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Tag: qualitative
08/21/2023

As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance”: barriers and facilitators to digital peer support implementation into community mental health centers.

Fortuna KL, Divatia S, Neupane S, Geiger P and Bohm A (2023) “As soon as I start trusting human beings, they disappoint me, and now I am going to get on an app that someone could hack. I really do not want to take that chance”: barriers and facilitators to digital peer support implementation into community mental health centers. Front. Digit. Health 5:1130095. doi: 10.3389/fdgth.2023.1130095

This study aimed to identify barriers and facilitators to implementation of digital peer support based on perspectives of patients with serious mental illness (SMI) and certified peer support specialists. Semi-structured qualitative interviews were conducted with 27 participants (17 persons with SMI and 10 certified peer support specialists) at an urban community mental health center. Agency staff in a community mental health center shared information about the study with potential participants for recruitment. The interview guide included six broad questions to evaluate feasibility, acceptability, and effectiveness of a digital peer support intervention for patients with SMI. Patient participants were on average 51 years of age, mostly male, white and had varying mental health diagnoses. Peer support specialists were on average 40 years of age, all female and white. Nine barriers were identified: 1) adaptability to the needs of older patients, 2) technology complexity, 3) cost of implementation, 4) compatibility with patients’ real-world environment, 5) quality of communications, 6) availability of resources, 7) access to information, 8) lack of human interaction, and 9) patients’ personality and characteristics. Two facilitators were identified: 1) increased access to health care and 2) relative advantage of implementing digital peer support compared to in-person meetings. Overall, patients with SMI have unique needs regarding training and access to digital peer support. In-person interaction is preferred, but digital peer support can be a helpful augment to clinical treatment.  Identification of implementation barriers and facilitators can inform multilevel strategies to increase uptake of digital peer support in community mental health centers.

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08/07/2023

Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily

Richards VL, Rajendran S, Cook RL, Leeman RF, Wang Y, Prins C, Cook C. Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily. J Med Internet Res 2023;25:e38713. doi: 10.2196/38713

Researchers identified desired features that could help people reduce their drinking in a wrist-worn biosensor-based alcohol intervention for adults who drink heavily. Wearable alcohol biosensors can passively and continuously measure ethanol excreted through the skin. Participants were at least 40 years old, drank at least twice per week, and were interested in reducing their drinking, and were recruited via an alcohol contingency study, a contact registry, and referrals. In-depth qualitative interviews were conducted on Zoom with 20 participants. Interviews included questions about participants’ thoughts about a wrist-worn biosensor, potential helpfulness to reduce drinking, and what information they would want to receive from the biosensor. Participants reported five major desired feature themes: 1) comfort and look of the biosensor, 2) personalized prompts and feedback, 3) time wearing the biosensor, 4) sharing data with friends, family, and providers, and 5) incorporation of mental health support. In general, participants were open to wearing the biosensor, but were only inclined to engage with the biosensor content if had they were motivation to reduce drinking. Findings also indicated that a mobile app that stores and interprets sensor data for participants to track drinking patterns could be beneficial. Engaging potential end-users to identify desire intervention features can inform and optimize development of interventions that use wrist-worn biosensors to reduce alcohol use.

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07/17/2023

Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses

Zhao X, Stadnick N, Ceballos-Corro E, Castro Jr J, Mallard-Swanson K, Palomares K, Eikey E, Schneider M, Zheng K, Mukamel D, Schueller S, Sorkin D. Facilitators of and Barriers to Integrating Digital Mental Health Into County Mental Health Services: Qualitative Interview Analyses. JMIR Form Res 2023;7:e45718. DOI: 10.2196/45718

This article identified barriers, facilitators, and best practices for implementing digital mental health interventions (DMHIs) according to the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. This qualitative interview study is part of a larger state-funded project in which six county behavioral health departments in California explored the use of DMHIs as part of mental health services. Interviews were conducted with clinical staff, peer support specialists and leadership. The interview was structured using the EPIS domains of relevant inner context (i.e., individual and organizational characteristics), outer context (i.e., patient characteristics, policy, fiscal mandates), innovation factors (i.e., fit of the innovation), and bridging factors (i.e., community-academic partnerships). Sixty-nine interviews were included for analysis. Three main themes were identified: readiness of individuals, readiness of innovations, and readiness of organizations and systems. Readiness of individuals included patients’ access to technology and digital literacy to participate in DMHIs. Innovation-level readiness pertained to accessibility, clinical usefulness, safety and fit of DMHIs. On the organization and system level, providers and leaders held positive views about DMHIs. Based on these findings, successful implementation of DHMIs requires readiness at the individual, innovation, and organizational levels. The authors recommend equitable device distribution and digital literacy training at the individual level. Adapting DMHIs to fit clients’ needs, as well as clinical workflow, is also recommended. To improve at the organization level, providers and local behavioral health departments should be supported with appropriate technology and training.

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07/10/2023

Informing the development of the Coaching Online and Community Health (COACH) program: a qualitative study of clubhouse members living with serious mental illness

O’Neill K, Hand R, Diop B, Weiss H, Cruz Pfaeffle A, Maragatham P, Rice K, Naslund JA. Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness. Transl Behav Med. 2023 May 13;13(5):343-353. doi: 10.1093/tbm/ibad001.

Clubhouse organizations for individuals with serious mental illness (SMI) are structured psychosocial rehabilitation communities, some of which have developed virtual service platforms during the COVID-19 pandemic. This qualitative study explored clubhouse members’ experiences engaging with a virtual clubhouse platform during the COVID-19 pandemic; preferences for interest in and access to digital health content was assessed, as well as suggestions for an online peer lifestyle intervention. The study was guided by a community-based participatory action research framework. Ten focus groups were conducted with 33 clubhouse members (ages 28 to 69 years old, 54.3% women). Participants expressed mixed views about use of the virtual clubhouse platform (delivered over Zoom), with some finding that meeting virtually was better for social anxiety, while others reporting it challenging to interact online and pick up on social cues. The virtual platform offered new opportunities to reach individuals with SMI during the pandemic, but participants noted the importance of having staff to help them get online and navigate the virtual platform. Focus group members highlighted that compatibility with the person facilitating the intervention content was necessary for engagement. Another reported motivation for engagement was participation in health and wellness activities that bring joy and access to community resources and involvement. Recommendations from this study will inform a future adaptation of an intervention, called Group Lifestyle Balance, to suit the needs of clubhouse members.

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02/27/2023

Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples’ Prevention, Service, and Care

Crouch MC, Cheromiah Salazar MBR, Harris SJ, Rosich RM. Dementia, Substance Misuse, and Social Determinants of Health: American Indian and Alaska Native Peoples’ Prevention, Service, and Care. Chronic Stress (Thousand Oaks). 2023 Jan 18;7:24705470221149479. doi: 10.1177/24705470221149479. PMID: 36699807; PMCID: PMC9869198.

A qualitative study was conducted to understand the cultural practices and beliefs among American Indian and Alaskan Native (AI/AN) Elders about Alzheimer’s disease and related dementia (ADRD). Interviews investigated the etiology, course, treatment, and cultural meanings of ADRD as well as the social determinants of health related to ADRD and role of substance use disorder. AI/AN tribal Elders are identified as individuals who are designated culture bearers, wisdom holders, and role models in their respective communities. Twelve AI/AN Elders (mean age=73) who speak English participated in semi-structured interviews. The sample was predominantly female (66.7%), Athabascan Tribal heritage (58.3%) and retired (66.7%). All participants had a family member with ADRD but did not themselves have an ADRD diagnosis. Qualitative analyses identified 6 themes of etiology, barriers to treatment, and social determinants: (1) postcolonial distress; (2) substance misuse; (3) distrust of Western medicine; (4) structural inequities; (5) walking in two worlds; and, (6) decolonizing and indigenizing medicine. Findings highlight potential causal factors in disease development and manifestation as viewed by AI/AN Elders. This study exemplified historical and ongoing discrimination and stress in Western medicine and the importance of adopting a holistic view to address cultural health disparities.

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05/10/2019

A qualitative exploration of service user views about using digital health interventions for self-management in severe mental health problems

Berry N, Lobban F, Bucci S. (2019). A qualitative exploration of service user views towards using digital mental health interventions. BMC Psychiatry. 19(35). doi: 10.1186/s12888-018-1979-1

Researchers in the United Kingdom recruited 18 people with bipolar (n=10) or schizophrenia-spectrum (n=8) disorders to participate in individual interviews about digital interventions for people with severe mental illness (SMI). Interviews included questions about the acceptability of and design considerations for using technology to address SMI. Read More

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04/19/2019

Social support for active substance users: A content analysis of r/Drugs

Wombacher K, Sheff SE, Itrich N. (2019). Social support for active substance users: A content analysis of r/Drugs. Health Communication. doi: 10.1080/10410236.2019.1587691

Researchers analyzed post content and engagement on r/Drugs, a Reddit forum (i.e. subreddit) dedicated to discussing substance use, to understand social support exchanges. Read More

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03/22/2019

Digital exclusion among mental health service users: Qualitative investigation

Greer B, Robotham D, Simblett S, Curtis H, Griffiths H, Wykes T. (2019). Digital exclusion among mental health service users: Qualitative investigation. Journal of Medical Internet Research. 21(1): e11696. doi: 10.2196/11696

Researchers interviewed 20 patients at a mental health clinic who were unable to use the internet (i.e. digitally excluded). Participants completed an assessment of technology access and confidence and participated in an interview exploring familiarity with the internet, barriers to internet use, and facilitators to initiating internet use. Read More

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03/15/2019

Beliefs and attitudes about the dissemination and implementation of internet-based self-care programs in a large integrated healthcare system

Hermes EDA, Burrone L, Heapy A, et al. (2019). Beliefs and attitudes about the dissemination and implementation of internet-based self-care programs in a large integrated healthcare system. Administration and Policy in Mental Health and Mental Health Services Research. 10.1007/s10488-018-0913-7

Researchers interviewed providers (n=12) and administrators or policy makers (n=8) from 10 Veterans Health Administration (VHA) programs to explore determinants of dissemination and implementation of digital health. Interviews were guided by the Unified Theory of Acceptance and Use of Technology. Researchers thematically coded interview transcripts and identified 8 distinct themes. All participants noted that current healthcare systems, including clinical norms and workflows do not facilitate use of digital health. Nineteen participants (95%) mentioned gaps in provider understanding of digital health and when or how to use digital health in practice, inadequate digital infrastructures (e.g., VHA internet systems, patient technology access), and the influence of support from leadership. Eighteen (90%) participants mentioned a need for organizational dissemination and implementation strategies (e.g., provider training, consumer advertising), specifically highlighting the need for a learning management system that allows providers and patients to access digital health programs. Fourteen participants (70%) mentioned that health system strategic priorities need to promote dissemination and implementation of digital health and that current strategies that may complement digital health implementation (e.g., measurement-based care, electronic health record development) also compete for funding. Twelve participants (60%) discussed how organizational structures and an emphasis on specialty care rather than integrated care can result in siloed information between central administration, specialty care facilities, and primary care facilities. Finally, 11 (55%) participants discussed regulations and policies relating to privacy and security (e.g. against the transmission of patient-reported information to health records) reducing the utility of digital health.

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