Health Gap Research Articles

A text messaging intervention to support the mental health of young adults: User engagement and feedback from a field trial of an intervention prototype

BackgroundYoung adults have high rates of mental health conditions, but most do not want or cannot access treatment. By leveraging a medium that young adults routinely use, text messaging programs have potential to keep young adults engaged with content supporting self-management of mental health issues and can be delivered inexpensively at scale. We designed an intervention that imparts strategies for self-managing mental health symptoms through interactive text messaging dialogues and engages users through novelty and variety in strategies (from cognitive behavioral therapy, acceptance and commitment therapy, and positive psychology) and styles of interaction (e.g., prompts, peer stories, writing tasks). MethodsThe aim of this mixed-methods study was to pilot 1- and 2-week versions of an interactive text messaging intervention among young adults (ages 18–25), and to obtain feedback to guide intervention refinements. Young adults were recruited via a mental health advocacy website and snowball sampling at a North American University. We used Wizard-of-Oz methods in which study staff sent messages based on a detailed script. Transcripts of interviews were subject to qualitative analysis to identify aspects of the program that need improvements, and to gather participant perspectives on possible solutions. ResultsForty-eight individuals ages 18–25 participated in the study (mean age: 22.0). 85 % responded to the program at least once. Among those who ever responded, they replied to messages on 85 % of days, and with engagement sustained over the study period. Participants endorsed the convenience of text messaging, the types of interactive dialogues, and the variety of content. They also identified needed improvements to message volume, scheduling, and content. ConclusionsYoung adults showed high levels of engagement and satisfaction with a texting program supporting mental health self-management. The program may be improved through refining personalization, timing, and message volume, and extending content to support use over a longer timeframe. If shown to be effective in randomized trials, this program has potential to help address a substantial treatment gap in young adults' mental health.

Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project.

Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.

Successful development and implementation of a clinical practice site with community partners to engage family nurse practitioner students in health equity.

Family nurse practitioner (FNP) student clinical practice site availability is limited. Concurrently, many populations lack healthcare access, a common health inequity. Collaboration with community partners to develop clinical practice sites offer students active learning opportunities to increase their engagement and understanding of health equity. Using community collaboration, develop and implement an FNP student clinical practice site that can provide learning opportunities in addressing health equity. Local health data was reviewed, and health gaps were associated with social determinant of health inequities. A community partner was identified with the goal of facilitating students to provide proactive health care to homeless women. Health promotion and disease identification has been the focus of care provided by FNP students and faculty during an early-program clinical course, increasing access to care for an underserved population. A community-academic partnership has developed where FNP students provide health promotion and safety net health care to homeless women since 2017. Student reflections have shown a positive impact on their understanding of health equity. The community partner has identified positive impacts to client health. This partnership has impacted health equity by increasing healthcare access for an underserved population while facilitating FNP student learning.

Food as Medicine Programs: Dietitians Bridging the Social Determinant of Health Gap Impacting Chronic Disease

Food as Medicine Programs: Dietitians Bridging the Social Determinant of Health Gap Impacting Chronic Disease

Neighborhood socioeconomic status is associated with low diversity gut microbiomes and multi-drug resistant microorganism colonization

Social disparities continue to limit universal access to health care, directly impacting both lifespan and quality of life. Concomitantly, the gut microbiome has been associated with downstream health outcomes including the global rise in antibiotic resistance. However, limited evidence exists examining socioeconomic status (SES) associations with gut microbiome composition. To address this, we collected information on the community-level SES, gut microbiota, and other individual cofactors including colonization by multidrug-resistant organisms (MDROs) in an adult cohort from Wisconsin, USA. We found an association between SES and microbial composition that is mediated by food insecurity. Additionally, we observed a higher prevalence of MDROs isolated from individuals with low diversity microbiomes and low neighborhood SES. Our integrated population-based study considers how the interplay of several social and economic factors combine to influence gut microbial composition while providing a framework for developing future interventions to help mitigate the SES health gap.

Psychiatric colonialism, PTSD and the Western psychiatric diagnostic tradition . . . is one man's food another man's poison?

Sadly, much of the world is no stranger to Psychological Trauma, particularly in poorer areas with poor health infrastructure. Western Aid Organisations frequently deploy to such areas bringing with them a western psychiatric tradition of nosology and therapy which may not be appropriate in other cultures. We argue that imposing a western system of diagnosis and treatment may not only undermine local culture but may also be bad for the patient. We discuss this with reference to the WHO's Mental Health Gap initiative (MHGap).

Effect of the COVID-19 Pandemic and Subsequent Social Distancing on Individual's Mental Health

The COVID-19 coronavirus, an infectious disease originating in Wuhan, has become an outbreak worldwide, leading to unprecedented measures restricting social and physical activities in many countries. The subsequent social distancing of COVID-19 has significantly resulted in many psychological consequences. The current study examines the impact of social distancing during the COVID-19 pandemic on the mental health symptoms of Selangor State, Malaysia residents. An online survey was conducted through social media platforms targeting residents of Selangor State in Malaysia. A convenience sampling method was led to include 258 respondents in the study. The questionnaire on the symptoms of mental health related to fear of COVID-19 included 13 items developed from the existing studies. The results showed that symptoms of mental health problems related to fear of COVID-19 are negatively associated with the likelihood of social interaction. The overall score of symptoms of mental health related to the fear of COVID-19 showed moderate symptoms of mental problems related to the fear of COVID-19. The factor of age was also associated with higher symptomatology of mental health problems related to fear of COVID-19. Thus, related measures and guidelines must consider the mental well-being of the at-risk person as the pandemic continues. The current study’s findings contribute to the knowledge gaps in behavioural health during biological disasters. It also provides a reference for professionals and policymakers to develop programs and measures to handle the psychosocial status of the affected people.

Neighborhood context and children's health care utilization and health outcomes: a comprehensive descriptive analysis of national survey data.

While child health and health care disparities arising from unequal distribution of resources are well documented, a nationally representative inventory of health and well-being for children across the spectrum of opportunity is lacking. Using the nationally representative sample of children from pooled 2013-2017 Medical Expenditure Panel Survey data linked to the census-tract-level Child Opportunity Index 2.0, a composite measure of neighborhood health, education, and socioeconomic conditions, we describe US children's socioeconomic characteristics, health care utilization and expenditures across the spectrum of child neighborhood opportunity levels. We found that neighborhood level of child opportunity was associated with almost all of children's health status, health care utilization, expenditures, access to care, and satisfaction with care outcomes. Children living in lower-opportunity neighborhoods had the highest rates of poor physical and mental health status and fewest ambulatory care visits but accounted for the highest share of emergency department visits. Their parents were also least likely to report having positive experiences with health care, good communication with providers, and easy access to care. Our findings underscore the myriad harms to children of gaps in health, education, and financial resources at the community level and provide targets for public investments to improve child-focused outcomes.

Closing the health gap in Central Australia: reduction in Indigenous Australian inpatient self-discharge rates following routine collaboration with Aboriginal Health Workers.

Indigenous Australians experience significant socioeconomic disadvantage and healthcare disparity compared to non-Indigenous Australians. A retrospective cohort study to describe the association between rates of self-discharge in Indigenous orthopaedic patients and the introduction of routine Aboriginal Liaison Officers (ALO) within the Orthopaedic multi-disciplinary team (MDT) was performed. ALO were introduced within our routine Orthopaedic MDT on the 22nd of February 2021. Two patient cohorts were analysed, Group 1; patients admitted in the 9-months prior to inclusion of ALO, and Group 2; patients admitted within 9-months thereafter. The primary outcome of interest was the rate of self-discharge among Indigenous patients. Secondary outcomes of interest were the stage of treatment when patients self-discharged, recurrent self-discharge, risk factors for self-discharge and association between self-discharge and length of hospital stay. Introduction of ALO within routine Orthopaedic MDT was associated with a significant 37% reduced risk of self-discharge among Indigenous patients (p = 0·009), and significantly fewer self-discharges before their definitive surgical and medical treatment (p = 0·0024), or before completion of postoperative intravenous antibiotic treatment (p = 0·030). There was no significant change in the risk of recurrent self-discharge (p = 0·557). Risk factors for self-discharge were younger age; pensioners or unemployed; residents of Alice Springs Town-Camps or of communities within 51 to 100km of Alice Springs; and those diagnosed with lacerations of the upper limb, but without tendon injury, wound and soft tissue infections or osteomyelitis. In Group 2, the odds of self-discharge decreased with increased length of hospital stay (p = 0·040). Routine inclusion of ALO within the Orthopaedic MDT reduced the risk of self-discharge in Indigenous patients. Those who self-discharged did so only after critical aspects of their care were met.

Understanding Disparities in Antiretroviral Therapy Adherence and Sustained Viral Suppression Among Black, Hispanic/Latina, and White Women in the United States - Medical Monitoring Project, United States, 2015-2019.

Racial and ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) have been documented among women with HIV. We examined factors that may account for these racial/ethnic differences among women to inform interventions that increase health equity. We used data from the 2015-2019 cycles of the Medical Monitoring Project, a probability sample of U.S. adults with diagnosed HIV. Using logistic regression with predicted marginal means, we calculated weighted prevalence differences (PDs) of ART adherence and SVS among Black, Hispanic/Latina, and White women taking ART. Using modeling with forward stepwise selection, we adjusted PDs for selected variables, including social and structural determinants of health (SDOH) factors, to examine whether magnitude of PDs was attenuated by their inclusion. We assessed relative changes between unadjusted and adjusted PDs. After adjusting for poverty, transportation needs, health literacy, and gap in health insurance/coverage, the Black-White PD in adherence decreased by 11% (-16.0% to -14.2%). After adjusting for adherence, poverty, type of health insurance, and gap in health insurance/coverage, the Black-White PD in SVS reduced 37% (-7.9% to -5.0%) and was no longer statistically different. The Hispanic/Latina-White PD in adherence reduced 24% (-12.7% to -9.6%) after adjusting for poverty, health literacy, and transportation needs. The unadjusted Hispanic/Latina-White PD in SVS was not significantly different. Racial/ethnic disparities in HIV outcomes among women taking ART were substantially reduced after accounting for SDOH and other factors although differences remained. Structural interventions to improve SDOH are needed to improve health equity for women with HIV.

Five-year trend of antipsychotic prescription practices in a district Hospital in Ghana: A retrospective study.

Antipsychotics are the mainstay treatment for psychotic conditions. Their prescription, however, should come with some caution since the consequences of their side effects can be dire for the patient receiving the prescription. Because of inadequate experts in low-middle-income countries, non-experts are trained through the Mental Health Gap Action Program (MHGAP) to reduce the treatment gap. This retrospective study analyzed the trend of antipsychotic prescriptions in a district hospital where mental health services are delivered by non-experts. This was a retrospective descriptive study that gathered data between 2015 and 2019 from the electronic database of the hospital. Statistical analysis was conducted using SPSS version 20. We reported the descriptive statistics of our findings in the form of frequencies and percentages. There was a year-on-year increase in antipsychotic prescriptions over the study period. Starting with 48.1% in 2015 to 56.4% in 2019. The main condition for which antipsychotics were prescribed was psychosis (58.6%), followed by substance use disorder (SUD) (26%). Patients with age ≥ 50 received the most prescription of antipsychotics. Starting from 2015, there was a high percentage of typical antipsychotic prescriptions (90.14%) with atypical antipsychotics being 9.86% and by 2019 atypical antipsychotic prescriptions had shot up to 74.8%. Polypharmacy prescription rate was 8.1% over the study period. Antipsychotics are essential in the treatment of psychosis and other mental health conditions. Prescribers need to know more about these drugs to prescribe them appropriately and to minimize the likelihood of side effects among patients who use these drugs.

Impact of problem-solving skills and attributional retraining intervention on conduct disorder among junior male students at public secondary school in Nigeria: a non-randomized control study

PurposeThis paper aims to report a non-randomized control study undertaken to investigate prevalence and correlates of conduct disorder among male secondary education students in South-West Nigeria and to assess the impact of a problem-solving skills and attributional retraining (PSSAR) intervention with this population.Design/methodology/approachIn total, 787 male students from two schools were screened for conduct disorder. All participants who met criteria for the disorder were allocated to either treatment (n = 55) or control (n = 47) groups. Outcome measures comprised the strengths and difficulties questionnaire (SDQ; teacher and student versions) and the teacher rating of students’ aggressive behaviors.FindingsOf the sample, 13% were found to present with difficulties that met criteria for conduct disorder. The presence of these difficulties correlated with several demographic variables, including parental conflict and alcohol use. A statistically significant reduction in mean scores was observed for the treatment group in the student rating of the SDQ emotional subscale and total difficulties scores. Teacher ratings were less consistent in that conduct problems, prosocial behavior and total difficulties increased following the intervention, whereas peer problems and aggressive behavior were reported by teachers to reduce. No statistically significant change was found in the outcome measures for the control group.Practical implicationsIn resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed.Originality/valueIn resource-constrained settings, school-based interventions are an important means through which treatment gaps in child and adolescent mental health can be addressed. This study’s findings offer some preliminary support for the PSSAR intervention for conduct disorder in this context and indicate areas for further research.

A weighted soil heath index approach for refined assessment of soil health in cropping systems

IntroductionPromoting sustainable crop production is enhanced by an effective method to assess soil health. However, soil health assessment is challenging due to multiple interactions among dynamic soil properties (i.e., soil health indicators) across management practices and agroecological regions. We tested several currently popular soil health assessment methods for cropping systems in Tennessee in the southeastern US and found that these methods failed to differentiate Tennessee soil health under long-term conservation and conventional management.Materials and methodsThis study developed a Tennessee weighted soil health index (WSHI) by: 1) selecting a set of management-sensitive soil health indicators, 2) assigning meaningful weights to indicators, and 3) normalizing the scores based on regionally relevant undisturbed natural reference sites. The tested cropping systems treatments were moldboard plow (MP) in continuous soybean (SS), no tillage (NT) in SS, NT with wheat cover (NTW) in SS, no cover and chisel plow (NCCT) in continuous cotton (CC), no cover and no tillage (NCNT) in CC, and hairy vetch cover and no tillage (VCNT) in CC. In addition, two woodlots and one grassland sites in the vicinity of the cropping systems were selected to represent undisturbed natural systems.Results and discussionOut of 22 indicators that proved to be management-sensitive, six were selected as a minimum dataset (MDS). These were particulate organic matter C (POM-C), soil respiration from 4-day incubation (4d CO2), small macroaggregate (0.250-2mm)-associated C (SMA-C), surface hardness (PR15), microbial biomass N (MBN), and bulk density (BD). Measured values of the MDS indicators were transformed into unitless normalized scores (based on the regional range of the indicator), and finally integrated into WSHI scores using a weighted-addition approach. Additionally, the soil health gap (SHG) between the soil health of the regional reference system and different cropping systems was calculated. Results revealed that WSHI strongly differentiated soil health between long-term conservation and conventional managements practices. The WSHI scores for southeastern cropland soils varied as follows: VCNT = NTW &amp;gt; NT &amp;gt; NCNT ≥ NCCT ≥ MP. The SHGs under MP, NCCT, NCNT, NT, NTW, and VCNT were 85.5, 79.9, 68, 45.1, 25.2, and 24.3, respectively, relative to the average WSHI of three undisturbed systems. Results showed that the WSHI approach is effective in more meaningful regional assessment of soil health and SHG can be a potential metric for comparing soil health across agroecological regions.

Evolution of the income-related gap in health with old age: evidence from 20 countries in European and Chinese panel datasets

Some studies show that the protective effect of higher income on health weakens with old age (age-as-leveller pattern), whereas others show that it strengthens with old age (cumulative advantage/disadvantage pattern). Many existing studies are limited in that they use single-country and/or single-timepoint designs. To overcome these limitations and better understand how the income-health gradient evolves in older age, we used cross-national and longitudinal data of the Survey of Health, Ageing and Retirement in Europe (2004–2019, N = 73,407) and the China Health and Retirement Longitudinal Study (2011–2018, N = 10,067). We operationalised health using multimorbidity and three alternative indicators (functional disability, mobility disability, and memory). We performed Poisson growth curve modelling to capture the between-participant effects of age and the within-participant effects of aging. We obtained three consistent and robust findings for Europe (patterns were observed in most countries) and China. First, the protective effect of higher income on multimorbidity, functional disability, and mobility disability was weaker for older than for younger adults (between-participant age-as-leveller pattern). Second, only the protective effect of higher income on mobility disability weakened over the later life course (within-participant age-as-leveller pattern). Third, the protective effect of higher income on memory was stronger for older than for younger adults and strengthened over the later life course (between-participant and within-participant cumulative advantage/disadvantage pattern). Longitudinal data, growth curve modelling distinguishing the between-participant from within-participant effect, and adjustments for potential confounders based on the hypothesised causal structure enabled us to better navigate the landscape of causal inference. Findings suggest that the income-related gap in physical health but not in cognitive health narrows in old age for both Europe and China.

Contextual Targeting in mHealth Apps: Harnessing Weather Information and Message Framing to Increase Physical Activity

Mobile technologies provide a unique opportunity for practitioners to identify users’ real-time context and provide personalized interventions to influence their behaviors. However, less is known about a way to improve the effectiveness of mobile health intervention by using context information. This study provides design guidelines on how to use weather information with messaging formats to spur exercise. Through a field experiment that each participant experience different weather conditions in two different treatment periods under the gain or loss interventions, we found that the effects of gain or loss interventions under different weather conditions are heterogeneous. Loss intervention leads to higher fulfillment of exercise goals than gain intervention in sunny weather, whereas gain interventions are more effective than loss interventions in cloudy weather. In addition, we found that weather-based intervention can be used repeatedly over time without losing its effectiveness. Furthermore, we reveal that weather-based intervention is effective toward at-risk populations such as inactive individuals or lower income groups, serving as an mhealth solution that closes the health gap between the haves and have nots. Our findings provide useful guidelines for health service providers and health policymakers regarding how to effectively leverage contextual cues into mobile health intervention.

Can Wealth Buy Health? A Model of Pecuniary and Non-Pecuniary Investments in Health

Abstract In this paper, we develop a life cycle model that features pecuniary and non-pecuniary investments in health in order to rationalize the socioeconomic gradients in health and life expectancy in the United States. Agents accumulate health capital, which affects labor productivity, utility, the distribution of medical spending shocks, and life expectancy. We find that unequal health insurance coverage plays a negligible role in generating the observed gaps in health and longevity. Universal health insurance increases preventive medical spending but not time spent in health promoting activities, as individuals are no longer worried about avoiding high curative medical expenditure shocks due to increased health insurance coverage. Our findings suggest that differences in lifetime income, preferences, and health shocks are the main determinants of inequality in life expectancy.

Bridging gaps in health? A qualitative study about bridge-building and social inequity in Danish healthcare

ABSTRACT Attendance to health appointments may pose challenges to patients, especially when living in socially disadvantaged situations, with a fragile network. Inequality in health is increasingly highlighted in Denmark. To enhance social equity in health, a non-governmental organization introduced bridge-building, where healthcare students volunteer to accompany persons in socially vulnerable situations to health appointments. The purpose of the study was to explore what bridge-building entails and which gaps bridge-building attempts to span, in a welfare state, based on equal rights to healthcare.The study is based on an ethnographic fieldwork among the stakeholders in bridge-building, using interviews and participant observation in the form of “walking fieldwork”. Informants emphasized safe-making and wayfinding as important components in bridge-building, with bridge-builders acting as as-if-relatives. Bridge-building navigates in borderlands, the in-between spaces with fluid and contested borders, encompassing public, civic society, and family spheres. All informants emphasized that bridge-building covers a need in contemporary Danish healthcare. Bridge-building entails a double temporality, a here-and-now intervention where persons in vulnerable situations get social support to make it to health appointments, and a future investment in future health professionals’ understanding of vulnerability in lives and barriers to health access; insights that may be valuable in their future job positions.

Living alone and mental health: parallel analyses in UK longitudinal population surveys and electronic health records prior to and during the COVID-19 pandemic

BackgroundPeople who live alone experience greater levels of mental illness; however, it is unclear whether the COVID-19 pandemic had a disproportionately negative impact on this demographic.ObjectiveTo describe the mental health...

Mental health assimilation of rural–urban migrants in developing countries: Evidence from Indonesia's four cities

AbstractThis study investigates the mental health consequences of rural–urban migrants in Indonesia. We use the migrant economic assimilation model applied to our individual longitudinal data specifically designed to observe migrants' performance. Compared with urban non‐migrants, this study finds that migrants' mental health conditions are persistently lower. Moreover, their mental health gap has worsened over the years since migration. Along with this pattern, we also found that migrants' earnings are persistently higher than those of urban non‐migrants, with a decline in social support. This study is expected to enrich the literature on the assimilation of internal labour migration in developing countries.

Online Training for Primary Care Staff: Skills Development on the Mental Health Gap Action Programme (mhGAP) Intervention Guide

Developing effective learning strategies to strengthen mental health professionals’ capacities and deliver evidence-based interventions in their communities is urgent. We developed and evaluated an online training program for the Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-specialized Health Settings. Nine hundred and seventy-five health professionals in Mexico were enrolled in the training program, during the period of social distancing brought about by the COVID-19 pandemic. Participants completed a pre-post online evaluation strategy including Knowledge screening, assessment of Learning Activities, and performance in Programmed-Simulated cases to evaluate knowledge and skills for the assessment, management, and follow-up of Mental, Neurological and Substance Use Disorders. We found that participants improved their knowledge and skills from training on the mhGAP online course. Notably we observed these positive results regardless of sex, profession, institution, or social vulnerability rating of participants, suggesting that this is a relevant training program for primary care staff. These results contribute to the Mental Health Gap Action Programme and advance the use of online teaching and evaluation technologies in this field.