How Psychological Telehealth Can Alleviate Society's Mental Health Burden: A Literature Review

Mental health professionals must establish new means to reach those in need that face obstacles related to geographical location, time limitations, and health. With the high incidence of mental illness, as well as the hypothesized increase in coming years, telehealth modalities propose a novel and far-reaching alternative to traditional therapy. This article outlines the positive aspects and interdisciplinary possibilities when telehealth is incorporated into mental health practice. Novel outlets including mHealth and the utilization of computer tablets as mental health facilitators are outlined. Considerations for practice including training are discussed, as well as potential future directions for the field. Available data supports telehealth as an effective mode for the treatment of clients who are unable to pursue mental health services in their current form. However, careful consideration and training for the mental health professional is needed if telehealth is to be effectively used to alleviate the mental health burden.     

Mobile technologies and communication strategies in an urban Midwifery Group Practice setting. An exploratory study

BackgroundAround-the-clock access to a known midwife is a distinct feature of Midwifery Group Practice (MGP) and caseload midwifery settings; although the literature suggests this aspect of working life may hinder recruitment and retention to this model of care. Mobile technologies, known as mHealth where they are used in health care, facilitate access and hence communication, however little is known about this area of midwifery practice.Research questionWhich communication modalities are used, and most frequently, by MGP midwives and clients?MethodsA prospective, cross sectional design included a purposive sample of MGP midwives from an Australian tertiary maternity hospital. Data on modes of midwife–client contact were collected 24 h/day, for two consecutive weeks, and included: visits, phone-calls, texts and emails. Demographic data were also collected.FindingsDetails about 1442 midwife–client contacts were obtained. The majority of contact was via text, between the hours of 07:00 and 14:59, with primiparous women, when the primary midwife was on-call. An average of 96 contacts per fortnight occurred.ConclusionThe majority of contact was between the midwife and their primary clients, reiterating a key tenet of caseload models and confirming mobile technologies as a significant and evolving aspect of practice. The pattern of contact within social (or daytime) hours is reassuring for midwives considering caseload midwifery, who are concerned about the on-call burden. The use of text as the preferred communication modality raises issues regarding data security and retrieval, accountability, confidentiality and text management during off-duty periods. The development of Australian-wide guidelines to inform local policies and best practice is recommended.     

An mHealth Approach to Extend a Brief Intervention for Adolescent Alcohol Use and Suicidal Behavior: Qualitative Analyses of Adolescent and Parent Feedback

Abstract

Mobile health (mHealth) tools that supplement inpatient psychiatric care can maintain and enhance intervention effects following hospitalization. Adolescents hospitalized following a suicidal event represent a vulnerable population who could greatly benefit from such an mHealth intervention. In specific, suicidal adolescents who drink alcohol are in need of robust interventions that address the bidirectional relationship between alcohol use and suicidal thoughts and behaviors, because it puts them at especially high risk for suicide upon discharge. The purpose of this study was to conduct qualitative interviews to gather feedback to improve a brief alcohol intervention provided to suicidal adolescents during psychiatric hospitalization, and to develop a mHealth tool to extend care after discharge. Participants, eight adolescents and their parents, identified the need for a smartphone application to deliver intervention content to adolescents and parents during the posthospitalization period. Adolescents sought support in meeting alcohol- and mood-related goals, while parents desired general resources as well as tips for conversations with their adolescent about mood and alcohol use.     

What encourages community health workers to use mobile technologies for health interventions? Emerging lessons from rural Rwanda

This article explores the determinants of using mobile phone technologies for public health (mHealth) through a quantitative study with community health workers (CHWs) in rural Rwanda. A total of 72 CHWs from two districts in Rwanda who were using the mHealth tool, RapidSMS, were surveyed in June 2014. Using a socio‐technical approach, user, programme and technical characteristics were tested and deemed influential in determining use. Technical characteristics (reminders and alerts) were by far the strongest predicting factors of use. The user characteristic, age, had no influence on utilization, while supports though training and supervision (programme characteristics) revealed mixed findings. These findings illustrate the uniqueness of each context and reiterate the need to consider social and technical factors when implementing mHealth projects.     

Design,development and usability testing of Essential Coaching for Every Mother: A postnatal text message educational intervention

BackgroundThe transition to motherhood is an exciting yet challenging period that requires physical, emotional, and social adjustment. During the postpartum period, mothers require support and information to ensure a smooth transition and adjustment to motherhood. One innovative strategy to provide mothers with this information is mobile health (mHealth), and specifically, text messaging.ObjectiveTo describe the design, development and usability testing of a postnatal text message intervention called Essential Coaching for Every Mother.MethodsFirst time mothers (n = 11) and postpartum healthcare providers (n = 18) were involved in iterative interviewing in Halifax, Canada. Adaption of content occurred through three rounds of user testing using semi-structured interviews. The Information Assessment Method (IAM) Parents survey was also completed by mothers.ResultsThree cycles of iterative testing were conducted with eight participants (3 mothers, 5 healthcare providers), thirteen participants (8 mothers, 5 healthcare providers) and 8 participants (8 healthcare providers), respectively. Messages evolved from risk-focused to prevention and education focused. Mothers felt the messages addressed their needs and healthcare providers ensured the content was consistent with the messaging currently provided to postpartum mothers.ConclusionEssential Coaching for Every Mother is the first postnatal educational text message intervention developed for mothers in Halifax, Canada. We sought to involve first time mothers (end-users) and postpartum healthcare providers (experts) in the development and usability evaluation to ensure the intervention adequately met needs and was consistent with current practices related to postpartum education.     

Does self-help increase rates of help seeking for student mental health problems by minimizing stigma as a barrier?

Objective: This study examined whether self-help (books, websites, mobile apps) increases help seeking for mental health problems among college students by minimizing stigma as a barrier. Participants and Methods: A survey was conducted with 200 college students reporting elevated distress from February to April 2017. Results: Intentions to use self-help were low, but a significant portion of students unwilling to see mental health professionals intended to use self-help. Greater self-stigma related to lower intentions to seek professional help, but was unrelated to seeking self-help. Similarly, students who only used self-help in the past reported higher self-stigma than those who sought professional treatment in the past. Although stigma was not a barrier for self-help, alternate barriers were identified. Conclusions: Offering self-help may increase rates of students receiving help for mental health problems, possibly by offering an alternative for students unwilling to seek in-person therapy due to stigma concerns.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.     

Enabling informal digital guanxi for rural doctors in Shaanxi,China

In China, rural healthcare systems have been neglected in favor of the development of market-driven, largely urban health information systems (HIS). We investigated the effective use of information and communication technologies (ICTs) to develop a healthcare model within the rural healthcare system. We investigated information needs, existing healthcare structure, and the use of informal networks – guanxi – to acquire health information mediated by technology. Qualitative interviews (N = 74) were conducted in Shaanxi province of China. Respondents included village doctors (30), rural patients (10), urban doctors (17), and 17 other healthcare stakeholders. We found benefits of the use of ICT in informal networks for village doctors, including the facilitation of communication, greater time efficiency, and better access to medical information, particularly in mobile phone and QQ online social network usage. Guanxi relationships were established at proximate, distant, and virtual levels. Emergent communicative practices, such as Internet-driven medical research by village doctors, led to negotiations in established relationships. As suggested by the theoretical model, infrastructural, economic, socio-cultural, and technological vulnerabilities were also observed. We caution against the drawbacks of replication of the closed guanxi system in the digital ICT healthcare arena, and discuss the implications for research and policy-making.     

Systematic review on the cost and cost-effectiveness of mHealth interventions supporting women during pregnancy

ObjectivesThe increased integration of digital health into maternity care—alongside growing use of, and access to, personal digital technology among pregnant women—warrants an investigation of the cost-effectiveness of mHealth interventions used by women during pregnancy and the methodological quality of the cost-effectiveness studies.MethodsA systematic search was conducted to identify peer-reviewed studies published in the last ten years (2011–2021) reporting on the costs or cost-effectiveness of mHealth interventions used by women during pregnancy. Available data related to program costs, total incremental costs and incremental cost-effectiveness ratios (ICERs) were reported in 2020 United States Dollars. The quality of cost-effectiveness studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS).FindingsNine articles reporting on eight studies met the inclusion criteria. Direct intervention costs ranged from $7.04 to $86 per woman, total program costs ranged from $241,341 to $331,136 and total incremental costs ranged from -$21.16 to $1.12 million per woman. The following ICERs were reported: $2168 per DALY averted, $203.44 per woman ceasing smoking, and $3475 per QALY gained. The full economic evaluation studies (n = 4) were moderate to high in quality and all reported the mHealth intervention as cost-effective. Other studies (n = 4) were low to moderate in quality and reported low costs or cost savings associated with the implementation of the mHealth intervention.Conclusions for practicePreliminary evidence suggests mHealth interventions may be cost-effective and “low-cost” but more evidence is needed to ascertain the cost-effectiveness of mHealth interventions regarding positive maternal and child health outcomes and longer-term health service utilisation.