Service Engagement Research Articles

Examining mental health engagement among veterans diagnosed with serious mental illness.

Engagement in psychosocial mental health services has been found to support and facilitate the process of recovery in individuals with serious mental illness. However, many individuals eligible for these services are not receiving them. Presently, little is known about the factors that contribute to treatment engagement. This study aimed to identify attitudes related to treatment engagement among veterans with serious mental illness enrolled at a large VA medical center. Thirty-six veterans participated in individual qualitative interviews about their beliefs about the efficacy and purpose of mental health care; their perceptions of societal attitudes regarding mental health; and their experiences accessing mental health care. Based on their level of treatment engagement in the last year, veterans were classified as either engaged in psychosocial mental health services (n = 15), engaged in psychiatric medication management only (n = 14), or not engaged in VA mental health services (n = 7). Attitudes associated with level of service usage were examined to identify factors that might improve engagement in treatment and quality of mental health services. Results suggest that provider expertise and rapport were critical to engagement. Our findings also suggest that barriers to accessing care included beliefs about when it was appropriate to request services, stigmatizing attitudes within one's social network, the complexity of the mental health system, and failures of providers and the treatment system to address the needs of a diverse patient population. Implications for clinical training and practice are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

First Nations Peoples' perspectives on telehealth physiotherapy: a qualitative study focused on the therapeutic relationship.

Relationships are the core of Indigenous Peoples' spiritual and cultural identities, and therapeutic relationships are an integral part of the physical rehabilitation process, directly influencing health outcomes. However, participating in therapeutic relationships can be difficult for First Nations Peoples, particularly in the virtual landscape. There is limited understanding of First Nations Peoples' perspectives on this issue, and this understanding is crucial to developing culturally safe and effective telehealth physiotherapy programs. Therefore, the purpose of this study is to explore the perspectives of First Nations Peoples from British Columbia, Canada, on telehealth physiotherapy, with an emphasis on the virtual therapeutic relationship. A narrative qualitative study that utilized one-on-one, semistructured interviews was conducted with 19 First Nations adults from remote and rural First Nations communities in north-central British Columbia, Canada. Interviews were recorded, transcribed verbatim, and analyzed using an inductive approach to reflexive thematic analysis. Three themes emerged from data analysis. 'Therapist's attitude and rapport' captures participants' perceptions of what matters the most in how physiotherapists relate to First Nations Peoples and carry out their work. 'Remote nature of virtual care' encompasses the main challenges of virtual care visits, particularly how these were perceived to impact establishing and maintaining solid therapeutic relationships. 'Fostering culturally appropriate and safe telehealth physiotherapy' focuses on what is needed to advance telehealth physiotherapy in a manner that respects and reflects First Nations cultures, equipping all involved parties to provide comprehensive and sensitive services. Our findings advocate a hybrid model that combines in-person and telehealth visits to address communication barriers and the absence of physical interaction. Bridging the digital health literacy gap through training and collaboration with local support staff is crucial (as it is to bridge the possible cultural literary gap of therapists), and the incorporation of cultural elements holds promise for enhancing the engagement and effectiveness of telehealth services in these communities. The pursuit of equitable health care for First Nations communities demands not only increased access but also a thoughtful, culturally safe, trauma-informed, and holistic approach. This approach must be tailored to the unique needs of First Nations Peoples, emphasizing the integration of cultural elements and community support. A hybrid model combining in-person and telehealth visits is recommended to address logistical challenges and enhance the therapeutic relationship, ensuring that care is both effective and respectful of cultural values and practices.

Protocol for a co-design study for the development of a chronotherapeutic mobile health behaviour change intervention targeting light exposure among older adults

Through its wide-ranging effects on human physiology and behaviour, daily light exposure is an important environmental modulator of healthy ageing. Integrating mobile health (mHealth) technology with behaviour change strategies offers a promising approach to optimise light exposure and positively impact sleep, rest-wake cycles, cognitive function, and mood at scale. This study aims to develop the LightSPAN mHealth behaviour change intervention to optimise light exposure across the lifespan. Employing a co-design methodology, the study comprises two distinct workstreams. The first focuses on conceptualising the theoretical framework and implementation strategies through a comprehensive review of light exposure interventions, behaviour change theories, mHealth user personas, and recommendations for designing mHealth interventions for older adults. The second workstream centres on co-designing the intervention, involving consultation with community service providers and engagement with older adults at ageing community centres (≥60 years of age). Community service providers will be consulted through open-ended discussions (target n=5). Older adult participants (n=20) will engage in telephone interviews, focus group discussions and prototyping workshops to explore older adult participants’ characteristics, needs, preferences, and mHealth intervention design elements and co-design the LightSPAN mHealth behaviour change intervention. The insights generated in these co-design components will ensure that the intervention addresses the needs of its future users.

Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study.

Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming "super users" of all resources.

Screening, brief intervention, and referral to treatment for pain management for veterans separating from military service: study protocol of a hybrid type 2 study testing implementation facilitation versus training-as-usual.

Veterans transitioning to civilian life often have chronic pain from service-related musculoskeletal disorders (MSD) with higher risk for substance misuse. Many seek VA (Department of Veterans Affairs) compensation for MSD. Use of Screening, Brief Intervention, and Referral to Treatment for Pain Management (SBIRT-PM) by VA Post-9/11 Military2VA (M2VA) case managers presents an opportunity to engage these veterans in VA pain care and address substance misuse. Implementation facilitation might help case managers use SBIRT-PM and engage veterans in services to improve outcomes. This study is a 2-cohort multisite cluster-randomized hybrid type 2 effectiveness-implementation trial. Within 2 separate cohorts of 14 VA sites each, sites will be allocated to receive an implementation strategy through the use of a constrained randomization procedure: virtual implementation facilitation or training-as-usual. Sites and M2VA case managers will receive the assigned implementation strategy to support use of SBIRT-PM. Recently discharged veterans (n = 1848) claiming service-connected MSD will be recruited, with case managers blind to veterans' study enrollment. The proportion of participants who receive any SBIRT-PM will be the primary implementation outcome. Veteran participants will complete baseline, 12-week, and 36-week assessments, irrespective of whether case managers conduct SBIRT-PM with them (intent-to-treat). Pain intensity and interference will be the primary clinical outcomes. The study emphasizes pragmatic over explanatory methodological features. This pragmatic trial will examine implementation facilitation versus training-as-usual in implementing SBIRT-PM to promote veteran engagement in nonpharmacological pain services. Using innovative methods to train and support VA case managers in SBIRT-PM, study outcomes could have broad implications for case management systems of care across the VA.

Accounting Faculty’s Motivation to Engage in Academic Citizenship: Evidence from Australia and New Zealand

ABSTRACT Academic citizenship, encompassing service and broader community engagement, is declining despite its pivotal role in the academic ecosystem, largely due to being underrecognized and underappreciated in university reward systems. This study identified factors that support and inhibit faculty engagement in academic citizenship so that initiatives to reverse this trend can be designed. We interviewed 24 accounting faculty from 11 universities across Australia and New Zealand. Drawing on social cognitive theory, this study identified personal factors such as faculty self-efficacy, goal commitment, and self-evaluation of progress as drivers of engagement. Our findings underscore the urgent need for university management to support academic citizenship, particularly among junior faculty, and to formally recognize it in institutional workload models, performance evaluations, and reward systems, to ensure the sustainability of the academe ecosystem. JEL Classifications: M49.

Unveiling game meat: an analysis of marketing mix and consumer preferences for a forest ecosystem product

This study explores the dynamics of the game meat market, with a particular focus on venison and wild boar meat, to assess the impact of a nuanced marketing mix and strategy grounded in a comprehensive customer analysis. By conducting three pivotal research studies—namely, the Omnibus Survey (2022) and Consumer Market Analysis Polls (2021 and 2023)—and analysing their data, this research comprehensively analyses buyers’ preferences, motivations, and purchasing patterns. This paper is guided by three research questions aimed at examining the relationship between the game meat consumption and engagement in forest ecosystem services, including forest visitation, the sociodemographic characteristics of consumers and the criteria for market segmentation. The analysis focuses on identifying factors influencing the game meat consumption and examines how these factors may influence consumer behavior over time. It also explores the implications for the development of marketing strategies, based on Michael E. Porter’s approach, which is discussed in detail. Additionally, the research evaluates the role of game meat within the context of forest ecosystem services, its contribution to forest reforestation initiatives, and its relevance in the formulation of forest policy. This examination highlights the dual nature of game meat as both a market commodity and a critical element in ecosystem management and policy frameworks, seeking to harmonize the economic and ecological objectives.

Exploring the Mechanisms Driving Sense of Community in a Smart Society in Wuhan: A Mixed-Methods Multidimensional Comparative Study

In the context of China’s community governance, as a result of the insufficient willingness and ability of residents to participate, most communities have formed a “strong political–weak social” governance structure, which limits the effective expansion of social capital. To address this challenge and promote resident participation, achieving a “strong social and political” transformation in governance structure has become a core issue in current research. Meanwhile, “sense of community” serves as a crucial perspective in this research, which remains to be deepened in domestic studies and needs to consider the impact of emerging factors such as smart technologies. This study innovatively introduces affective events theory (AET), constructing a theoretical model and taking Wuhan as an example. By adopting quantitative and case comparison research methods, the paper delves into the factors influencing Wuhan residents’ sense of community in the context of a smart society and the promoting role of smart governance. On the basis of the findings, this paper presents the following conclusions: (1) Communities should attribute equal importance to the construction of both traditional and smart environments while reinforcing the leading and participatory roles of community administrators; (2) In the community’s daily governance processes, equal focus and importance must be attributed to both service delivery and engagement; (3) Communities must acknowledge the individual distinctions among residents and implement tailored governing strategies accordingly; (4) The government should prioritize the research and development of smart applications while boosting financial investments in the creation and operation of smart communities.

Semmelweis University’s innovative Center of Preventive Services in support of healthy ageing

Abstract Issue/problem Europe’s aging population presents substantial hurdles for healthcare sustainability. To alleviate the social and economic impacts of age-related diseases, promoting healthy aging is imperative. However, motivating individuals to adopt a healthier lifestyle proves challenging. Description of the problem Semmelweis University, a leading institution in medicine, health sciences, and health care in Hungary and Central Eastern Europe, has addressed this challenge by establishing the Center of Preventive Services (CPS), serving 12,500 Semmelweis University employees. The CPS conducts comprehensive health risk assessments and offers consultations with specialists in preventive medicine, public health, dietetics, physiotherapy, and health psychology. Motivational interviewing is used to enhance patient engagement and commitment to healthy lifestyle changes. Results The CPS has effectively integrated preventive services into the university’s healthcare system, reaching a significant number of employees. Early results show improvements in participants’ lifestyle and health behaviors due to the effective use of motivational interviewing. According to the first preliminary result, a study on step count conducted within the CPS found that those taking part in motivational interviewing session were able to increase their average daily step count by 1074 (95% Confidence Interval: 116-2033) steps more than controls. Lessons The Semmelweis University’s CPS provides valuable lessons for integrating healthy aging-focused preventive care into healthcare systems: 1. Effective preventive care requires targeted interventions based on detailed risk assessment and motivational interviewing; 2. Embedding preventive services within existing health infrastructure improves accessibility and utilization; 3. Collaborative and multidisciplinary approaches are essential to comprehensively address the needs of ageing populations. Key messages • Motivational interviewing boosts the effectiveness and engagement of preventive health services, which is essential to meet the challenges of ageing populations. • The Semmelweis University’s model program shows that embedding preventive services into the infrastructure of existing institutions like universities is scalable for better public health.

Incorporating client perspectives: moving towards digital outcome measurement in pediatric speech-language pathology

ABSTRACT Caregivers’ needs and preferences regarding outcome measurement in pediatric speech-language pathology are not well-understood, but are critical to the development and implementation of meaningful clinical tools. This project engaged caregivers of preschoolers with speech, language and communication needs to understand their views on the potential for, and their preferences surrounding a digital version of one participation-focused outcome measure called the Focus on the Outcomes of Communication Under Six (FOCUS-34). Fifteen caregivers of preschoolers who were receiving services in a large health system participated in one of four 30–60-minute virtual focus groups or one of three individual interviews. Caregivers shared their perceptions of whether and how a digital FOCUS-34 may improve their service experience, and their preferred features and formats to make it useful. An inductive content analysis was used to identify relevant categories that described caregivers’ perspectives. Data were sorted into two categories: (1) caregivers believe a digital solution would improve their service experience, and (2) caregivers want a user-friendly digital FOCUS-34 to measure and give feedback on intervention outcomes. Multiple sub-categories were also identified, which further described caregivers’ views on how a digital measure would improve the feasibility of outcome measurement, family engagement in services, and transparent communication with providers. Sub-categories also outlined caregivers’ preferences for the features and functions of a digital measure and their suggested considerations for developers of the digital tool. Results provide new insight into caregivers’ perspectives on digital outcome measurement and will inform efforts to improve the utility of the FOCUS-34 for families.

Navigating the digital beat: a review of social media as a public engagement tool in policing

PurposeThis article explores the changing nature of social media use as a public engagement tool by police services.Design/methodology/approachA comprehensive review is conducted of academic studies from criminology and policing journals. Sources are identified from key academic databases and are analysed in relation to three decades (2000–2009, 2010–2019 and 2020 to present) to show how the use of social media has changed over time.FindingsThe way in which social media is used in policing has changed considerably over time. From initial enthusiasm, it is found that there is growing scepticism in the use of social media as a public engagement tool. After an initial proliferation in use, there is then increasing consolidation and control in response to concerns about reputational risk.Research limitations/implicationsThe research highlights underlying dynamics of engagement and retrenchment, which offer important insights for how we understand public engagement and value creation in policing and emergency services more generally. We draw on academic research from English-language academic journals, but we have endeavoured to include research from the broadest possible range of countries.Practical implicationsThis study demonstrates how the police and other public services must respond to the growing use of social media by the public to maximise value creation whilst minimising the threats that come from potential value destruction.Originality/valueThis study is the first to comprehensively review the policing and criminology literature related to social media and to apply a public engagement lens to this analysis.

First-year domestic and international university students’ knowledge and use of mental health services and self-care practices in Australia

ABSTRACT Objective Transitioning to university brings challenges and stress that could be mitigated through self-care practices and knowledge and use of mental health services. This study examined these variables in first-year students at an Australian university, exploring any differences between international and domestic students and whether demographic variables and psychological distress influence knowledge and use of mental health services and self-care practices. Method Participants were 821 first-year students (77.6% female, 25.2% international, Mage = 20.7, SDage = 5.54 years). Measures included the Mental Health Literacy Scale, purpose-written questions about awareness, confidence, and engagement with mental health services, self-care knowledge and use, and PsyCheck. T-tests examined differences between domestic and international students. Hierarchical regression analysis assessed relationships between demographic factors, psychological distress, and mental health-related variables. Results Compared with international students, domestic students had greater awareness, confidence, and engagement in mental health services, and better self-care knowledge. Demographic variables were associated with mental health outcomes, with limited model strength. Psychological distress was associated with less knowledge and confidence in accessing mental health services yet higher engagement with services, and lower self-care knowledge and use. Conclusions The findings underscore the need for targeted mental health resources, particularly for international students and those experiencing higher psychological distress.

Engaging primary care patients at risk for suicide in mental health treatment: user insights to inform implementation strategy design

BackgroundGiven that the majority of suicide decedents visit primary care in the year preceding death, primary care has been identified as a key setting in which to engage patients at risk for suicide in mental health services. The objective of this research was to identify barriers and facilitators to engagement in mental health services among primary care patients at risk for suicide to inform the development of strategies to increase engagement.MethodsSeventy-four semi-structured qualitative interviews were conducted with primary care patients (n = 20), primary care (n = 18) and behavioral health (n = 12) clinicians, mental health intake coordinators (n = 4), and health system and clinic leaders (n = 20). Patients who had been referred for mental health services from primary care and reported an elevated score (≥ 1) on item 9 on the Patient Health Questionnaire at the time of referral were eligible to participate. Eligible clinicians and leaders were employed in a primary care or behavioral health setting in a single large health system with an integrated mental health program. Interviews typically lasted 30–60 min, were completed over video conference or phone, and were coded by members of the research team using a rapid qualitative analysis procedure.ResultsParticipants were primarily female (64.9%), white (70.3%) and non-Hispanic/Latine (91.9%). The most identified barriers to mental health care engagement were waitlists, capacity limits, insurance, patient characteristics, communication, collaboration, and/or difficulties surrounding travel. The most commonly cited facilitators of engagement included telehealth, integrated care models, reminders, case management support, psychoeducation, motivational enhancement, and scheduling flexibility. Concrete suggestions for improving engagement in mental health services included increasing communication between providers, streamlining referral and intake processes, providing reminders and follow ups, and advocacy for increased reimbursement for suicide risk assessment.ConclusionsResults underscore the myriad barriers patients at risk for suicide encounter when attempting to engage in mental health care in a primary care setting. Facilitators of engagement and suggestions for improving connections to care were also identified, which can inform the design of implementation strategies to improve engagement in mental health services among primary care patients at risk for suicide.Trial registrationClinicalTrials.gov Identifier: NCT05021224 (Registered August 19, 2021).

It’s all about the patients: a shift in medical students’ approach to learning during a novel distributed integrated clinical rotation

IntroductionTo ensure that pre-final year medical students at Stellenbosch University were able to resume clinical training during the COVID-19 pandemic, a 12-week integrated rotation was introduced, during which students were distributed across a widespread training platform in two provinces of South Africa, utilizing a range of health care facilities in both rural and urban areas, rather than the central academic hospital (CAH) in which they would have been doing clerkships. Called the Integrated Distributed Engagement to Advance Learning (IDEAL) rotation, this clerkship was based on supervised engagement in healthcare services, focusing on patient-based clinical training, self-regulated learning and student participation as integral members of clinical teams. The success of this emergency intervention has led to its formal incorporation into the medical curriculum. This study aimed to understand the factors that influenced learning among students undertaking the IDEAL rotation at multiple sites on a distributed training platform.MethodsUsing an interpretive paradigm, we sought to conduct focus group interviews with students who completed the first iteration of the IDEAL rotation in the year after they had undertaken it to understand their experiences. All 252 students who were eligible were invited to participate by email on several occasions. Ultimately three focus group discussions and two individual interviews were undertaken, based on volunteers. Using a semi-structured interview guide, these explored student perceptions of their learning and growth through the rotation. Inductive and deductive analysis was carried out to identify themes.FindingsStudent descriptions of their learning experiences coalesced in 6 themes. The rotation was an enabling learning experience, which was more practically focused and assisted students in developing confidence in their clinical skills. It was seen to be a humanizing learning experience with greater opportunities for the development of relationships with patients and families, as well as with health professionals, who made them feel part of the team, so it was also a more collegial learning experience. At the same time, it was a variable learning experience with a lack of standardization on a number of levels and challenges being experienced at particular sites regarding both logistics and the nature of the exposure. Students perceived it to be a very different learning experience from what they had encountered in the CAH in terms of relationships, the kinds of patients and problems they saw, and their active participation. Through this, they also learned more about themselves and their roles, making it a personal learning journey. The findings confirm the importance of the dimensions of person, participation and place for being and becoming a doctor in a clinical environment.ConclusionsStudent learning experiences in the IDEAL rotation emphasize the importance of context, reinforcing the value of a distributed training platform in developing health professionals who are responsive to their environment. They emphasize the vital role of active participation in learning and the centrality of relationships in medical training, helping to develop graduates who are human beings and not only human doings.

Identifying Motivators, Facilitators, and Barriers to Engagement and Retention in Anal Cancer Screening Among Men and Women with HIV in One Ryan White HIV/AIDS Clinic.

Anal squamous cell carcinoma disproportionally affects people with HIV (PWH); however, engagement in anal cancer screening is low in many settings. This study was conducted to assess knowledge and perceptions of anal cancer screening to identify factors in the engagement and retention in prevention services among PWH. Semistructured interviews were conducted among adult PWH eligible for anal cancer screening in our Ryan White HIV/AIDS Program clinic. Descriptive statistics were tabulated; thematic analyses were performed to identify emerging motivators, facilitators, and barriers. Among 26 PWH, 9 had not been screened, 8 had undergone Papanicolaou (Pap) testing alone, and 9 had undergone anoscopy. The median age of the cohort was 55.2 years; 54% identified as men who have sex with men, and 54% identified as Black. In the unscreened cohort, participants were motivated by investing in their health and positive attitudes toward cancer prevention however were deterred by a lack of referral and low awareness about screening. Among those who had Pap testing, trust in healthcare providers and abnormal testing results were motivators to engagement, whereas lack of perceived risk of anal cancer and worry about pain of an anoscopy were prominent barriers. Among those who had anoscopy, perceived risk, positive experience with the procedure, and use of anxiolytics prior to anoscopy were motivators, whereas anxiety around a new cancer diagnosis and negative experience with anoscopy were barriers. Clinics seeking to build or strengthen their anal cancer screening programs can address the barriers described in this study to promote access to anal cancer screening among PWH.

Service Engagement Among People Experiencing Homelessness and Mental Disorders: A Call for Person-centred Innovations.

In recent years, there has been increased support for the use of coercive policies to address the seemingly intractable problem of homelessness among people with mental disorders in North America. Although these policy approaches respond to a critical issue, rising rates of unsheltered homelessness, low service engagement and concerns about disruptive behaviors in public settings, they are unlikely on their own to be successful. To avoid coercive practices, there is an urgent need to consider alternative, person-centred approaches to promote service engagement among people experiencing homelessness and mental disorders, with input from those with lived experience and frontline homeless service providers. Three person-centred approaches are proposed for consideration: (1) cross-sectoral service delivery models, (2) peer-led services, and (3) financial incentives. These approaches merit further study to support voluntary treatment engagement and exits from homelessness among people with mental and substance use disorders and safeguard the human rights of this population.

6920 Engagement and Mood assessments in Emerging Adults Attending a Multi-disciplinary Diabetes Transition Clinic

Abstract Disclosure: G.P. Thota: None. S. Glaros: None. S. Dixon: None. S.T. Chung: None. Introduction &amp; Objective: Transitioning to adult diabetes care can be challenging and associated with interruption in care, worsening glycemic control, and social stress. However, most studies have been conducted in emerging adults (YA) with type 1 diabetes (T1D), and contemporary data in multi-disciplinary clinics designed with supportive resources, especially for YA with youth-onset type 2 diabetes (Y2D) is lacking. Our objectives were to assess mood and engagement in psychology therapy services within a structured multidisciplinary diabetes clinic. Methods: This was a single-center observational analysis of YA (18-30y) attending a research diabetes transition clinic supported by clinical coordinators, social navigators, a certified diabetes educator, and a nutritionist between January 2021 and December 2023. All YA were offered free transportation to and from visits. Clinical coordinators communicated regularly for appointment reminders. Mood was assessed with Patient Health Questionnaire (PHQ-9) and the General Anxiety Disorder (GAD-7) at each visit and Endocrine Society Transition Readiness Form at initial visit. In January 2023, all YA were given the option to meet with a clinical psychologist during the diabetes visit. Student t-test were used to compare groups using STATA v.18. Results: In 62 YA (73% Y2D, 10% T1D, 17% other) aged 20.2±2.7y, BMI:37.3±9.6 kg/m2, all engaged in nutrition counseling and 52% (32/62) utilized transportation services. A diagnosed psychiatric disorder was present in 16% (10/62). At initial visit, PHQ-9 scores were 6.1±6.3, n=62 and39% (24/62) had score &amp;gt;8 (moderate depression). Within the last 2 weeks, 13% (10/62) reported suicidal ideation. GAD-7 scores were 6.0±6.3 and 54% had anxiety that interfered with activities of daily living. Psychology services were accepted in 61% (38/62) with higher initial GAD-7 scores in those who saw psychologist (8.2±6.8 vs. 4.1±5.3, P=0.02) but no difference in PHQ-9 scores (7.2±6.6 vs. 5.1±5.9, P=0.2). Most YA (81%) reported adequate diabetes knowledge while 25% YA reported diabetes-related challenges including feeling burned out, not knowing how to navigate specialty diabetes care, challenges with medication insurance, transportation, and insurance coverage. Conclusion: Approximately 50% of emerging adults with diabetes reported moderate depression and anxiety scores and were interested in engaging in psychology services. Transition diabetes care programs should focus on increasing access to routine integrated mental health services and social support.Such an initiative could potentially ameliorate psychological stressors associated with diabetes management during the transition to adult care. Presentation: 6/1/2024

Interrogating the effectiveness of service engagement for underserved populations in complex health and social care systems: towards an equitable engagement strategy

There are increased sector-wide efforts within health and social care systems to engage those with lived experience in service design, delivery, and monitoring – aiming to secure more equitable health outcomes. However, critical knowledge gaps persist around how national whole-system engagement strategies can account for the challenges experienced by populations that encounter exclusion within complex multi-layered systems. This includes a failure to delineate shared challenges across groups, and to develop transferable cross-group frameworks to assist sector-wide change. There is, therefore, a danger that those groups already least heard will be collectively left behind. With a view to informing a more inclusive engagement strategy in Ireland, this national study aims to investigate multi-level (policy and strategic, operational, on-the-ground services, individual) shared challenges impacting engagement for five populations who have been identified as underserved groups in a complex health and social care system, including: (1) those who misuse drugs and alcohol, (2) those who are experiencing homelessness, (3) those experiencing mental health, (4) migrants and those of minority ethnicies, and (5) Irish Travellers. Adopting a mixed-methods approach which draws on an evidence-informed multistakeholder perspective, this study employs data from: focus groups and life-course interviews with lived-experience populations (n=136), five focus groups (n=39) and a national on-line survey (n=320) with population-specific services providers; and national-level stakeholder interviews (n=9). Two cross-group participatory consultative forums with lived-experience and provider participants (n=28) were used to co-produce priority action areas based on study findings. This article presents findings on shared challenges in engaging these groups around leadership and commitment, implementation and action, population capacities, trust, and representation, stigma, and discrimination. Derived from these challenges, six development areas are presented to advance an inclusive equitable engagement approach in Ireland. These comprise: 1) balancing top-down prioritisation, and bottom-up direction; 2) sustaining multi-level, multi-form implementation; 3) measuring effectiveness and action; 4) embedding inclusive equitable engagement; 5) trust as a prerequisite, and outcome; and 6) an equalising, agency empowering agenda.

Marketing mental health services: a mixed-methods analysis of racially and ethnically diverse college students’ engagement with and perspectives on U.S. university mental health clinics’ websites

BackgroundThe United States (U.S.) faces a significant mental health crisis, with around 52.9 million adults experiencing mental health disorders, with young adults (18–25 years old), such as college students, having the highest prevalence and lowest service utilization rates. While efforts to expand mental health services through “push” strategies are in place (e.g., training therapists in evidence-based therapies), limited initial engagement suggests a need for “pull strategies” and targeted marketing that make services attractive to college students and increase demand. This mixed-methods study identifies U.S. university mental health clinic websites and website characteristics that are attractive and engaging to college students interested in seeking mental health services (i.e., students were considering or actively looking for mental health support).MethodsEleven U.S. university websites were chosen (10 randomly and one from the university where students were attending) from a pool of 44 Psychological Clinical Science Accreditation System training clinics websites. Fifty-seven college students (Mage = 20.95, SD = 2.97; 81% female; 68% racial/ethnic minority) were videorecorded engaging with two U.S. university mental health clinic websites, completed self-report engagement measures, and gave detailed feedback about websites through semi-structured interviews.ResultsLikert scale scores revealed moderate engagement with all websites (e.g., they were interesting and helpful). Qualitative results indicated that websites that provided important and easily understood information about key features of services (e.g., types, evidence-base, and cost), therapist backgrounds, psychoeducation, used lay language, and had an appealing website layout (e.g., color, font, images, organization, and interactive components) generated greater consumer interest and trust in their mental health services.ConclusionsThis study emphasizes the importance of using marketing strategies to enhance college students’ engagement through mental health service websites. Salient features, psychoeducation, and effective promotional strategies (e.g., how information is presented) were identified as crucial for website engagement and subsequent mental health service uptake. Using marketing strategies, such as tailoring language to consumer literacy levels, describing the evidence-base of services, and improving website design may address college students’ needs and enhance initial mental health service engagement.

Outcomes of a policy to prioritize populations with expected healthcare barriers for subsidized PrEP care in Amsterdam, the Netherlands: a cross-sectional study.

The Dutch HIV pre-exposure prophylaxis (PrEP) pilot provided subsidized PrEP care to maximum 2,900 individuals at a time in Amsterdam. Populations with expected barriers to accessing PrEP elsewhere were prioritized for program inclusion. We evaluated their prior sexual health service engagement and PrEP need. Cross-sectional analysis using enrolment data. We included individuals ever enrolled in the PrEP program at the Center for Sexual Health (CSH) Amsterdam between 2019-2023. We calculated the proportion belonging to higher-priority groups (i.e.,<25 years old, transgender, sex worker, uninsured or migrant). We defined classes of sexual health service engagement in the 12 months preceding enrolment using latent class analysis (LCA). We compared engagement classes, sexual behavior and positivity of HIV and sexually transmitted infections (STI) between higher- and lower-priority groups. 2,004/4,075 (49%) individuals enrolled belonged to higher-priority groups. LCA showed three classes of prior engagement: "Newly engaged" (14%,n = 551) were new to the CSH-Amsterdam; "PrEP initiators" (40%,n = 1,642) previously visited the CSH-Amsterdam but had not used PrEP; "PrEP experienced" individuals (46%,n = 1,882) previously accessed PrEP. Higher-priority groups were more often "newly engaged" or "PrEP-initiators" than "PrEP-experienced". Higher-priority groups less often had condomless anal sex with casual partners or chemsex in the prior six months. Positivity of bacterial STI was similar between higher-priority (n = 300/2,004, 15.0%) and lower-priority (n = 315/2,071, 15.2%) groups. 13/14 HIV diagnoses at enrolment were in higher-priority groups. Higher-priority populations had less often previously used sexual health services and accounted for most new HIV diagnoses at enrolment. Engaging these populations in sexual healthcare, including PrEP, should be stressed.