Strict social distancing and lockdown measures imposed to curb transmission during the early phase of the outbreak of the COVID-19 pandemic posed challenges to people’s psychological wellbeing, limited access to social support, and disrupted routine mental health service delivery. In response, a consortium of mental health stakeholders from Goa, India launched the COVIDAV program, which provided pro-bono virtual psychiatric and counselling consultations across India through an online platform. This study describes the acceptability and feasibility of the program from the perspective of various stakeholders.

Data were collected via a survey with clinicians who had volunteered on COVIDAV (n = 40), in depth interviews of the clinicians (n = 14), and focus group discussion with key collaborators (n = 1). Process data were mapped at various stages during the online platform’s development and use. The qualitative and quantitative data was analysed using thematic analysis and a descriptive analysis respectively.

Over 17 months, 63 clinicians conducted 2245 online sessions through the COVID platform, primarily accessed by youth across the country. The clinicians acknowledged the online platform’s ability to enhance access and reduce stigma. Challenges included session time constraints, connectivity issues, and user interface inconsistencies that interfered with clients’ accessibility to the services. High satisfaction rates amongst the service providers were reported, with 79.3% content with the service provision and 82.8% with pro bono contributions through the platform.

This study illustrates the feasibility, flexibility, and applicability of a rapidly designed pro-bono online platform for delivering mental health care services through the collaboration of stakeholder groups in the mental health care, private, social, and governmental sector. Our findings highlight the potential of rapidly deployed digital platforms, developed via cross-sector partnerships, to meet mental health care needs during unprecedented global emergencies such as the COVID-19 pandemic.

Referral system is among the key elements of primary health care that leads to enhanced efficiency, reduced costs, reduced waiting time, and patients’ enhanced access to more specialized services. The present study was aimed at analysing the policies of the electronic referral (e-Referral) system in Iran.

This qualitative study was conducted based on Walt and Gilson’s policy triangle and Kingdon’s models. Data were collected through document analysis and 51 semi-structured interviews with managers at various levels, experts, family physicians, specialist physicians, and patients. Document analysis was performed by content analysis method, and interview analysis was performed through framework analysis method in Atlas.ti 8.

The e-Referral system was launched with the aim of equitable access to services and to benefit from better management of health resources. Valid scientific evidences were used to formulate policies. Numerous meetings were held with domestic and foreign stakeholders at the provincial, city, and rural levels. The implementation of the programme followed a bottom-up approach, and the main obstacles to the implementation of the programme included the change of senior managers of the health system and their not being fully aware of the importance of the programme, inadequate allocation of financial resources, and unwillingness of some patients to follow the referral system.

The policy triangle framework, while explaining the components of the e-Referral system programme, revealed the obstacles to the proper implementation of the programme. In order to ensure that the programme goes on continuously and successfully, it is essential to create the necessary determination and commitment on the part of the minister of health and medical education and senior managers of the health system, earmark resources for the programme, improve resource allocation with insurance management, reform the payment system, plan to raise public awareness, and attract community participation.

This study is aimed to assess the implementation science outcomes of the coronavirus disease (COVID-19) e-health educational intervention in Ethiopia targeting health care workers via the RE-AIM (Reach, Effectiveness, Adaption, Implementation, Maintenance) framework.

A series of three 1-hour medical seminars focused on COVID-19 prevention and treatment education were conducted between May and August 2020. Educational content was built from medical sites previously impacted by COVID-19. Post-seminar evaluation information was collected from physician and other participants by a survey instrument. Cross-sectional evaluation results are reported here by RE-AIM constructs.

The medical seminars reached 324 participants. Key success metrics include that 90% reporting the information delivered in a culturally sensitive/tailored manner (effectiveness), 80% reporting that they planned to share the information presented with someone else (adoption and implementation), and 64% reporting using information presented in their daily clinical responsibilities 6 months after the first medical seminars (maintenance).

Grounded in a theoretical framework and following evidence-based best practices, this intervention advances the field of dissemination and implementation science by demonstrating how to transition health care training and delivery from an in-person to digital medium in low-resource settings like Ethiopia.

Patients attending psychiatric specialist health services in Northern Norway have since 2015 had the opportunity to access their medical records online. Prior to implementation, there were some concerns in the professional field that patient accessible electronic health records might introduce some challenges.

In this study, we asked psychiatric providers in outpatient psychiatric care about the impact of patients’ online access to documentation practices and whether they felt the access impacted the provider-patient relationship. We also examined whether the providers sought to deny patients’ access to any information.

16 qualitative in-depth interviews were performed with mental health providers working in the specialist services in North Norway. Participants had different professional backgrounds, and included doctors, nurses, psychologists and others. The interviews were audio recorded and transcribed verbatim. The data were qualitatively analyzed by means of the framework method.

The providers varied in their encouragement of patients’ online access, but few expressed concerns. There had been little specific training on how to optimize the writing of notes to accomodate patients’ online acces, but several pointed out that there had been an increased focus on the importance of adapting the notes to promote understanding. Increased transparency was in general seen positively, but the service might not fit all patient categories. Very few patients were denied access. In most cases, the service could improve the patients’ understanding of the treatment and the provider-patient relationship.

While some voiced caveats, patients’ online access was in general seen as beneficial to the treatment and the provider-patient relationship.

No significant relationships.

No significant relationships.

Despite its potential scalability, little is known about the outcomes of internet-based cognitive behaviour therapy (iCBT) for post-traumatic stress disorder (PTSD) when it is provided with minimal guidance from a clinician.

To evaluate the outcomes of minimally guided iCBT for PTSD in a randomised control trial (RCT, Study 1) and in an open trial in routine community care (Study 2).

A RCT compared the iCBT course (n=21) to a waitlist control (WLC, n=19) among participants diagnosed with PTSD. The iCBT group was followed up 3 months post-treatment. In Study 2, treatment outcomes were evaluated among 117 adults in routine community care. PTSD symptom severity was the primary outcome in both studies, with psychological distress and co-morbid anxiety and depressive symptoms providing secondary outcomes.

iCBT participants in both studies experienced significant reductions in PTSD symptom severity from pre- to post-treatment treatment (within-group Hedges’ g=.72–1.02), with RCT findings showing maintenance of gains at 3-month follow-up. The WLC group in the RCT also significantly improved, but Study 1 was under-powered and the medium between-group effect favouring iCBT did not reach significance (g=0.64; 95% CI, –0.10–1.38).

This research provides preliminary support for the utility of iCBT for PTSD when provided with minimal clinician guidance. Future studies are needed to clarify the effect of differing levels of clinician support on PTSD iCBT outcomes, as well as exploring how best to integrate iCBT into large-scale, routine clinical care of PTSD.

Empirically validated digital interventions for recurrent binge eating typically target numerous hypothesized change mechanisms via the delivery of different modules, skills, and techniques. Emerging evidence suggests that interventions designed to target and isolate one key change mechanism may also produce meaningful change in core symptoms. Although both ‘broad’ and ‘focused’ digital programs have demonstrated efficacy, no study has performed a direct, head-to-head comparison of the two approaches. We addressed this through a randomized non-inferiority trial.

Participants with recurrent binge eating were randomly assigned to a broad (n = 199) or focused digital intervention (n = 199), or a waitlist (n = 202). The broad program targeted dietary restraint, mood intolerance, and body image disturbances, while the focused program exclusively targeted dietary restraint. Primary outcomes were eating disorder psychopathology and binge eating frequency.

In intention-to-treat analyses, both intervention groups reported greater improvements in primary and secondary outcomes than the waitlist, which were sustained at an 8-week follow-up. The focused intervention was not inferior to the broad intervention on all but one outcome, but was associated with higher rates of attrition and non-compliance.

Focused digital interventions that are designed to target one key change mechanism may produce comparable symptom improvements to broader digital interventions, but appear to be associated with lower engagement.

Accurate and objective risk assessment is important in the evaluation of many mental disorders and behaviours. For example, in the evaluation of suicidal behaviour or the assessment of accidents in ADHD. Video games could contribute to improve the assessment and increase engagement.

Our hypothesis is that the proposed videogame can precisely evaluate risk. In addition, the developed game is able to indirectly assess the risk. This feature is useful in setups where patients are prone to lie.

We have developed a car driving video game where users are told that they should drive near to the border but not too much. We record distance to the border and each key pulsation every 0.1 seconds.

It has been observed that the median of recorded distance positively correlated with the score obtained by Self-report of Risk-taking Behaviors (SRB). In addition, the interquartile range significant correlates with the global score obtained in this questionnaire.

The proposed videogame is able of performing an accurate risk assessment. Our game takes seven minutes and it does not need complicated nor expensive hardware and could be deployed online. Results obtained open up new possibilities of creating video games which make an objective assessment risk.

In France about 10,000 suicides/year are recorded. General practitioners (GPs) have an important role in prevention, with consultation rates between 20% and 76% the day preceding suicide. StopBlues is an application/website for primary prevention of suicide in the general population. Its promotion was supported by municipalities and involved GPs.

To evaluate how the involvement of GPs in the promotion of StopBlues had an impact on its utilization.

StopBlues was promoted in 25 French municipalities randomly assigned to a ‘basic’ promotion group organized by municipalities only or an ‘intensified’ promotion group that also includes promotion in GPs’ waiting rooms. StopBlues users were asked how they found out about StopBlues. After two years, an ad hoc questionnaire was sent to all GPs (N=2,111).

StopBlues users from those municipalities (N=885) were 16% to learn about StopBlues from GPs, 93% of them living in municipalities with ‘intensified’ promotion. In the ‘basic’ group, where no GPs have heard about StopBlues, 15% would like to know more about it/will have a look at it and 8% will use it and recommend it to colleagues. Half of GPs from the ‘intensified’ group had heard about the program, with 24% who recommended StopBlues to some patients. 21% of GPs agreed that they will use it and recommend it to colleagues.

Involving GPs in the use of e-health tools is of major interest to improve their utilization. Our results show that GPs are in need of those in dealing with patients with psychological pain/distress.

No significant relationships.

Web-based tools allowed the provision of psychological counseling and therapy at-distance during the COVID-19 lockdown. Nevertheless, psychologists’ attitudes towards the adoption of these tools and its impact in their professional practices need to be further explored.

The objective was to study the use of web-based tools on psychological practices before and during COVID-19 lockdown, trying to identify changes on psychologists’ professional practices related to the pandemic, as well as to explore factors that could have affected such changes.

One-hundred and eight psychologists filled-in an online survey, developed for the purposes of this study, during mandatory lockdown. The study was disseminated by mailing list, social networks, and by the Portuguese Psychologists Association.

The results have shown that psychologists kept providing their services during lockdown thanks to the adoption of web-based tools. Although psychologists have recognized that additional precautions were needed for at-distance practice in comparison to in-person interventions, the experience of using IC technologies in clinical practice was described as positive, ensuring clients’ adherence with positive results. Additionally, despite psychological services were maintained on a larger scale by psychologists with more years of experience, professionals with average experience stated more favorable attitudes towards the use of web-based tools in counseling and therapy.

Although the implementation of ICT based practice was enforced by current circumstances, the experience that psychologists gathered and shared during the lockdown can guide future professional practice, improving and fostering the replication of best practices at distance.

South Africa's commitment to progressively achieve universal health coverage can lead to the effective and appropriate use of Health Technology Assessment (HTA) to strengthen the healthcare system. The study aimed to analyze the challenges faced in the formal implementation and utilization of HTA in the public health sector.

Review and analysis of health technology policies and legislation introduced in South Africa since 1965 serves as the backbone of this study. Walt and Gilson's health policy triangle framework and Kingdon's model were used for data analysis. In addition, a semi-structured survey was conducted among key stakeholders, including those attending HTA workshops that were held in 2016 and 2017.

The document review identified appropriate legislative and policy framework for informing healthcare decisions. Survey participants (n = 55) reported limited political support, local capacity, and awareness of HTA as barriers to implementing HTA. They noted that adequate financial resources and availability and sharing of quality data are primary drivers for HTA development. Effective governance, collaboration, and cooperation between key stakeholders of the healthcare system were suggested as possible ways forward for the institutionalization of HTA.

The South African government's goal to introduce the national health insurance program provides an excellent opportunity to formally introduce the use of HTA in decision making. Individual capacity development supported by institutional and organizational environments is urgently needed to achieve its full potential.

Le suicide et les conduites auto-agressives sont fréquents dans la population adulte. De précédentes études ont prouvé que le fait de maintenir le lien avec le sujet suicidant, par lettres ou cartes postales, après la prise en charge en aigu, réduit le risque de récidive. De plus, les études de faisabilité ont montré que l’intervention par SMS est acceptable pour les patients. L‘objectif principal de cette étude est de démontrer l’efficacité du dispositif de veille par SMS sur la réduction de la récidive suicidaire à 6 mois. Nous présenterons dans un premier temps l’étude de faisabilité puis l’étude multicentrique démarrée dans 8 CHU.

Il s’agira d’un essai de supériorité, contrôlé, randomisé, multicentrique, d’une durée de 2 ans, et piloté par le CHRU de Brest. Les sujets seront des adultes ayant survécu à un passage à l’acte suicidaire, inclus après une prise en charge aux urgences ou une courte hospitalisation. Le recrutement s’étalera sur une période de 9 mois. Les SMS seront envoyés à j2, j7, j15, puis mensuellement. Ces messages se soucieront du bien-être du patient, et lui rappelleront les coordonnées d’urgence dont il dispose en cas de besoin. Les patients seront évalués à j0, puis à 6 et 13 mois. Le critère de jugement principal sera le nombre de patients récidivant à 6 mois, dans le groupe recevant les SMS et dans le groupe témoin (qui bénéficie de la prise en charge de référence). Les critères de jugement secondaires seront le nombre de patients récidivant à 13 mois, le nombre de tentatives de suicide à 6 et 13 mois, le nombre de décès par suicide à 6 et 13 mois, dans les deux groupes. Les idées suicidaires seront évaluées dans chaque groupe, à j0, à 6 mois, et à 13 mois. Enfin, les coûts médicaux et la satisfaction seront évalués à 13 mois.

La fréquence de récidive attendue à 6 mois dans le groupe témoin est de l’ordre de 18 %. Nous espérons la réduire à 9 % grâce au contact par SMS. Afin d’y parvenir, le nombre de sujets nécessaires a été évalué à 530, soit 265 dans chaque bras.

Ce dispositif de veille par SMS s’appuie sur de précédentes interventions, aux résultats significatifs dans le domaine, et est facilement reproductible. Nous proposons d’évaluer son efficacité dans la réduction du risque de récidive suicidaire au sein d’une population d’adultes ayant fait un passage à l’acte.