Context Of Health Services Research Articles

Working around the border: Shared experiences of art therapists working with families impacted by immigration and political realities in Mexico and the United States.

This art-based, participatory action research sought to foster dialog between art therapists working on both sides of the US (Southern California)-Mexico (Tijuana) border in 2019. The paper summarizes the narratives from three initial focus groups, highlighting main findings arising from systematic analyses of verbal, creative and reflective writing input of participants. Identified themes include therapists' need to respond to immigration crisis; the realities of being a part of a border town; observing differences between communities; learning from the art of art therapists working with immigrants and refugees; and identifying challenges as a therapist. These themes inspired the creation of preliminary guidelines and are discussed within the context of mental health services around the border at this time.

The challenges of becoming and being a clinician manager: a qualitative exploration of the perception of medical doctors in senior leadership roles at a large Australian health service

BackgroundIn Australia, activity-based funding models have emphasized the need for hospitals to be accountable for their clinical performance. Clinician managers, with medical backgrounds are essential to ensuring high quality clinical performance and operational management of hospital services. The purpose of this study is to 1. Identify factors influencing doctors to become clinician managers in the Australian healthcare setting. 2. Understand the pathways and challenges faced by doctors in becoming clinician managers.MethodsWe undertook a qualitative study with semi-structured interviews of 18 clinician managers (who have medical practitioner backgrounds) with formal leadership administrative roles. Interview transcripts were analysed with systematic text condensation.ResultsAll eligible participants approached in this context, agreed to participate and over 80% of the participants were male. We identified five themes: ‘Motivations for leadership’, ‘Pathways to managerial role’, ‘Challenges faced in management roles’, ‘Credibility through clinical practice’ and ‘Management skill cultivation and support’. Clinician managers progressed from being doctors to leadership roles through being encouraged to take on roles, while others felt pressure to take on leadership roles even if this was not a personal goal. Clinician managers described challenges such as feeling under-prepared, maintaining respect form colleagues through still participating in a clinical load, along with juggling priorities such as administrative tasks, managing budgets and performance managing other doctors.ConclusionsThere needs to be an intentional and more structured approach to training and supporting clinician managers that considers the complex challenges faced by individuals (especially women) as they progress into these roles in the Australian tertiary health services context. There is a need to consider ways of supporting clinician managers to focus on management skills, effective mentorship and address perceptions around losing respect from colleagues if clinician managers cease their clinical loads. Further research is needed among the female medical workforce, along with research to understand if maintaining clinical loads when undertaking a clinical management role in fact leads to better effectiveness in contributing to better patient safety and quality outcomes. Such evidence may assist in addressing these social pressures among clinician managers, and contribute to addressing gender inequality among the clinical management workforce.

Art therapy with people diagnosed with psychosis: therapists’ experiences of their work and the journey to their current practice

ABSTRACT Background: There was insufficient understanding of how art therapists experience their work with people with psychosis-related diagnoses, and of their practice development. Aims: To understand art therapists’ perceived practise and its development regarding psychosis. Methods: Within a grounded theory framework, interviews and a focus group carried out in the years 2015–2017 elicited the experiences of 18 UK-based art therapists, working in a range of National Health Service (NHS) contexts, concerning art therapy in relation to psychosis and how they developed their current practice. Audio-recordings were transcribed verbatim and analysed to build theory. Results: The grounded theory proposes how practice and its development intertwine. Training confers resilience but therapists learn greatly from their clients, enhancing their ability for alliance-building. Therapists’ early struggles also spur further training. Skills for trauma are helpful. Clients may become stuck or disengage, and/or develop through ongoing engagement with art and the art therapist, who supports their journey. The service and wider societal contexts impact the art therapist's work through their effect on clients and/or the art therapist's ability to attune to clients. Conclusions: The findings concur with previous research regarding common therapeutic factors, especially the alliance, and on other therapists’ practice development. Implications for practice and research: Understanding therapy processes should incorporate service and societal influences on therapist and client. Training needs to include understanding adversity and trauma, and working with trauma. Plain-language summary People who receive a diagnosis of psychosis or schizophrenia are sometimes offered art therapy. However, we did not know enough about exactly what art therapists do. It was also important to understand how art therapists come to know what helps people in art therapy. Art therapy training has to cover many things, not only psychosis, so art therapists learn their skills in various ways. Through interviews and a focus group we talked to 18 UK-based art therapists working in different NHS contexts and digitally recorded the discussions. We made written records of what was said, and analysed these to create a theory of how art therapists work with people who have been given a diagnosis of psychosis or schizophrenia across inpatient and outpatient settings. Our theory proposes that art therapists’ training makes them quite resilient. However, they learn vital things from their clients. This especially helps them to become better at building a helpful relationship with each client. Some art therapists also seek further training when they are newly qualified, especially if they run into difficulties when trying to help a client. Some art therapists find it helpful to have skills for supporting people who have experienced past trauma. Clients develop through art-making and talking with the art therapist. Art therapists find it easier to do their work with clients if the service they work in is supportive. Our theory fits in with previous research, which says that building a good relationship with clients makes an important difference to the outcome in different kinds of therapies. Our theory also fits in with previous research on how other therapists develop their skills. Future research on art therapy should include looking at the service where the therapist works, and how it may affect both therapists and clients. Art therapy training needs to include trauma-related work.

Thinking, feeling and coping by BoP healthcare consumers: policy-based intervention in an emerging market

ABSTRACT We examine the co-creation of value by bottom of the pyramid consumers in the health services context. Following a qualitative approach, we use the empirical context of the National Rural Health Mission (NRHM) in India, one of the largest healthcare policy interventions in the world. Our grounded theory-based research used semi-structured interviews conducted in 28 villages across three states using a purposive sample (NRHM beneficiaries). The qualitative data were analysed utilising a discovery-oriented approach, in accordance with the value co-creation and service-dominant logic frameworks. We draw insights about the roles of individual agency, the individual’s social milieu, and supplementary forces in affecting different types of individual wellbeing. Our results help to explicate the processes of the exploitation, combination and reinforcement of resources within a co-created healthcare ecosystem, and six propositions explain value co-creation-driven health service delivery. We also discuss implications for marketers and policy implementers.

From “Cost Analysis” to “Economic Evaluation”: An Integrative Review of Hospital Rehabilitation in Public Health

The scientific literature on the use of economic evaluation studies in health was reviewed to identify the costs related to hospital rehabilitation in public health services and/or systems. An integrative review was carried out on the Virtual Health Library (VHL) portal. The search strategy was built by the hubs: economic evaluation (phenomenon); hospital rehabilitation (population); and public health (context). Portuguese, Spanish and English were the limit of languages used. Two independent reviewers selected the publications using the PRISMA protocol. Data analysis was performed using the thematic mode. 11 articles were included. The following elements of the articles were summarized: country, method, objective, main results, type of economic evaluation, type of hospital rehabilitation and the context of public health systems or services. Finally, it focused on the boundaries between “cost analysis” and “economic evaluation” that studies used. The evidence gathered in this review allows us to conclude that the topic is very incipient, with a low level of scientific evidence available (levels 4 and 5). The studies range from cost analysis to economic evaluations. All studies considered as economic evaluation are cost-effective and converge in stating that hospital rehabilitation is cost-effective in relation to the diseases studied in the various health systems analyzed.

Urinary Tract Infection- Knowledge and Habitual Practices among Adolescent Girls Residing in College Hostel of Mangaluru, India: A Cross-sectional Study

Introduction: Urinary Tract Infection (UTI) is a common infection among female adolescents, causing significant distress in the hospital or community settings. Most of the issues related to UTI could be prevented by adequate knowledge and safe habitual practices. Within the context of reproductive health services, nurses or nursing students being healthcare providers are typically expected to have knowledge on the causes of UTI, methods of preventing and managing such conditions and teaching the same to young girls and women. Education provided to women, particularly adolescents, by nurses and by trainers who have relevant experience and knowledge may ensure proper hygiene practices. Aim: To determine the level of knowledge, expressed habitual practice among 82 adolescent girls of a selected nursing college hostel. Materials and Methods: This was a descriptive cross-sectional study conducted between June 2019 and December 2019. Tools included structured questionnaire on knowledge of UTI and a rating scale on expressed habitual practice on UTI prevention. All the 82 students of 1st BSc Nursing from the study institute were recruited. Adolescent girls who have undergone training on prevention of UTI in nursing curriculum and who had congenital defects of urinary system were excluded from the study. Results: The mean age of the subjects was 18.69±0.46 years. Total 13.4% experienced UTI in their life time. In terms of overall knowledge score, out of 82 subjects, around 40.2% had average (scoring between 8-10 out of 14) and few (28%) had good knowledge (≥11) on UTI prevention. In terms of overall expressed habitual practice, majority (53.7%) had average practice (score between 26-33 out of 46) whereas, 4.9% had unsafe practice (score ≤25). The Karl Pearson correlation coefficient was 0.1 and showed weak positive correlation between knowledge and expressed habitual practice. Association was found between experience of UTI p-value<0.001 and expressed habitual practice. Conclusion: Pooled results showed overall knowledge and expressed habitual practice was average and safe. Healthcare professionals, especially primary care givers such as nurses and nursing students, have the responsibility to broadcast proper information about UTI so that women/adolescents can identify the causes, risk factors, symptoms of UTI in early stages thereby preventing the mortality and morbidity related to UTI.

Segurança no uso dos medicamentos: revisão integrativa das estratégias utilizadas no ensino em saúde

A falta de segurança do paciente no uso de medicamentos constitui um problema de saúde mundial aumentando a preocupação em torno de políticas que visam a melhoria da qualidade e segurança assistencial. O objetivo deste trabalho é conhecer as metodologias utilizadas para o ensino na graduação em saúde sobre a segurança no uso dos medicamentos. A metodologia utilizada foi uma revisão integrativa de artigos publicados entre janeiro/2014 e junho/2019 que apresentam metodologias de ensino para a graduação em saúde sobre a segurança no uso de medicamentos. Foram selecionados 35 artigos. Os temas sobre administração de medicamentos (n=11) e cálculo de dose de medicamentos (n=6) foram os mais abordados, especificamente para os graduandos de enfermagem. O tema “prescrição de medicamentos” (n=4) foi abordada pelos acadêmicos de medicina. A segurança da medicação foi abordada em quatro estudos. As principais metodologias identificadas foram: simulação, aprendizagem baseada em problemas e multimídias. Conclui-se que a metodologia a ser aplicada no ensino do uso seguro de medicamentos depende do contexto do discente e dos serviços de saúde, bem como dos objetivos de aprendizado. O raciocínio clínico e o pensamento crítico referente ao uso seguro de medicamentos devem ser praticados durante o ensino da graduação dos cursos de saúde.

Denials, Surprise Charges, Starting Over: How Medicare Recipients Navigate the Medicare Mental Health Coverage Gap

Medicare is the primary insurance provider for approximately 51 million older adults, including those who seek mental health care. Medicare provider eligibility was last updated in 1989, and approximately one-third of the graduate-level mental health workforce (i.e., Licensed Professional Counselors and Licensed Marriage and Family Therapists) is excluded from Medicare, despite these professionals participating in Medicaid, TRICARE, the Veterans Administration, and private insurance plans. This Medicare mental health coverage gap (MMHCG) raises concerns about older adults’ access to mental health care, resulting in a policy misalignment between Medicare’s provider regulations and a growing number of older adults seeking mental health care. However, little is known about the precise impact of the MMHCG. To better understand how the MMHCG impacts older adults, we interviewed 17 Medicare-insured individuals about their experiences accessing mental health services. Using a phenomenological framework to analyze our data, we found that Medicare recipients described several consequences, such as: 1) a detrimental impact on their mental health and well-being; 2) concerns about having to start over with new providers due to commencing mental health treatment only to have services interrupted once the provider is no longer Medicare-reimbursable; and 3) relying on pro bono services from Medicare-excluded providers with uncertainty about the long-term sustainability of these arrangements. The presenters will describe how these findings fit within the current Medicare mental health service context, including the direct impact on older adults’ mental health. Discussion will also focus on policy implications of the findings and possible solutions for addressing the MMHCG.

The complexity of TB/HIV coinfection: an analysis of the social and health services context in the state of São Paulo, Brazil.

Brazil is in the 19th position of priority countries for the control of TB/HIV coinfection, so we aimed to analyze the social and health services contexts that are associated with TB/HIV coinfection in São Paulo state. Ecological study conducted in 645 cities of the state. The study population consisted of 10,389 new cases of TB/HIV coinfection in state residents between 2010 and 2015. The variables and indicators used in the study were collected from secondary sources. To identify the factors associated with the occurrence of TB/HIV coinfection cases, generalized additive models for location, scale and shape were used. The best distribution model was defined from the lowest Akaike information criterion value. There was an association between the occurrence of coinfection and the diagnosis of TB after death and greater treatment default. There was also an association with greater coverage of nurses and Family Health Strategy, which comprises Primary Care settings focused on families. Regarding the social context, the Gini Coefficient of inequality was identified as a determinant of coinfection. The study presents the complexity of TB/HIV coinfection, proposing critical points in the health services and social context. Despite the high coverage of nurses and Family Health Strategy in some cities, this did not affect the reduction of the incidence of coinfection. These findings may be attributed to a fragmented care and focused on acute conditions. Furthermore, this model of care holds few prospects for care integration or prioritization of prevention and health promotion actions.

Symptom Burden and Unmet Support Needs of Patients With Parkinson's Disease: A Cross-Sectional Study in Asia-Pacific Regions

ObjectivesSupport care is rarely assessed and offered to people with long-term neurologic conditions, particularly Parkinson's disease. This study aimed to assess the symptom burden and unmet support care needs in people with mild to severe Parkinson's disease. DesignCross-sectional study. Setting and ParticipantsPatients with Parkinson's disease were recruited from neurologic outpatient clinics from 3 East and Southeast Asian regions, including Hong Kong, Taiwan, and Thailand. MethodsA standardized set of questionnaires assessing unmet care needs [Palliative care Outcome Scale (POS)], disease-specific symptom burden (POS–Symptoms–Parkinson's Disease), generic health-related quality of life (HRQOL) (EQ-5D-3L), and sociodemographic and clinical background. ResultsCompleted questionnaires (n = 186) were collected from 64 Hong Kong Chinese, 64 Taiwanese, and 58 Thai patients. Their mean age was 67.23 ± 8.07, 54% were female, and 80% had mild-to-moderate disease. Their mean POS score was 10.48 ± 6.38, indicating moderate unmet support needs. Two-thirds of the participants rated constipation, fatigue, leg problem, and daytime somnolence as the most prevalent and burdensome symptoms. Patients from Hong Kong and Taiwan prioritized psychosocial and spiritual support, whereas Thai patients prioritized physical needs and emotional concerns. Multivariate adjustment for demographics and clinical characteristics showed that high psychological, spiritual, and practical burdens are associated with young age, male gender, and advanced disease stages. Conclusions and ImplicationsPatients experience significant symptom burden and moderate unmet support needs at the early to middle stage of Parkinson's disease. Routine assessment of changes in symptom burden should start early. The timely referral of support care services should provide appropriate psychospiritual and practical support in addition to motor training. Planning for support care services should consider cultural and health service contexts.

Therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in long-term conditions.

Improving Access to Psychological Therapies (IAPT) services in England have established a long-term condition (LTC) pathway in recent years, meaning that LTC therapies are now delivered via varied modes and by professionals with varied experiences. To gain insight into how this new pathway is functioning in practice, this study aimed to explore therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in LTCs. A qualitative design was employed using semi-structured interviews. Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation. Four key themes highlighted patient, therapist, and service-level factors related to uptake and engagement: Working flexibly with barriers within the National Health Service context; Acceptability of 'embedded' versus 'separate' psychological care; Confidence in working with people with LTCs; and Navigating implementation of online therapies. Therapists recognized the need for tailored LTC therapies, though opinions about online therapies varied. Therapists expressed commitment to flexibly adapting their practice to suit patient needs, but felt their flexibility was limited by system and service constraints. Barriers to uptake and engagement need to be addressed to optimize LTC pathways. Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.

Social norms interventions to change clinical behaviour in health workers: a systematic review and meta-analysis

Background A social norms intervention seeks to change the clinical behaviour of a target health worker by exposing them to the values, beliefs, attitudes or behaviours of a reference group or person. These low-cost interventions can be used to encourage health workers to follow recommended professional practice. Objective To summarise evidence on whether or not social norms interventions are effective in encouraging health worker behaviour change, and to identify the most effective social norms interventions. Design A systematic review and meta-analysis of randomised controlled trials. Data sources The following databases were searched on 24 July 2018: Ovid MEDLINE (1946 to week 2 July 2018), EMBASE (1974 to 3 July 2018), Cumulative Index to Nursing and Allied Health Literature (1937 to July 2018), British Nursing Index (2008 to July 2018), ISI Web of Science (1900 to present), PsycINFO (1806 to week 3 July 2018) and Cochrane trials (up to July 2018). Participants Health workers took part in the study. Interventions Behaviour change interventions based on social norms. Outcome measures Health worker clinical behaviour, for example prescribing (primary outcome), and patient health outcomes, for example blood test results (secondary), converted into a standardised mean difference. Methods Titles and abstracts were reviewed against the inclusion criteria to exclude any that were clearly ineligible. Two reviewers independently screened the remaining full texts to identify relevant papers. Two reviewers extracted data independently, coded for behaviour change techniques and assessed quality using the Cochrane risk-of-bias tool. We performed a meta-analysis and presented forest plots, stratified by behaviour change technique. Sources of variation were explored using metaregression and network meta-analysis. Results A total of 4428 abstracts were screened, 477 full texts were screened and findings were based on 106 studies. Most studies were in primary care or hospitals, targeting prescribing, ordering of tests and communication with patients. The interventions included social comparison (in which information is given on how peers behave) and credible source (which refers to communication from a well-respected person in support of the behaviour). Combined data suggested that interventions that included social norms components were associated with an improvement in health worker behaviour of 0.08 standardised mean differences (95% confidence interval 0.07 to 0.10 standardised mean differences) (n = 100 comparisons), and an improvement in patient outcomes of 0.17 standardised mean differences (95% confidence interval 0.14 to 0.20) (n = 14), on average. Heterogeneity was high, with an overall I 2 of 85.4% (primary) and 91.5% (secondary). Network meta-analysis suggested that three types of social norms intervention were most effective, on average, compared with control: credible source (0.30 standardised mean differences, 95% confidence interval 0.13 to 0.47); social comparison combined with social reward (0.39 standardised mean differences, 95% confidence interval 0.15 to 0.64); and social comparison combined with prompts and cues (0.33 standardised mean differences, 95% confidence interval 0.22 to 0.44). Limitations The large number of studies prevented us from requesting additional information from authors. The trials varied in design, context and setting, and we combined different types of outcome to provide an overall summary of evidence, resulting in a very heterogeneous review. Conclusions Social norms interventions are an effective method of changing clinical behaviour in a variety of health service contexts. Although the overall result was modest and very variable, there is the potential for social norms interventions to be scaled up to target the behaviour of a large population of health workers and resulting patient outcomes. Future work Development of optimised credible source and social comparison behaviour change interventions, including qualitative research on acceptability and feasibility. Study registration This study is registered as PROSPERO CRD42016045718. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 41. See the NIHR Journals Library website for further project information.

Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers.

Systematic reviews cataloguing the barriers to and facilitators of various outcomes are increasingly popular, despite criticisms of this type of review on philosophical, methodological, and practical grounds. The aims of this review are to appraise, analyze, and discuss the reporting and synthesis practices used in recently published barriers and facilitators reviews in health services research. All English-language peer-reviewed systematic reviews that synthesized research on barriers and facilitators in a health services context were eligible for inclusion. We searched 11 databases over a 13-month period (1 November 2017-30 November 2018) using an exhaustive list of search terms for "barrier(s)," "facilitator(s)," and "systematic review." One hundred reviews were included. We found a high degree of variation in the synthesis practices used in these reviews, with the majority employing aggregative (rather than interpretive) approaches. The findings echo common critiques of this review type, including concerns about the reduction of complex phenomena to simplified, discrete factors. Although several reviews highlighted the "complexity" of barriers and facilitators, this was usually not analyzed systematically. Analysis of the subsample of reviews that explicitly discussed the barriers and facilitators approach revealed some common issues. These tended to be either conceptual/definitional (eg, ideas about interrelationships and overlap between factors) and methodological/practical (eg, challenges related to aggregating heterogeneous research). Barriers and facilitators reviews should (a) clearly operationally define "barrier" and "facilitator," (b) explicitly describe how factors are extracted and subsequently synthesized, and (c) provide critical reflection on the contextual variability and reliability of identified factors.

Great expectations: views and perceptions of professionalism amongst mental health services staff, patients and carers

Background Numerous studies have explored the concept of ‘professionalism’ in medicine, yet little attention has been paid to the concept in a mental health services context. Aims This study sought to determine how the lived experience of patients, carers and healthcare professionals in mental health services align with medically defined, generic, professionalism standards. Method Interviews and focus groups were conducted with patients, carers, nurses, occupational therapists, psychiatrists and psychologists. A framework analysis approach was used to analyse the data, based on the ‘Improving Selection to the Foundation Programmes’ Professional Attributes Framework. Results Fifty-six individuals participated. Data aligned to all nine attributes of the Professional Attributes Framework, however the expectations within each attribute varied from that originally cited. A tenth attribute was devised during the process of analysis; Working with Carers. This attribute acknowledges the need to liaise with, and support carers in mental health services. Situational examples included both online and offline behaviours and the topic of ‘black humour’ emerged. Conclusions Compared to a conventional medical definition of professionalism, additional themes and differing emphases were observed for mental health and learning disability services. These findings should be used to inform the teaching and evaluation of professionalism, especially for staff pursuing mental health service careers.

Surveillance, and the boundaries of binary gender: flashpoints for queer ethics

Despite ubiquitous surveillance of identity and scrutiny of performances of binary gender, an increasingly large number of people are choosing to stake out public and private spaces that are inbetween, including ‘non-binary’ and ‘gender-queer’. In this article I outline some of the ways in which gender is literally and metonymically monitored at boundary-crossings at national borders and bathroom thresholds, and in the certification of birth and citizenship. I think through why shifting perceptions of gender, and the ways that we categorise gender in different spaces, for different audiences, is an issue for queer ethics in practice. What is a ‘safe space’ for sharing stories of stigma and state-imposed identity categorisation? How can affirmed gender-diverse categories and spaces remain open to accommodate change, fluidity and multiplicity? I draw on auto-ethnographic experiences of self-surveillance and attempts to propagate and celebrate my own multiplicity as a non-binary person. I speculate on the ways that (un)gendered Selfies might constitute creative and imaginative practice that challenges hegemonic injunctions to perform gender in finite and rigid binary ways. Can this sharing of complex and multiple selves have implications for the ethics and politics of categorising gender in educational, health and social service contexts? What might ‘queer ethics in practice’ look like in workshops, at reception desks, at airports?

Unravelling the mental health productivity puzzle: where do we start?

In this editorial we define 'productivity' and 'efficiency' in a mental health service context, outlining the key challenges to measuring these in practice. We attempt to bring clarity of thought to this often debated, but rarely researched area.

Digital Game Interventions for Youth Mental Health Services (Gaming My Way to Recovery): Protocol for a Scoping Review.

BackgroundDigital or video games are played by millions of adolescents and young adults around the world and are one of the technologies used by youths to access mental health services. Youths with mental health problems strongly endorse the use of technologies, including mobile and online platforms, to receive information, support their treatment journeys (eg, decision-making tools), and facilitate recovery. A growing body of literature explores the advantages of playing digital games for improving attention span and memory, managing emotions, promoting behavior change, and supporting treatment for mental illness (eg, anxiety, depression, or posttraumatic stress disorder). The research field has also focused on the negative impact of video games, describing potential harms related to aggression, addiction, and depression. To promote clarity on this matter, there is a great need for knowledge synthesis offering recommendations on how video games can be safely and effectively adopted and integrated into youth mental health services.ObjectiveThe Gaming My Way to Recovery scoping review project assesses existing evidence on the use of digital game interventions within the context of mental health services for youths (aged 11-29 years) using the stepped care model as the conceptual framework. The research question is as follows: For which youth mental health conditions have digital games been used and what broad objectives (eg, prevention, treatment) have they addressed?MethodsUsing the methodology proposed by Arksey and O’Malley, this scoping review will map the available evidence on the use of digital games for youths between 11 and 29 years old with mental health or substance use problems, or both.ResultsThe review will bring together evidence-based knowledge to assist mental health providers and policymakers in evaluating the potential benefits and risks of these interventions. Following funding of the project in September 2018, we completed the search in November 2018, and carried out data screening and stakeholder engagement activities during preparation of the protocol. We will conduct a knowledge synthesis based on specific disorders, treatment level and modality, type of service, population, settings, ethical practices, and user engagement and offer recommendations concerning the integration of video game technologies and programs, future research and practice, and knowledge dissemination.ConclusionsDigital game interventions employ unique, experiential, and interactive features that potentially improve skills and facilitate learning among players. Digital games may also provide a new treatment platform for youths with mental health conditions. Assessing current knowledge on video game technology and interventions may potentially improve the range of interventions offered by youth mental health services while supporting prevention, intervention, and treatment.International Registered Report Identifier (IRRID)PRR1-10.2196/13834

Adaption and pilot implementation of an autism executive functioning intervention in children\u2019s mental health services: a mixed-methods study protocol

BackgroundYouth with autism spectrum disorder (ASD) represent a growing population with significant service needs. Prominent among these needs are high rates of co-occurring psychiatric conditions that contribute to increased functional impairments and often necessitate mental health services. Executive functioning deficits are associated with ASD as well as common co-occurring conditions (e.g., attention-deficit/hyperactivity disorder) and an evidence-based intervention has been developed and tested to address executive functioning within the school context. There is an urgent need to implement indicated evidence-based interventions for youth with ASD receiving care in community mental health settings. Interventions that optimally “fit” the mental health services context as well as the complex and co-occurring mental health needs of these youth have the potential to improve key clinical outcomes for this high priority population.MethodsThis mixed-methods developmental study will apply the Exploration, Preparation, Implementation, Sustainment implementation framework and a community-academic partnership approach to systematically adapt and test an evidence-based executive functioning intervention for youth with ASD for delivery in community mental health settings. Specific aims are to (1) conduct a need and context assessment to inform the systematic adaptation an executive functioning evidence-based intervention; (2) systematically adapt the clinical intervention and develop a corresponding implementation plan, together entitled “Executive Functioning for Enhancing Community-based Treatment for ASD,” (EFFECT for ASD); and (3) conduct a feasibility pilot test of EFFECT for ASD in community mental health settings.DiscussionTailoring evidence-based interventions for delivery in community-based mental health services for youth with ASD has the potential to increase quality of care and improve child outcomes. Results from the current study will serve as the foundation for large-scale hybrid implementation and effectiveness trials and a generalizable approach for different service systems of care and clinical populations.Trial registrationClinicaltrials.gov, NCT04295512.

Sexual and reproductive health of women living with HIV in Muslim-majority countries: a systematic mixed studies review

BackgroundThe number of women living with the human immunodeficiency virus (WLHIV) in Muslim-majority countries has increased significantly in the last decade. These women are often marginalized and face insecure sexual and reproductive health (SRH) needs and rights. However, little is known about the multi-faceted factors influencing these women’s fertility, contraceptive, and perinatal decisions and sexual life. This systematic mixed studies review aimed to synthesize the empirical evidence on social, cultural, and structural factors influencing the SRH of WLHIV in Muslim-majority countries.MethodsThis review provides a synthesis of quantitative, qualitative and mixed-method research findings searched from PubMed, EMBASE, Scopus, CINAHL and Cochrane databases. We screened 3452 SRH studies involving WLHIV. The studies, published in English between 2008 and 2017, were from 20 Muslim-majority countries with increased numbers of WLHIV. The quality of eligible studies was appraised using a mixed-methods appraisal tool (MMAT) version 2011. Findings were thematically analysed by a hybrid deductive-inductive approach. Two independent reviewers were involved in the study selection, data extraction, quality appraisal, and data synthesis.ResultsWe included 13 SRH-related studies involving 1748 WLHIV in eight Muslim-majority countries. Most of these studies explored fertility desire and sexual health, while only a small proportion related to contraceptive use and the perinatal-care experience. We identified that WLHIV faced neglect of their SRH rights. These rights were predominantly affected by the socio-cultural, religious and health-services context of the women’s lives, which directed them to unsafe sex practices and stressful perinatal experiences.ConclusionsThis study points to the need for SRH laws, policies, and interventions which stop WLHIV experiencing SRH discrimination violence and achieving their SRH rights.

Impact of transition to an individualised funding model on allied health support of participation opportunities

Introduction The National Disability Insurance Scheme is the new consumer-controlled funding system for people with disability in Australia, and is expected to enhance participation outcomes of people with disability. This research explored participation opportunities for people with disability during the formative period of transition to the scheme, through stakeholder accounts of changes in allied health service contexts. Materials and methods Qualitative data were generated during interviews, workshops and meetings with industry, policy, practice and education stakeholders involved in scheme services. Inductive coding explored key themes within the data. The International Classification of Functioning model was then applied as a deductive coding framework to illuminate how the scheme was perceived to be impacting participation opportunities for recipients of scheme funding. Results and discussion Using the International Classification of Functioning helped us illuminate whether changes resulting from scheme transition posed participation opportunities or barriers for scheme recipients. Research participants often framed these changes negatively, even when examples suggested that changes had removed participation barriers for scheme recipients. Some participants viewed changes as obstructing equitable and quality professional practice. We explore potential opportunities to resolve tensions that also optimise the participation outcomes of individuals who receive services through individualised funding. IMPLICATIONS FOR REHABILITATION The introduction of individualised funding has removed barriers to participation for many National Disability Insurance Scheme recipients. Efforts must be made to build the trust of stakeholders involved in National Disability Insurance Scheme service provision regarding how fee-for-service funding can lead to good participation outcomes for scheme recipients. Transparency around the shared processes of clinical governance and equitable service access operating in Australia’s individualized disability funding scheme are suggested to build trust. A visible commitment to maintaining a broad range of services is also indicated to build trust for stakeholders involved in the scheme.