symptoms. The posts identified clear barriers to women accessing mental health services, including low mental health literacy, the stigma associated with mental healthcare-seeking behavior, and the poor availability of mental health care services.

CONCLUSION

The study revealed that raising mass awareness and designing culturally acceptable evidence-based interventions with multisectoral collaborations are crucial to ensuring better mental healthcare coverage for women in Bangladesh.

Protocol for integrating mental health services into primary healthcare facilities: a qualitative study of the perspectives of patients, family members and healthcare providers in rural Bangladesh

INTRODUCTION

In Bangladesh, Non-communicable diseases (NCDs) account for 67% of all deaths. Mental health services are not available in routine healthcare at the primary facilities in Bangladesh. The protocol is for a qualitative study that seeks to understand the perceptions, beliefs and norms regarding common mental disorders (CMDs) among patients with NCD with and without CMDs to identify barriers to accessing mental health services in rural communities in Bangladesh. We also aim to explore the feasibility of integrating mental healthcare into routine NCD services at primary health facilities in rural Bangladesh.

METHODS AND ANALYSIS

This study will be conducted at the outpatient departments in two subdistrict hospitals and one district hospital in Munshiganj district in Bangladesh. We will purposefully select patients with hypertension and diabetes from the patient inventory generated from a recently completed randomised control trial titled 'Control of Blood Pressure and Risk Attenuation Bangladesh, Pakistan, Sri Lanka' in two subdistricts in Munshiganj district in Bangladesh. The selected participants will be screened for CMD using the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) over the telephone. Sixty in-depth interviews with patients and family members, 8-10 key informant interviews with healthcare providers and 2 focus group discussions with community health workers will be held following consent.The study is conceptualised under Levesque et al's framework. Thematic analysis will be applied following the study objectives and key issues, and commonly emerging topics generated by the data. The findings will be presented anonymously to corroborate the interpretation.

ETHICS AND DISSEMINATION

Approval has been obtained from the Institutional Review Board at icddr,b (PR-19108) and the University of York (HSRGC/2020/382/F). Written informed consent or audio recording consent form in Bangla will be obtained. For dissemination, we will invite representatives of the collaborating institutions to share the findings in national or international conferences and peer-reviewed journals.

Mental Health Issues in the COVID-19 Pandemic and Responses in Bangladesh: View Point of Media Reporting

Background: The negative impact of COVID-19 on mental health has been reported by media throughout the world, although this role is not well-understood in low-and middle-income countries (LMIC). We examined the reporting of mental health issues during the COVID-19 pandemic in Bangladesh and initiatives undertaken to support mental health reported from the viewpoint of media. Methods: We reviewed articles published in 10 local newspapers, including seven Bangla and three English newspapers, during the first year of the COVID-19 pandemic. News topics were identified through discussions among the team members, with searches across online newspapers and portals. Data extrapolated from newspapers were documented in an Excel spreadsheet. A mixed-method approach was used following a framework analysis for analyzing data. Recurring issues and commonly emerging topics were generated from the data. Descriptive statistics were applied for analyzing quantitative data. Results: Between March 2020 and March 2021, we have identified 201 reports on mental health issues including 45 reports (22.4%) focused on stress due to the associated financial crisis, unemployment and loneliness, 50 reports (24.9%) of 80 apparent suicides linked to family issues, disharmony in conjugal relationships, harassment, sexual violence, emotional breakdown, financial crisis, and stigma due to COVID-19.There were 77 reports (38.3%) concerning domestic violence during the pandemic. Twenty-nine reports (14.4%) referenced actions taken by different organizations to address mental health issues in response to the pandemic in Bangladesh. Conclusion: News coverage has the scope to highlight important issues that can emerge as a consequence of the COVID-pandemic, such as mental health, in a low resource setting. Capacity building of the media on the way to report mental health issues during emergency situations could be a useful strategy for more credible reporting on mental health issues during the COVID-19 pandemic for raising awareness of the public and policymakers about the negative consequences on mental health of the COVID-19 pandemic in Bangladesh. Adopting policies to support essential mental health care and promoting the local organizations to take timely public health measures will be imperative for averting the negative consequences of mental health due to the COVID-19 pandemic in Bangladesh.

Effect of Smoking Status on Mortality and Morbidity Following Coronary Artery Bypass Surgery

BACKGROUND

We aimed to examine the effect of smoking on outcomes following coronary artery bypass grafting (CABG).

METHODS

We retrospectively analysed 6 367 consecutive patients who underwent CABG between April 1997 and March 2003. Logistic regression was used to risk adjust in-hospital outcomes, while Cox proportional hazards analysis was used to risk adjust Kaplan-Meier survival curves. Outcomes were adjusted for variables suggested by the American Heart Association and American College of Cardiology.

RESULTS

947 (14.9 %) patients were current smokers (smoking within 1 month of surgery), while 3857 (60.6 %) were ex-smokers and 1 563 (24.5 %) were non-smokers. After adjusting for differences in case-mix, current smokers were more likely to develop chest infections ( p < 0.001), atelectasis ( p < 0.001), and require ventilation longer than 48 hours ( p = 0.003). Current smokers were also more likely to stay in intensive care for more than 3 days ( p < 0.001). Ex-smokers were not associated with excess mortality ( p = 0.11), while current smokers had significantly increased mortality during follow-up ( p = 0.029).

CONCLUSIONS

Patients should be encouraged to stop smoking to maximise the long-term benefits of CABG.