Health Support Services Research Articles

Mapping Uncharted Territory in Later Life Disablement Trajectories: A Closer Look at Progressive Disease.

Aging research has conceptualized disablement via two primary frameworks. Paradigms of successful aging frame substantial disablement in aging as universally abnormal. These models have often been challenged as narrow and ableist, leaving out common experiences among people with chronic conditions. By contrast, steady decline paradigms frame substantial disablement in aging as universally normal. These models have invited challenges due to ageism inherent in automatically conflating older age and disability. Both frameworks juxtapose monolithic and rigid ideas of normalcy-and thus limit our understanding of dynamic possibilities in later life health and functioning. Given that people with progressive conditions often experience wide variability in daily status and inconsistency in long-term outcomes, current later-life disablement models may overlook such experiences. We thus propose additional nuance in later-life disablement modeling that brings innovative stochastic frameworks of daily health and functioning to longitudinal trajectory concepts. Using an "aging with progressive disease perspective," we outline gaps and opportunities in the current landscape of later-life disablement modeling. We then engage our standpoints from lived experience with progressive conditions to recommend new directions in conceptualizing relationships between aging and disability. Including such conditions in later-life disablement models can improve health care and supportive services for affected individuals.

Differential outcomes: early marriage, marital identity and mental health of displaced female youth in the Kurdistan Region of Iraq

ABSTRACT Little is known about the mental health and well-being outcomesfor females that marry under-age in conflict and displacement settings. Even less is known about how such outcomes differ based on marital experience and marital identity. To explore these gaps and relationships empirically, a cohort of 63 female youth between the ages of 14 and 24 was followed for 27 months using predominantly qualitative and participatory methods. The sample was comprised of Syrian refugees, internally displaced Yazidis, and conflict-affected Iraqi Arabs in the Kurdistan Region of Iraq. Results indicate that regardless of marital status, female youth experienced a high number of traumatic events stemming from the conflict, family, and community, which significantly impacted their mental health and well-being. This was further impacted by the on-going stressors of living with gender inequality, deprivation and in displacement. Marital identities led to differential mental health and well-being outcomes. Females that married early had poor outcomes if they experienced abuse or if they had been forcibly married. Divorced and widowed female youth had uniformly very high levels of psychological distress, as did those who were unmarried and living with disabilities. Female youth who showed the most positive mental health and well-being outcomes were unmarried, and actively pursuing their educational and career aspirations with the support of their families. At the same time, married youth that had expanded their opportunities (economic, social, movement, educational, legal status) through their marriages also reported positive mental health. Findings indicate that Mental Health and Psychosocial Support Services (MHPSS) are urgently needed for female youth in conflict and displacement, and that these services should take into account marital identity. Findings also indicate that the relationship between conflict, early marriage, and mental health is not unidimensional and requires a more subtle and nuanced analysis by key stakeholders in order to design appropriate and effective interventions.

Delving into the world of webCHAT - an e-mental health support service for distressed youths in Singapore.

Young people face high rates of mental health issues, yet many do not seek professional help. In 2017, CHAT launched webCHAT - a free, anonymous, one-on-one synchronous web-based text service managed by case managers (CMs) to support young people aged 16 to 30 who may be hesitant about engaging in face-to-face mental health services. This study aimed to explore the perspectives and experiences of users who accessed webCHAT for mental health support in Singapore. A qualitative thematic analysis was conducted using transcripts of webCHAT sessions to identify main themes. Many users accessed webCHAT to seek support with emotional and behavioural concerns, valuing its immediacy and anonymity over traditional appointment-based services. A desire to 'get better' and self-realisation emerged as important motivators for seeking help, with webCHAT offering a supportive space for reflection. Key barriers to seeking additional support included fear of stigma, concerns about leaving a 'medical record', potential hospitalisation, and treatment costs. webCHAT appears to be a viable early intervention and preventive approach, providing young people with a pathway towards in-person support services. Professional guidance from CMs is essential in encouraging users to pursue further support, emphasising the importance of human expertise in digital mental health platforms. By fostering early help-seeking and self-realisation, webCHAT has the potential to reduce the long-term impact of mental health challenges. Future research could explore webCHAT's long-term effects and identify improvements to facilitate users' transitions to in-person support.

TELEMEDICINE AND MEDICAL MALPRACTICE

Digitization in healthcare covers many topics such as artificial intelligence, robotic surgery, wearable health technologies, nanotechnology, 3D printers, virtual reality applications, electronic prescription, and remote health delivery services (telemedicine). Among these developments, telemedicine is one of the applications that are expected to cause significant changes in the classical patient-physician relationship in the near future. Telemedicine is defined as the use of electronic information and communication technologies to provide and support health services in situations where distance is a problem. According to the World Health Organization (WHO), telemedicine applications are divided into five main categories: teleradiology, teledermatology, telepathology, telepsychiatry, and telemonitorization. Due to the increasing need and demand after the COVID-19 epidemic in Turkey, the "Regulation on the Delivery of Remote Health Services" was published in the Official Gazette dated 10.02.2022. Telemedicine applications, which are fast, effective and financially sustainable healthcare services, have various advantages and disadvantages. This system offers main advantages such as increasing the quality of health services, decreasing economic costs, providing equally accessible health services to everyone, including those living in different age groups and/or rural areas, alleviating the workload of the emergency service, and preventing the increasing incidence of violence in health. Besides lack of face-to-face communication, insurance payment coverage, and digital security problems are the possible disadvantages of the system. The lack of the necessary legal infrastructure and the new implementation of telemedicine pose significant risks in terms of malpractice. In addition to informed consent, diagnosis, follow-up, treatment, consultation, and medical record processes, in these cases, it is important for medical malpractice evaluation to reveal the differences between telemedicine from classical medical education teachings and to draw its legal framework clearly. In our study, it is planned to guide the possible processes in Turkey by considering the approaches to malpractice in the practices of countries where telemedicine is applied.

Resilience as a predictor of internet addictive behaviours: a study among Ghanaian and Saudi samples using structural equation modelling approach

This study aimed to examine the relationship between resilience and internet addictive behaviours, focusing on cross-cultural contexts involving tertiary education students in Ghana and Saudi Arabia. Using a cross-sectional survey design, data were collected from 738 students across selected universities in both countries. Structural equation modeling (SEM) techniques were employed to analyse the data. The findings indicated that most respondents exhibited low resilience levels alongside a high prevalence of internet addictive behaviours. A significant positive relationship was identified between resilience levels and various dimensions of internet addiction, as well as the overall composite of internet addictive behaviours. Interestingly, while low resilience levels were found to increase the risk of internet addiction, higher resilience levels also appeared to heighten susceptibility to addictive behaviours. These results suggest the need for targeted interventions to address internet addiction. Programs should focus on enhancing resilience through resilience-building initiatives, promoting digital well-being, and integrating mental health support services. These approaches can help mitigate the risks associated with internet addiction while fostering healthier coping mechanisms in students across diverse cultural settings.

Reels to Remembrance: Attention Partially Mediates the Relationship Between Short-Form Video Addiction and Memory Function Among Youth

Abstract: Background and Purpose: The proliferation of short-form video content on social media platforms has led to increased user engagement but also raised concerns about potential addictive behaviors and cognitive consequences, particularly among youth. This study explored the prevalence of short-form video addiction (SVA) among Jordanian youth, its correlates, and its impact on attention and memory function, with an emphasis on understanding the mediating and moderating role of attention in the relationship between SVA and memory. Methods: Utilizing a cross-sectional survey design, data were collected from 1029 university students across 25 higher-education institutions in Jordan. Results: Half of the participants exhibited moderate to high levels of SVA. The findings indicated a significant increase in SVA scores among female students (p = 0.003), those of a younger age (p = 0.045), those with lower GPAs (p = 0.013), and those who dedicated fewer hours to study (p = 0.006). Notably, there was a significant and large correlation between SVA scores and students’ perceptions of user-generated content (p < 0.001). Attention partially mediated the relationship between SVA and memory function with excellent model fit indices (χ2(12) = 14.11, p = 0.05, RMSEA = 0.03, GFI = 0.99, IFI = 0.99, TLI = 0.98, CFI = 0.99). However, attention did not moderate this relationship, suggesting that the impact of SVA on memory is consistent across varying levels of attention. Discussion: The findings underscore the significant engagement of Jordanian youth with short-form video content and the potential cognitive risks associated with SVA. Interventions to manage attention could mitigate the adverse effects of SVA on cognitive functions. This study calls for a comprehensive approach to address SVA among youth, including the development of digital literacy programs, mental health support services, and policy interventions that promote a balanced digital ecosystem and responsible media consumption.

Healing beyond bone: a qualitative study of the core decompression experience of physically active patients with stage II hip avascular necrosis

BackgroundAvascular necrosis (AVN) of the femoral head is a degenerative condition characterized by ischemic bone death, resulting in pain and impaired mobility. Core decompression, a surgical intervention, is widely performed for stage II AVN to alleviate symptoms and delay disease progression. While clinical and radiological outcomes are well-documented, the psychosocial dimensions of recovery remain underexplored. This study aims to understand the experiences of physically active patients diagnosed with stage II AVN who have undergone core decompression surgery during their follow-up period, allowing for a broader evaluation of the experiences of this patient group.MethodsThis study used semi-structured interviews, in-depth follow-up questions, and thematic analysis to explore the experiences of physically active patients who underwent core decompression surgery for stage II AVN of the femoral head. The participants were assessed 1–3 years post-surgery. Conducted in the Orthopaedics and Traumatology outpatient clinic of Adana City Training and Research Hospital, the study included 31 patients who had core decompression surgery between January 2020 and January 2024, with at least one year of follow-up data. Data collection, including demographic and qualitative information, was carried out during the first week of April 2024, followed by the member-checking process in the third week. A thematic analysis checklist and COREQ guidelines were used to ensure analysis reliability.ResultsThe experiences of 31 patients (mean age 37.19 ± 8.21 years, 12 females, 19 males) were summarized into five main themes that emerged from the data analysis process: ‘Expectations and Concerns Before Surgery,’ ‘Postoperative Physical Experiences,’ ‘The Psychological and Emotional Process,’ ‘Social Support and Family Relationships,’ and ‘Health Services and Medical Support.’’ Twelve sub-themes emerged from the main themes.ConclusionsCore decompression offers significant benefits to patients with stage II AVN by improving mobility and reducing pain. However, psychological support, patient education, and robust social networks are essential to address the holistic needs of recovery. These findings highlight the importance of integrating patient-centered approaches into surgical care to optimize outcomes and satisfaction. Further qualitative research is needed to explore the experiences of AVN patients at different stages to inform multidisciplinary care strategies.

Caregivers’ Experience of Supporting Deaf Adults with Mental Health Disorders in Ghana

Background: Caregivers play a crucial role in the support and management of individuals experiencing mental health disorders; however, there is a paucity of research concerning the experiences of caregivers of deaf persons diagnosed with any form of mental disorder in Ghana. This study aims to explore the lived experiences of these caregivers, with a particular focus on their perceptions of mental health, available support systems, challenges encountered, and the consequent impact on familial relationships while supporting this underserved population. Method: This qualitative study engaged eleven family caregivers of deaf adults diagnosed with a mental health disorders made up of ten females and one male aged 45–68 years, recruited across four of the sixteen administrative regions in Ghana. Utilizing a semi-structured interview guide, face-to-face interviews were conducted to gather in-depth narratives from the participants. Results: Thematic analysis of the data revealed several key themes, including the awareness and understanding of mental health disorders, availability and accessibility of mental health support services and training, dynamics of psychosocial and familial relationships, and the multifaceted challenges faced in caregiving for individuals with mental health disorders. Conclusion: The findings underscored an urgent need for the development of a specialized caregiving manual tailored for caregivers of deaf individuals experiencing mental health disorders. This study advocates for policymakers to prioritize the creation of such resources to enhance care delivery and improve overall mental health outcomes for this vulnerable population.

The parent empowerment scale: development and psychometric properties

Background Parents of trans and gender diverse (herein ‘trans’) children experience additional challenges in their parenting role relative to parents of cisgender children. Understanding and enhancing parents’ empowerment is a promising approach to support both parents and children. We aimed to develop an empowerment scale specific to parents of trans children, grounded in parents’ lived experiences. Methods Based on a previous qualitative investigation of empowerment in parents of trans children, 32 items were created and iteratively reviewed by a parent advisory group to ensure understanding, respectfulness, and comprehensiveness. Parents and caregivers of trans children 5–17 years old living in Australia, New Zealand, Canada, The Netherlands and the United Kingdom completed the scale (N = 270), as well as additional measures of parenting self-efficacy (Me as a Parent Scale – Short Form) and parent self-esteem (Rosenberg Self-Esteem Scale), to assess the scale’s validity. Results Exploratory factor analysis showed a five-factor solution consisting of Acceptance and Inclusion (α = .91), Supportive Health Services (α = .95), Organizations Support the Child (α = .65), School Supports the Parents (α = .93) and Parent Supports and Advocates for their Child (α = .81). The final 22 item Parent Empowerment Scale (PES) demonstrated convergent, concurrent, and incremental validity. Conclusion This Parent Empowerment Scale is a novel measure grounded in lived experience that can be used in both clinical and research contexts to understand, assess and promote empowerment in parents of trans children.

Support groups for family members of older adults in residential aged care: A pilot feasibility study.

There are limited mental health support services in Australia that address the well-being of family members of aged care residents. The aim of this project was to evaluate the feasibility, acceptability and preliminary effectiveness of an online program designed to support residents' families. This one-arm mixed methods project examined uptake, attendance and retention patterns, satisfaction and experience with the service, and pre- and postoutcomes with respect to depressive and anxiety symptoms and loneliness. The sample comprised 38 participants. The uptake, attendance and retention rates were high: 86%, 87% and 95%, respectively. Participants were satisfied with the content and format of the program. The benefits of participation included the following: connecting with peers, developing emotional well-being strategies, and learning about dementia and mental health issues. Suggestions for improving the program included the following: offering additional sessions and an option for meeting face-to-face. Symptoms of depression and anxiety improved significantly from pre- to postintervention time points, but loneliness did not statistically reduce over time. This study found the family support group feasible and acceptable, and showed preliminary indications of effectiveness for improving depressive and anxiety symptoms for families of aged care residents.

Knowledge of Accredited Social Health Activists in India: a systematic review and meta analysis of evidence drawn from primary studies published between 2005 and 2022

BackgroundSince the inception of the ASHAs in the year 2005, their work horizons have increased from Reproductive, Maternal, Newborn, Child, and Adolescent health (RMNCH + A), Communicable and Non-Communicable Diseases (CD & NCD) to oral health, ophthalmologic care, and other supportive community level healthcare services. The present literature lacks comprehensive understanding and synthesis of domain-wise knowledge of ASHAs and the factors affecting their knowledge. Therefore, this study aimed to synthesize and collate the relevant evidence to understand the overall knowledge of ASHAs.MethodsThis systematic review and meta-analysis sourced literature from Google Scholar, PubMed, and Web of Science. Of the 1062 articles identified, 37 articles were selected for narrative synthesis and meta-analysis which focused on knowledge of ASHAs. In meta-analysis, pooled prevalence was estimated using the random effect model. Meta-analysis was performed using the statistical software R version. 3.6.1 for Microsoft Windows.ResultsThe overall pooled prevalence of knowledge regarding maternal, neonatal/child health, communicable, and non-communicable diseases among ASHAs was 62%, 69%, 62%, and 73%, respectively. The level of education, years of experience, inadequate supervision, and training were the factors affecting their knowledge and subsequently its translation into practices within the community. The review also evidenced variation of knowledge among ASHAs across domains and geographical regions of India.ConclusionThe systematic review and meta-analysis highlight that ASHAs have proven to be indispensable assets to India’s healthcare system with their strengths lying in maternal and child health programs. To further enhance their impact, it is imperative to invest in areas where they lack knowledge such as disease surveillance, and preventive healthcare. Empowering ASHAs with necessary resources, and training will not only enhance their capabilities but also contribute to the overall improvement of the healthcare system in India.

Housing matters: The long-term impact of stable housing on mortality among people with HIV in British Columbia, Canada.

For several decades, British Columbia (BC), Canada, has been experiencing a housing crisis marked by a shortage of safe and affordable housing, which coincides with a severe drug poisoning epidemic in the region. We explore the impact of housing instability on mortality (all-cause, drug-related) among a cohort of people with HIV (PWH) in BC. Data are from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) study (n=997). Data from the cross-sectional LISA survey (2007-2010) are linked with administrative health data from Population Data BC and the BC Centre for Excellence in HIV/AIDS Drug Treatment Program (DTP) until March 31, 2020. We used inverse probability of participation weighting (IPPW) to address selection bias, introduced in LISA through oversampling of PWH marginalized by sociostructural inequities. We constructed participation weights using information from the DTP database, which includes all known PWH in BC accessing antiretrovirals via the DTP (including respondents and non-respondents to LISA). We estimated hazards of all-cause and drug-related mortality associated with housing instability using an adjusted, IPPW-weighted Cox proportional hazards model. In this sample, 317 (31.8%) people reported housing instability. Overall, 302 people (30.3%) died from any cause between the completion of the LISA survey until March 31, 2020; of those people, 138 (45.7%) experienced housing instability. Results suggest housing instability is associated with increased hazards of all-cause mortality (adjusted Hazards Ratio (aHR): 1.46; 95% CI: 1.08-1.96). The association between housing instability and hazards for drug-related mortality include a range of values consistent with the null (aHR: 1.67; 95% CI: 0.89-3.13). PWH experiencing housing instability may have greater hazards of all-cause mortality. Our findings add to the literature supporting a need to expand access to safe and affordable housing.

Community Perspectives on Optimizing Community Health Volunteer Roles for HIV Prevention Services in Kenya and Uganda.

Community health workers (CHWs) play a significant role in supporting health services delivery in communities with few trained health care providers. There has been limited research on ways to optimize the role of CHWs in HIV prevention service delivery. This study explored CHWs' experiences with offering HIV prevention services [HIV testing and HIV pre- and post-exposure prophylaxis (PrEP and PEP)] during three pilot studies in rural communities in Kenya and Uganda, which aimed to increase biomedical HIV prevention coverage via a structured patient-centered HIV prevention delivery model. In-depth semi-structured interviews were conducted from November 2021 to March 2022 with CHWs (N = 8) and their clients (N = 18) in the Sustainable East Africa Research in Community Health (SEARCH) SAPPHIRE study. A seven-person multi-regional team coded and analyzed data using a thematic analysis approach. CHWs offered clients PrEP and PEP refills, adherence monitoring, counseling on medications, and phone consultations. Clients reported CHWs maintained close interpersonal relationships with clients, and demonstrated trustworthiness and professionalism. Some clients reported that community members trusted the authenticity of CHWs, while others expressed concerns about the CHWs' ability to maintain confidentiality, and felt that some community members would be uncomfortable receiving HIV services from them. CHWs valued the expansion of their role to include prevention services but expressed concerns about balancing competing demands of CHW responsibilities, income-generating activities, and family roles. CHWs were well accepted as HIV prevention service providers despite contextual challenges. CHWs need ongoing training support. Establishing structures for remunerating CHWs in health systems could improve their performance and retention.

Faculty Workload and Well-being at President Ramon Magsaysay State University: Impacts of Allied Tasks on Stress and Health

Faculty members in higher education institutions are increasingly burdened by a growing workload, particularly non-teaching assignments or allied tasks. The time spent on workloads were observed to have increased in the past years. Hence, the researchers decided to undertake this study entitled,”Faculty Workload and Well-being at President Ramon Magsaysay State University: Impacts of Allied Tasks on Stress and Health,” during the academic year 2021-2022. A quantitative descriptive design was employed to evaluate the variables of the study. A researcher-made survey questionnaire was administered to forty-three faculty members using population sampling. Data were collected through online platform due to limited face to face interactions. A letter of consent was emailed to the three(3) Campus Directors of north campuses prior the online survey. Descriptive statistics such as percentage, weighted means, and Pearson Correlation was used in the treatment of data. The findings revealed that on average, faculty members spent approximately 29.54 hours on teaching tasks and 34.73 hours on allied tasks per week. This study revealed significant differences in the time spent on allied tasks across various demographic groups, such as age, gender, civil status, highest educational attainment, and length of service. Additionally, a significant relationship was found between the time spent on teaching and allied tasks and the extent of experienced stress, but not on personal life, mental health, or physical health. Based on these findings, it is recommended that the university administration implement strategies such as offering mental health support services and creating a more supportive work environment. Reallocating administrative responsibilities or hiring support staff is highly encouraged. Providing health breaks may also be implemented which could help address stress.

Economic Impacts of Technology-Facilitated Abuse Among U.S. Young Adults.

Technology-facilitated abuse (TFA) can result in long-term financial and mental health impacts on survivors. However, little research has been published to date about the types of costs and the economic burden that survivors of TFA experience. This study presents results from a U.S. nationally representative sample of young adults aged 18 to 35 on financial cost experienced as a result of TFA, including findings of healthcare utilization and associated healthcare costs. Respondents who reported experiencing one or more forms of TFA were asked about the lifetime health and economic impacts of the TFA. Nearly one in five TFA survivors (18.2%) reported experiencing an economic cost from the TFA, with a median total cost of $900 USD. There was a significant difference in the likelihood of reporting a financial cost among TFA survivors by race/ethnicity, TFA exposure, average use of online sites/apps, and the number of sites/apps used. Financial fraud, technology, and housing costs were the most common types of cost reported. More than 1 in 10 survivors (11.3%) reported receiving mental health counseling related to the TFA, with a per-person total cost estimate of $6,228 USD from mental health counseling. A similar proportion (11.6%) of TFA survivors reported taking one or more prescribed medications to manage the impact of the TFA, with an average duration of 37.4 weeks of use. Older age, identifying as non-Hispanic Black/African American or Hispanic/Latino/a/x, identifying as a sexual or gender minority, and greater TFA severity were associated with higher financial cost reported. Findings present novel information on the economic and psychological harms associated with TFA and indicate the importance of access to mental health and financial support services for TFA survivors.

Perceived Health Needs, Social Support, and Depression Among Patients with Myocardial Infarction: A Cross-Sectional Study.

Cardiovascular diseases are the leading cause of mortality globally. Myocardial infarction (MI), a major type of cardiovascular disease, presents long-term challenges for patients. Recognizing patients' perceived health needs and the factors that influence them is crucial for providing comprehensive care and improving outcomes. This paper explores the perceived health needs, levels of depression, and social support among MI patients, as well as investigates the correlations between these factors. A cross-sectional study was conducted at King Salman Specialist Hospital from March to June 2024, enrolling 244 MI patients through convenience sampling. Data collection was performed using the following three validated questionnaires: the Cardiac Patient Learning Needs Inventory (CPLNI) to assess the learning needs of MI patients, the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression levels, and the Oslo Social Support Scale (OSSS-3) to measure social support. Statistical analysis was carried out using IBM SPSS Statistics, Version 27. Patients aged 40 years or older and those who were employed exhibited greater learning needs (p < 0.001). Female patients were more depressed than males (p = 0.008). Higher social support was reported by the female patients, those with a family history of MI, and those who were employed (p = 0.002, 0.002, and 0.003, respectively). The total mean score for perceived learning needs was 3.72, with the highest needs in "other pertinent information", "medication information", and "anatomy and physiology". Depression was indicated in 45.1% of MI patients, with significantly higher depression levels in female than in male patients. Additionally, a significant positive correlation was found between social support and perceived learning needs (r = 0.205, p = 0.001), as well as a negative correlation between social support and depression (r = -0.441, p < 0.001). Addressing both the physical and psychological needs is essential for MI patients. Comprehensive educational programs and mental health support services are necessary for improving outcomes. Personalized patient education and routine depression screenings should be integrated into post-MI care. Future research should examine longitudinal changes in learning needs and mental health status.

A Digital Mental Health Solution to Improve Social, Emotional, and Learning Skills for Youth: Protocol for an Efficacy and Usability Study.

The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth's functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study's completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention's efficacy in addressing the mental health needs of students. The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. DERR1-10.2196/59372.

LGBT Myanmar Migrants in Thailand: Unveiling Diverse Forms of Abuse, Healthy and Unhealthy Coping Strategies

ABSTRACT This study investigates the challenges faced by LGBT Myanmar migrants in Thailand, including discrimination and abuse due to their gender identity or sexual orientation, and their coping strategies. Through qualitative interviews with 20 self-identified LGBT Myanmar migrants aged over 18 years who experienced discrimination or abuse in Thailand, the findings underscore the presence of a segment within the Myanmar LGBT migrant community in Thailand subject to discrimination and violence across diverse settings, including workplaces, public areas, and even within their homes. Additionally, the research identified healthy coping strategies like self-soothing thoughts, relaxation activities, and seeking support, contrasted with unhealthy coping strategies such as negative self-talk, rumination, and suppressing one’s identity, leading to harmful behaviors and even suicidality. The experiences of severe discrimination and violence among LGBT migrants help this study advocate for policy interventions, such as extending the coverage of the Gender Equality Act to encompass LGBT migrants and implementing mental health support services as a form of secondary prevention. Given the significant contribution of LGBT migrants to various sectors of Thailand’s workforce, these measures are essential. However, the existing legislation concerning gender equality in Thailand inadequately addresses the specific concerns of this demographic group.

Midwife-led birthing centre in the humanitarian setup: An experience from the Rohingya camp, Bangladesh.

In Bangladesh, Midwife Led Birthing Centres (MLBCs) have been established to provide midwifery care and sexual and reproductive health services for the displaced Rohingya population in Cox's Bazar. The aim of this study was to explore MLBCs in this humanitarian context from the perspectives of women, midwives, and other key stakeholders. A mixed-method case study was conducted at one of the MLBCs within the Rohingya refugee camps in Cox's Bazar. The MLBC serves a population of approximately 8,500 people. Quantitative data were collected from the medical records and documents of the MLBC. Qualitative data included two key informant interviews (KIIs) with policy makers, one focus group discussion (FGD) with 7 midwives and ten in-depth interviews (IDIs) with Rohingya women who gave birth in this MLBC. Thematic analysis of qualitative data was performed. In 2022, 267 women gave birth at the MLBC, and 70 women with complications were transferred to higher-level facilities. Women chose the MLBC because of the respectful care provided by kind and skillful midwives, and the high-quality services. The MLBC was often recommended by community volunteers and relatives. Midwives provided a range of health services including antenatal, labour and birth, postnatal, family planning, mental health support and gender-based violence services. Challenges included language barriers, difficulty obtaining transport from home and back particularly at night in remote areas, security fears and weak cell phone coverage that affected communication for referral and follow-up. Recommendations included increased support and security staff, establishing a referral hospital nearer to the camp, refresher training for midwives and monitoring, and mentoring to improve service quality. The MLBC in the Rohingya camp shows that respectful midwifery care including management and referral of obstetric complications with wider sexual and reproductive health services can be provided in a humanitarian setting to optimize maternal and neonatal health outcomes.

Social determinants of the mental health of pregnant women in Nepal: Stakeholder perspectives.

Women during pregnancy are at a greater risk of experiencing poor mental health, which is one of the major global public health issues, and more so in many developing countries like Nepal, but limited evidence of research on this topic is evident. In this paper, we are focused on exploring the social determinants of the mental health of pregnant women in Nepal from the stakeholder perspectives. This paper utilises eight stakeholder perspectives collected through open-ended in-depth interviews. All the interviews were analysed thematically using an inductive approach. This paper presents three major findings: Inadequate social support, Limited availability and accessibility of maternal health services, and Restricted socioeconomic and cultural context. The inadequate social support from family/relatives, neighbours, community and national policies such as maternity leave, alongside the absence of NGOs/INGOs support, put women at risk of poor mental health. In addition to the inadequate support, limited availability and accessibility of maternal health services potentially cause immense distress among pregnant women. Furthermore, in the context of a patriarchal society, the impact of socioeconomic and cultural context on pregnant women's mental health is also presented as a major determinant of poor mental health among pregnant women. Based on the findings, we conclude that pregnant women are at risk of poor mental health experiences in Nepal and recommend that promoting mental health among pregnant women needs a multifaceted approach that should be considered in all the policies and practices involved in promoting the mental health of pregnant women.