Cannabis use, mental health, and problematic Internet use in Quebec: A study protocol.

BACKGROUND: Problematic Internet use is characterized by excessive use of online platforms that can result in social isolation, family problems, psychological distress, and even suicide. Problematic Internet use has been associated with cannabis use disorder, however knowledge on the adult population remains limited. In Quebec, cannabis use has significatively increased since 2018, and it is associated with various risks in public safety, public health, and mental health. This study aims to identify factors associated with problematic Internet use among adult cannabis users and to better understand their experiences. METHOD: This project is a mixed explanatory sequential study consisting of two phases. Phase 1 (n = 1500) will be a cross-sectional correlational study using probability sampling to examine variables that predispose individuals to problematic Internet use, characteristics associated with cannabis use, Internet use, and the mental health profile of adult cannabis users in Quebec. Descriptive analyses and regression models will be used to determine the relationship between cannabis use and Internet use. Phase 2 (n = 45) will be a descriptive qualitative study in the form of semi-structured interviews aimed at better understanding the experience and background of cannabis users with probable problematic Internet use. DISCUSSION: The results of this study will support the development of public policies and interventions for the targeted population, by formulating courses of action that contribute to the prevention and reduction of harms associated with cannabis use and problematic Internet use. Furthermore, an integrated knowledge mobilization plan will aid in the large-scale dissemination of information that can result useful to decision-makers, practitioners, members of the scientific community, and the general population regarding the use of cannabis and the Internet.

Nudge theory and gambling: a scoping review.

Background: Gambling disorder (GD) is a pressing public health concern with significant societal costs. The recently developed nudge theory, which is rooted in behavioral economics, aims to influence the decision-making behaviors of individuals by implementing changes in the environment. Aim: This scoping review aims to synthesize the literature on nudge theory as it relates to gambling. Methods: This scoping review accords with the Arksey and O'Malley framework, as refined by Levac et al. It includes only articles from peer-reviewed journals that focus, as main themes, on both nudge theory and gambling. The final study selection includes six articles. Results: The scoping review process led to studies explaining how (1) nudges aim to prod people toward healthier gambling choices, fostering the adoption of more responsible gambling practices, and (2) some gambling features, called dark nudges (or sludges), exploit and harm the decision-making processes of people who gamble. Conclusion: This scoping review highlights the fact that many stakeholders are involved in the field of gambling, and that better cooperation between them would promote safer and more responsible gambling practices. Future research is also needed to empirically test nudges to develop a better understanding of their impact on those who gamble.

Pharmacotherapy and gambling disorder: a narrative review.

BACKGROUND: Gambling disorder (GD) is a psychiatric disorder classified in the DSM-5 as a non-substance-related and addictive disorder with extensive health and socioeconomic impacts. Its chronic and high-relapsing nature makes it essential to find treatment strategies that improve functioning and reduce impairment associated with it. The purpose of this narrative review is to evaluate and summarize the available evidence on the effectiveness and safety of pharmacotherapy in GD. METHODS: An electronic literature search of Medline, Embase, and Cochrane Central was conducted to identify systematic reviews, meta-analyses, and reviews on pharmacological interventions in patients with gambling disorder. A similar search of these databases and of Prospero, Clinicaltrials.gov, and Epistemonikos was conducted to identify clinical trials that were published since 2019. RESULTS: The initial search identified 1925 articles. After screening and duplicate removal, 18 articles were included in the review (11 studies were systematic reviews and meta-analyses, 6 were reviews, and 1 was an open-label trial). Eight pharmacological agents (naltrexone, nalmefene, paroxetine, fluvoxamine, citalopram, escitalopram, lithium, and topiramate) that were studied in randomized controlled trials and open-label trials showed small to moderate effect sizes in reducing GD symptoms in some studies during post-hoc analyses. CONCLUSION: The overall sum of evidence in the literature on the use of pharmacotherapy in GD is conflicting and inconclusive. Some studies have shown that pharmacotherapy's role in GD is promising, especially when the choice of the agent is guided by comorbid psychiatric disorders. However, significant limitations exist in the study designs, which need to be addressed in future research on the topic. Conducting future and more rigorous trials that address the limitations in the existing literature is necessary to establish more accurate efficacy data on the use of pharmacotherapy in this population.

A call for qualitative and mixed-methods research on gambling and cannabis.

Gambling disorder and cannabis use disorder are both considered major public health issues. Despite the well-documented frequency of substance use disorders among people with gambling disorder, little is known about the experiences of those who both engage with gambling and cannabis. A scoping review was undertaken to investigate studies focusing on the experiences of people who gamble and use cannabis. Unexpectedly, no qualitative or mixed-methods studies that included an in-depth qualitative component to study the lived experiences of this population were found. This absence highlights the critical need to diversify research methods and fill the gap in knowledge of the lived experiences of people who both gamble and consume cannabis.

Researchers' experiences with patient engagement in health research: a scoping review and thematic synthesis.

CONTEXT: Implicating patients in research is gaining popularity around the world and is now the reference of many funding agencies. Understanding these partnerships is necessary to grasp this new reality. The experiences of researchers who have involved patient-partners (PPs) in health research are important for a better understanding of these practices. OBJECTIVE: This study aimed to identify and analyze the existing qualitative scientific literature on the experiences of academic researchers involved in health research with patient engagement (PE). DESIGN: A scoping review of the available literature with an inductive thematic synthesis, guided by the methodological framework of Arksey and O'Malley. DATA COLLECTION: A search strategy was developed to include keywords relating to researchers, patient-partners, experiences, and the qualitative methodologies of the targeted studies. Five databases were searched using the EBSCO-host engine. The search results were screened by four reviewers to only include articles written in English on the topic of the experience of academic researchers having worked with PPs in health research based on qualitative studies or mixed-methods studies with a distinct qualitative section. ANALYSIS: Articles included were charted for general information. All "results" sections were coded line by line. These codes were organized inductively to form descriptive and analytical themes. This led to the synthesis of the ideas found in the selected articles. RESULTS: The search strategy yielded 7616 results, of which 2468 duplicates were removed. The remaining 5148 articles were screened, resulting in the exclusion of 5114 off-topic studies. The remaining 29 full-text articles were evaluated for inclusion from which 5 additional studies were identified. The final selection consisted of 11 articles that met all the criteria. These articles were published between 2009 and 2019. Five general themes inductively emerged from the analysis: the understanding of PE, motivations, contexts, attitudes, and practical aspects of PE that are central to researchers. CONCLUSION: This scoping review provides a better understanding of the experiences of researchers who have implemented patient partnerships in health research projects. Our findings reveal many positive elements central to health researchers' discourses about PE, but they provide insights into the challenges and postures of resistance. This knowledge can support the development of empirically sound improvements in PE practices.

The practice of involving patients in research is gaining popularity around the world and is now the reference for many institutions and funding agencies. The individual experiences of researchers who have involved patient-partners in health research are essential for a better understanding of how these relationships unfold within research teams, and allows for identifying the challenges and best practices. This review's objective is to identify and analyze the existing scientific literature focused on the experiences of academic researchers involved in health research with patient engagement (PE). A close screen of 7616 search results yielded 11 scientific peer-reviewed articles corresponding to all inclusion criteria for further analysis. Five general themes emerged from the analysis: (1) the understanding of PE, (2) the motivations for PE, (3) the contexts of PE, (4) the attitudes toward PE, and (5) the practical aspects of PE that are central to health researchers. This analysis provides a novel summary of the current knowledge on the in-depth experiences of researchers who have implemented patient-partnerships in health research projects. Beyond many positive elements central to health researchers, our analysis also revealed the challenges and postures of resistance. Both positive and negative perspectives on PE help to draw a better understanding of these collaborations. This knowledge can support the development of empirically sound improvements in PE.

Qualitative Experience of Self-Exclusion Programs: A Scoping Review.

Gambling disorder is a major public health issue in many countries. It has been defined as a persistent, recurrent pattern of gambling and is associated with substantial distress or impairment, lower quality of life, and living with a plurality of psychiatric problems. Many people suffering from gambling disorder seek help in ways other than formal treatment seeking, including self-management strategies. One example of responsible gambling tools that has gained popularity in recent years is self-exclusion programs. Self-exclusion entails individuals barring themselves from a gambling venue or a virtual platform. The aim of this scoping review is to summarize the literature on this topic and to explore participants' perceptions and experiences with self-exclusion. An electronic literature search was conducted on 16th May 2022 in the following databases: Academic Search Complete, CINAHL Plus with Full Text, Education Source, ERIC, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, APA PsychInfo, Social Work Abstracts, and SocINDEX. The search yielded a total of 236 articles, of which 109 remained after duplicates were removed. After full-text reading, six articles were included in this review. The available literature shows that although there are many barriers and limitations to the current self-exclusion programs, self-exclusion is generally viewed as an effective responsible gambling strategy. There is a clear need to improve the current programs by increasing awareness, publicity, availability, staff training, off-site venue exclusion, and technology-assisted monitoring, as well as by adopting more holistic management approaches to gambling disorders in general.

Experience of LGBTQIA2S+ populations with gambling during the COVID-19 pandemic: protocol for a mixed-methods study.

INTRODUCTION: Research undertaken since the beginning of the COVID-19 pandemic has provided us information about the impact of the pandemic on the gambling habits of the general population. However, very little is known about certain subgroups at increased risk of developing gambling disorder, such as the LGBTQIA2S+ population. The purpose of this study is to describe the impact of the COVID-19 pandemic on gambling behaviours among LGBTQIA2S+ individuals. In addition, we want to understand the experiences of the LGBTQIA2S+ population with gambling disorder and identify interventions that LGBTQIA2S+ people have found to be effective in addressing problem gambling during the COVID-19 pandemic. METHODS AND ANALYSIS: This study has a sequential explanatory mixed-method design in two phases over 2 years. The first phase is a correlational study. We will conduct a cross-sectional survey using a stratified random sampling among Canadian residents who are 18 years of age or older, self-identify as sexually and gender-diverse (ie, LGBTQIA2S+) and have gambled at least once in the previous 12 months. This survey will be administered online via a web panel (n=1500). The second phase is a qualitative study. Semistructured interviews will be conducted with LGBTQIA2S+ people with problematic gambling (n=30). ETHICS AND DISSEMINATION: This research project has been ethically and scientifically approved by the Research Ethics Committee and by the CIUSSS de l'Estrie-CHUS scientific evaluation committee on 3 March 2022 (reference number: 2022-4633-LGBTQ-JHA). Electronic and/or written informed consent, depending on the data collection format (online survey and online or in-person interviews), will be obtained from each participant. A copy of the consent form and contact information will be delivered to each participant.

Gamblers' Perceptions of the Impact of the COVID-19 Pandemic on Their Gambling Behaviours: Analysis of Free-Text Responses Collected through a Cross-Sectional Online Survey.

The COVID-19 pandemic has brought drastic changes to the lives of a substantial portion of the world's population. Many stakeholders have expressed concern about the impact of the pandemic on gambling practices, which have historically increased during times of crisis. The purpose of this study was to provide a snapshot of the impact of the pandemic on gambling practices, focusing on the lived experiences of people who gamble. An online cross-sectional survey was conducted between 16 February and 15 March 2021. An open-ended question allowed the participants to describe in their own words the impact of the COVID-19 pandemic on their gambling practices. A qualitative analysis was conducted based on 724 responses to this question. Among the participants, 57% were problem gamblers, according to their Problem Gambling Severity Index score. Three themes were identified: (1) changes in gambling practices perceived by the respondents during the pandemic, (2) the impacts of these changes, and (3) the factors that influenced the changes in their gambling practices. A meaningful proportion of the sample of gamblers felt that their gambling practices had increased during the pandemic. Many of them did not report the deleterious effects of this increase, whereas others were devastated. Thus, variations in gambling practices during the pandemic must be interpreted with caution, as they may reflect a variety of realities.

The experience of patient partners in research: a qualitative systematic review and thematic synthesis.

CONTEXT: Patient engagement in research consists in involving patients as partners across the research cycle. This practice has quickly become an international standard, with funding bodies actively encouraging it. As the increased incentive to engage patients can lead to tokenistic partnerships, it is important to consider the experiences of patient-partners. OBJECTIVE: To synthesize the qualitative literature on the experience of patients as partners in research. DESIGN: A systematic review of the literature with thematic synthesis was realized, guided by the framework developed by Thomas and Harden (Bmc Med Res Methodol 8: 45, 2008). DATA COLLECTION: A search strategy was developed to encompass keywords relating to patient-partners in research, their experience, and the qualitative nature of the target studies. 10 databases were searched using the EBSCO-host engine, along with the Scopus engine to include EMBASE. The search results were screened for the following inclusion criteria: articles written in English; articles reporting on the experience of patient-partners in research; qualitative studies or mixed-methods studies with a distinct qualitative section. ANALYSIS: Included articles were charted for general information. The CASP qualitative checklist was used for critical appraisal. The "results" section of each article was coded line by line. Codes were aggregated inductively to form descriptive themes and analytical themes, in order to synthesize the ideas found in the selection of articles. RESULTS: The initial search yielded 10,222 results. After the removal of duplicates, 5534 titles and abstracts were screened, 88 full-text reports were evaluated, and 41 studies were included. Articles reporting on these studies were published between 2005 and 2020. Seven themes emerged from the analysis: "motivations to engage in research", "activities in patient engagement", "structure", "competence", "team dynamics", "impacts on broader life", and "illness". Articles reported varying degrees of perceived impact on research and satisfaction concerning the level of engagement. The importance of power differentials and team dynamics were widely stated. CONCLUSIONS: Findings provide an in-depth view of the experiences of patient-partners in research. Most articles reported a generally positive experience, but challenges and pitfalls of patient engagement were identified. This will serve research teams by highlighting good practices and possible improvements.

Patient engagement is the practice of involving patients as partners in research teams. Through these partnerships, patients become co-researchers, which promotes patient-centered research. In recent years, this practice has quickly gained popularity and is now encouraged by scientific funding bodies. This financial incentive to engage patients helps to promote the practice but can lead to tokenistic partnerships. Therefore, it is important to understand how patient-partners experience engagement in research.This systematic review aimed to describe the experience of patient-partners in research by synthesizing existing studies on the subject. 41 relevant studies were found, which described seven general themes in patient-partners' experience. These themes were "motivations to engage in research", "activities in patient engagement", "structure", "competence", "team dynamics", "impacts on broader life", and "illness". Within these themes, many positive experiences were described, such as the stimulating intellectual challenges of research, or the pride of helping others. Negative experiences were also identified, such as when patient-partners felt inadequately prepared for research activities, or when hierarchies of powers were formed. These findings will allow future research teams to improve patient engagement and will hopefully lead to better experiences for patient-partners.

Impacts of the COVID-19 pandemic on gamblers in Canada: qualitative analysis of responses to an open-ended question.

CONTEXT: Many stakeholders have expressed concerns about the impacts of the COVID-19 pandemic on gambling practices. These have historically increased during crises, potentially leading to deleterious effects on problematic gamblers, their families, and their communities. Primary care professionals need to better understand gamblers' experience during the pandemic to offer high level of care for this population. OBJECTIVE: draw up a portrait of the experience of gamblers regarding the impacts of the COVID-19 pandemic on their gambling practices. STUDY DESIGN: Qualitative analysis. SETTING: Content analysis of responses to a single open-ended question placed at the end of a cross-sectional survey which was online from February 16 to March 15 2021 in Quebec (Canada). Participants were recruited by a non-randomised online sampling. POPULATION STUDIED: 1529 individuals participated in the study, of whom 724 answered the open-ended question. Inclusion criteria were: (1) 18 years and older (2) living in the province of Quebec, Canada (3) has gambled at least once in the past year. RESULTS: Respondents' median age is 43 years, 54% are women and 57% are problem gamblers according to the Problem Gambling Severity Index. Three main themes were identified: (1) the changes in gambling practices during the pandemic as perceived by the respondents, (2) the impacts of these changes on their lives, and (3) the factors that influenced these changes. A significant proportion of gamblers felt that their gambling practices had increased during the pandemic, mainly due to boredom and increased free time. Many of them did not report deleterious effects of this increase whereas others reported being devastated. On the opposite, the pandemic was perceived by some participants as a unique window of opportunity to decrease their problematic gambling practices. CONCLUSIONS: The pandemic has created space to fill into many individuals' lives as usual leisure activities, hobbies and spending habits became out of reach. It led to increased gambling for many participants. While many did not report deleterious effects of this increase, others expressed being at great risk and therefore need primary care professionals to be equipped to support them.

Gambling and the COVID-19 pandemic in the province of Quebec (Canada): protocol for a mixed-methods study.

INTRODUCTION: The COVID-19 pandemic has major collateral impacts on mental health. Gambling is among the major public health issues that seems to have been transformed by the pandemic. In the province of Quebec in Canada, gambling is an important leisure activity. About two out of three adults are in Quebec gamble. The objective of this study is to draw a portrait of the impacts of the COVID-19 pandemic on gamblers and to learn more about their experiences during the pandemic in the province of Quebec. METHOD AND ANALYSIS: This study has a sequential explanatory mixed-method design in two phases. The first phase is a cross-sectional online survey with Quebec residents who are 18 years of age or older and have gambled at least once in the previous 12 months. The second phase will be a qualitative study. Semistructured interviews will be conducted with gamblers, family members, addiction counsellors and state representatives selected through purposing sampling. ETHICS AND DISSEMINATION: This study is one of the first mixed-methods studies on the impacts of the COVID-19 pandemic on gambling. This study will generate new scientific knowledge on a worrisome public health issue, that is, gambling, and provide a better understanding of the experiences and gambling behaviours of gamblers during the pandemic. This study is funded by the Ministry of Health and Social Services of the Government of Quebec and was approved on 27 October 2020 by the Scientific and Research Ethics Committee of the CIUSSS de l'Estrie-CHUS. This is a 2-year study that will be completed in June 2022.

Gambling and the COVID-19 pandemic: A scoping review.

BACKGROUND: The impact of COVID-19 on mental health is tremendous. Since the beginning of the pandemic, several actors have raised concerns about the impact of the pandemic on gambling. Many actors fear a switch to online gambling in the context of the closure of many land-based gambling activities due to the restrictions imposed by public health authorities, such as physical distancing and lockdowns. This switch is worrisome because online gambling is considered a high-risk game. In that context, we need to know more about the impacts of the pandemic on gambling. This scoping review aims to summarize the literature that addresses the impacts of the COVID-19 pandemic on gambling. To our knowledge, this is the first review to focus on this subject. METHODS: An electronic literature search involving a strategy using keywords related to COVID-19 and gambling was conducted using MEDLINE, Academic Search Complete, CINAHL, PsychINFO, Social Works Abstract, and Socio Index databases on February 25th 2021. This search was combined with a manual search in Google Scholar. To be included, studies had to discuss gambling and COVID-19 as a primary theme, be written in English, and be published in a peer-reviewed journal. After collecting the information, we collated, summarized, and reported the results using narrative synthesis. RESULTS: The search identified 181 articles. After the removal of duplicates and screening, 24 full-text articles were reviewed and included in this study: 14 original articles, 8 commentaries or editorials, and 2 protocols. Contrary to expectations, preliminary evidence suggested that gambling behavior often either decreased or stayed the same for most gamblers during the pandemic. However, for the minority who showed increased gambling behavior, there was frequently an association with problem gambling. CONCLUSION: The available literature on COVID-19 and gambling is limited and the impact of the COVID-19 pandemic on gambling behavior and gambling problems is still unclear. Therefore, there is a need for more research on this topic, both qualitative and mixed methods studies, to better understand the impact of the pandemic on gambling. Considering the results, we need to be careful, particularly with problem gamblers and other subgroups of the population who seem to be more vulnerable to increased gambling habits during this pandemic period.

Experience of being a frequent user of primary care and emergency department services: a qualitative systematic review and thematic synthesis.

BACKGROUND: Frequent users of healthcare services are often categorised as 'heavy-cost patients'. In the recent years, many jurisdictions have attempted to implement different public policies to optimise the use of health services by frequent users. However, throughout this process, little attention has been paid to their experience as patients. OBJECTIVE: To thematically synthesise qualitative studies that explore the experience of frequent users of primary care and emergency department services. DESIGN: Qualitative systematic review and thematic synthesis. SETTING: Primary care and emergency department. PARTICIPANTS: Frequent users of primary care and emergency department services. METHODS: A qualitative systematic review was conducted using three online databases (MEDLINE with full text, CINAHL with full text and PsycINFO). This search was combined to an extensive manual search of reference lists and related citations. A thematic synthesis was performed to develop descriptive themes and analytical constructs. STUDY SELECTION: Twelve studies were included. All included studies met the following inclusion criteria: qualitative design; published in English; discussed frequent users' experiences from their own perspectives and users' experiences occurred in primary care and/or emergency departments. RESULTS: The predominant aspects of frequent users' experiences were: (1) the experience of being ill and (2) the healthcare experience. The experience of being ill encompassed four central themes: physical limitations, mental suffering, impact on relationships and the role of self-management. The healthcare experience embraced the experience of accessing healthcare and the global experience of receiving care. CONCLUSION: This synthesis sheds light on potential changes to healthcare delivery in order to improve frequent users' experiences: individualised care plans or case management interventions to support self-management of symptoms and reduce psychological distress; and giving greater importance on the patient-providers relationship as a central facet of healthcare delivery. This synthesis also highlights future research directions that would benefit frequent users.

Case management in primary care for frequent users of healthcare services with chronic diseases and complex care needs: an implementation and realist evaluation protocol.

INTRODUCTION: Significant evidence in the literature supports case management (CM) as an effective intervention to improve care for patients with complex healthcare needs. However, there is still little evidence about the facilitators and barriers to CM implementation in primary care setting. The three specific objectives of this study are to: (1) identify the facilitators and barriers of CM implementation in primary care clinics across Canada; (2) explain and understand the relationships between the actors, contextual factors, mechanisms and outcomes of the CM intervention; (3) identify the next steps towards CM spread in primary care across Canada. METHODS AND ANALYSIS: We will conduct a multiple-case embedded mixed methods study. CM will be implemented in 10 primary care clinics in five Canadian provinces. Three different units of analysis will be embedded to obtain an in-depth understanding of each case: the healthcare system (macro level), the CM intervention in the clinics (meso level) and the individual/patient (micro level). For each objective, the following strategy will be performed: (1) an implementation analysis, (2) a realist evaluation and (3) consensus building among stakeholders using the Technique for Research of Information by Animation of a Group of Experts method. ETHICS AND DISSEMINATION: This study, which received ethics approval, will provide innovative knowledge about facilitators and barriers to implementation of CM in different primary care jurisdictions and will explain how and why different mechanisms operate in different contexts to generate different outcomes among frequent users. Consensual and prioritised statements about next steps for spread of CM in primary care from the perspectives of all stakeholders will be provided. Our results will offer context-sensitive explanations that can better inform local practices and policies and contribute to improve the health of patients with complex healthcare needs who frequently use healthcare services. Ultimately, this will increase the performance of healthcare systems and specifically mitigate ineffective use and costs.