Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol.

INTRODUCTION: The burden of mental health-related visits to emergency departments (EDs) is growing, and agitation episodes are prevalent with such visits. Best practice guidance from experts recommends early assessment of at-risk populations and pre-emptive intervention using de-escalation techniques to prevent agitation. Time pressure, fluctuating work demands, and other systems-related factors pose challenges to efficient decision-making and adoption of best practice recommendations during an unfolding behavioural crisis. As such, we propose to design, develop and evaluate a computerised clinical decision support (CDS) system, Early Detection and Treatment to Reduce Events with Agitation Tool (ED-TREAT). We aim to identify patients at risk of agitation and guide ED clinicians through appropriate risk assessment and timely interventions to prevent agitation with a goal of minimising restraint use and improving patient experience and outcomes. METHODS AND ANALYSIS: This study describes the formative evaluation of the health record embedded CDS tool. Under aim 1, the study will collect qualitative data to design and develop ED-TREAT using a contextual design approach and an iterative user-centred design process. Participants will include potential CDS users, that is, ED physicians, nurses, technicians, as well as patients with lived experience of restraint use for behavioural crisis management during an ED visit. We will use purposive sampling to ensure the full spectrum of perspectives until we reach thematic saturation. Next, under aim 2, the study will conduct a pilot, randomised controlled trial of ED-TREAT at two adult ED sites in a regional health system in the Northeast USA to evaluate the feasibility, fidelity and bedside acceptability of ED-TREAT. We aim to recruit a total of at least 26 eligible subjects under the pilot trial. ETHICS AND DISSEMINATION: Ethical approval by the Yale University Human Investigation Committee was obtained in 2021 (HIC# 2000030893 and 2000030906). All participants will provide informed verbal consent prior to being enrolled in the study. Results will be disseminated through publications in open-access, peer-reviewed journals, via scientific presentations or through direct email notifications. TRIAL REGISTRATION NUMBER: NCT04959279; Pre-results.

Black American women's attitudes toward seeking mental health services and use of mobile technology to support the management of anxiety.

Objectives: This study aimed to understand Black American women's attitudes toward seeking mental health services and using mobile technology to receive support for managing anxiety. Methods: A self-administered web-based questionnaire was launched in October 2019 and closed in January 2020. Women who identified as Black/African American were eligible to participate. The survey consisted of approximately 70 questions and covered topics such as, attitudes toward seeking professional psychological help, acceptability of using a mobile phone to receive mental health care, and screening for anxiety. Results: The findings of the study (N = 395) showed that younger Black women were more likely to have greater severity of anxiety than their older counterparts. Respondents were most comfortable with the use of a voice call or video call to communicate with a professional to receive support to manage anxiety in comparison to text messaging or mobile app. Younger age, higher income, and greater scores for psychological openness and help-seeking propensity increased odds of indicating agreement with using mobile technology to communicate with a professional. Black women in the Southern region of the United States had twice the odds of agreeing to the use of mobile apps than women in the Midwest and Northeast regions. Discussion: Black American women, in general, have favorable views toward the use of mobile technology to receive support to manage anxiety. Conclusion: Preferences and cultural appropriateness of resources should be assessed on an individual basis to increase likelihood of adoption and engagement with digital mental health interventions for management of anxiety.

Seeking and Providing Social Support on Twitter for Trauma and Distress During the COVID-19 Pandemic: Content and Sentiment Analysis.

BACKGROUND: The COVID-19 pandemic can be recognized as a traumatic event that led to stressors, resulting in trauma or distress among the general population. Social support is vital in the management of these stressors, especially during a traumatic event, such as the COVID-19 pandemic. Because of the limited face-to-face interactions enforced by physical distancing regulations during the pandemic, people sought solace on social media platforms to connect with, and receive support from, one another. Hence, it is crucial to investigate the ways in which people seek and offer support on social media for mental health management. OBJECTIVE: The research aimed to examine the types of social support (eg, emotional, informational, instrumental, and appraisal) sought and provided for trauma or distress on Twitter during the COVID-19 pandemic. In addition, this study aimed to gain insight into the difficulties and concerns of people during the pandemic by identifying the associations between terms representing the topics of interest related to trauma or distress and their corresponding sentiments. METHODS: The study methods included content analysis to investigate the type of social support people sought for trauma or distress during the pandemic. Sentiment analysis was also performed to track the negative and positive sentiment tweets posted between January 1, 2020, and March 15, 2021. Association rule mining was used to uncover associations between terms and sentiments in tweets. In addition, the research used Kruskal-Wallis and Mann-Whitney U tests to determine whether the retweet count and like count varied based on the social support type. RESULTS: Most Twitter users who indicated trauma or distress sought emotional support. Regarding sentiment, Twitter users mostly posted negative sentiment tweets, particularly in January 2021. An intriguing observation was that wearing masks could trigger and exacerbate trauma or distress. The results revealed that people mostly sought and provided emotional support on Twitter regarding difficulties with wearing masks, mental health status, financial hardships, and treatment methods for trauma or distress. In addition, tweets regarding emotional support received the most endorsements from other users, highlighting the critical role of social support in fostering a sense of community and reducing the feelings of isolation during the pandemic. CONCLUSIONS: This study demonstrates the potential of social media as a platform to exchange social support during challenging times and to identify the specific concerns (eg, wearing masks and exacerbated symptoms) of individuals with self-reported trauma or distress. The findings provide insights into the types of support that were most beneficial for those struggling with trauma or distress during the pandemic and may inform policy makers and health organizations regarding better practices for pandemic response and special considerations for groups with a history of trauma or distress.

Toward Community-Based Natural Language Processing (CBNLP): Cocreating With Communities.

Rapid development and adoption of natural language processing (NLP) techniques has led to a multitude of exciting and innovative societal and health care applications. These advancements have also generated concerns around perpetuation of historical injustices and that these tools lack cultural considerations. While traditional health care NLP techniques typically include clinical subject matter experts to extract health information or aid in interpretation, few NLP tools involve community stakeholders with lived experiences. In this perspective paper, we draw upon the field of community-based participatory research, which gathers input from community members for development of public health interventions, to identify and examine ways to equitably involve communities in developing health care NLP tools. To realize the potential of community-based NLP (CBNLP), research and development teams must thoughtfully consider mechanisms and resources needed to effectively collaborate with community members for maximal societal and ethical impact of NLP-based tools.

Attitudes Toward Seeking Mental Health Services and Mobile Technology to Support the Management of Depression Among Black American Women: Cross-Sectional Survey Study.

BACKGROUND: Depression is a common mental health condition among Black American women. Many factors may contribute to the development of depressive symptoms, such as gender and racial discrimination, financial strain, chronic health conditions, and caregiving responsibilities. Barriers such as the stigmatization of mental illness, less access to treatment, the lack of or inadequate health insurance, mistrust of providers, and limited health literacy prevent marginalized populations from seeking care. Previous literature has shown that mobile health interventions are effective and can increase access to mental health services and resources. OBJECTIVE: We aimed to understand the attitudes and perceptions of Black women toward using mental health services and determine the acceptability and concerns of using mobile technology (ie, voice call, video call, SMS text messaging, and mobile app) to support the management of depression. METHODS: We launched a self-administered web-based questionnaire in October 2019 and closed it in January 2020. Women (aged ≥18 years) who identify as Black or African American or multiracial (defined as Black or African American and another race) were eligible to participate. The survey consisted of approximately 70 questions and included topics such as attitudes toward seeking professional psychological help, the acceptability of using a mobile phone to receive mental health care, and screening for depression. RESULTS: The findings (n=395) showed that younger Black women were more likely to have greater severity of depression than their older counterparts. The results also revealed that Black women have favorable views toward seeking mental health services. Respondents were the most comfortable with the use of voice calls or video calls to communicate with a professional to receive support for managing depression in comparison with SMS text messaging or mobile apps. The results revealed that higher help-seeking propensity increased the odds of indicating agreement with the use of voice calls and video calls to communicate with a professional to receive support for managing depression by 27% and 38%, respectively. However, no statistically significant odds ratios (all P>.05) were found between help-seeking propensity and respondents' agreement to use mobile apps or SMS text messaging. Moderate to severe depression severity increased the odds of using mobile apps to communicate with a professional to receive support for managing depression by 43%; however, no statistically significant odds ratios existed for the other modalities. Privacy and confidentiality, communication issues (eg, misinterpreting text), and the impersonal feeling of communicating by mobile phone (eg, SMS text messaging) were the primary concerns. CONCLUSIONS: Black American women, in general, have favorable views toward seeking mental health services and are comfortable with the use of mobile technology to receive support for managing depression. Future work should address the issues of access and consider the preferences and cultural appropriateness of the resources provided.

Personal Health Libraries for People Returning From Incarceration: Protocol for a Qualitative Study.

BACKGROUND: Individuals released from carceral facilities have high rates of hospitalization and death, especially in the weeks immediately after their return to community settings. During this transitional process, individuals leaving incarceration are expected to engage with multiple providers working in separate, complex systems, including health care clinics, social service agencies, community-based organizations, and probation and parole services. This navigation is often complicated by individuals' physical and mental health, literacy and fluency, and socioeconomic status. Personal health information technology, which can help people access and organize their health information, could improve the transition from carceral systems to the community and mitigate health risks upon release. Yet, personal health information technologies have not been designed to meet the needs and preferences of this population nor tested for acceptability or use. OBJECTIVE: The objective of our study is to develop a mobile app to create personal health libraries for individuals returning from incarceration to help bridge the transition from carceral settings to community living. METHODS: Participants were recruited through Transitions Clinic Network clinic encounters and professional networking with justice-involved organizations. We used qualitative research methods to assess the facilitators and barriers to developing and using personal health information technology for individuals returning from incarceration. We conducted individual interviews with people just released from carceral facilities (n=~20) and providers (n=~10) from the local community and carceral facilities involved with the transition for returning community members. We used rigorous rapid qualitative analysis to generate thematic output characterizing the unique circumstances impacting the development and use of personal health information technology for individuals returning from incarceration and to identify content and features for the mobile app based on the preferences and needs of our participants. RESULTS: As of February 2023, we have completed 27 qualitative interviews with individuals recently released from carceral systems (n=20) and stakeholders (n=7) who support justice-involved individuals from various organizations in the community. CONCLUSIONS: We anticipate that the study will characterize the experiences of people transitioning from prison and jails to community settings; describe the information, technology resources, and needs upon reentry to the community; and create potential pathways for fostering engagement with personal health information technology. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44748.

A Socio-Ecological Approach to Addressing Digital Redlining in the United States: A Call to Action for Health Equity.

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining-the systematic process by which specific groups are deprived of equal access to digital tools such as the internet-creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity.

Evaluating diversity, equity, and inclusion consultation requests.

Diversity, equity, and inclusion (DEI) efforts have increased drastically as companies and institutions recognize their value in fostering innovative ideas for success. Individuals trained in these efforts can impart their knowledge and expertise in consultation, but this transaction should be mutually beneficial. Here, we provide recommendations to maximize consulting opportunities.

Towards Reducing Health Information Inequities in the Caribbean: The Eastern Caribbean Health Outcomes Research Network Data Sharing Platform Usability Study.

There is a dearth of health research among Caribbean populations. Underrepresented individuals are affected by structural and data inequities that limit the usefulness, availability, and accessibility to health information systems and research-generated data. To overcome this limitation, a data sharing platform was created for the Eastern Caribbean Health Outcomes Research Network Cohort Study. This study aimed to evaluate the usability of the platform. Usability testing was conducted remotely, via video conferencing, using a cognitive walkthrough and think-aloud protocol. Participants completed a self-administered web-based survey which included an adapted version of the System Usability Scale (SUS). The results showed (N=16) overall average SUS score was 73.1 (SD±21.0), translating to a 'good' usability rating. Most recommendations for improvement focused on navigation and error prevention. Participatory data sharing platforms have the potential to reduce health information inequities in the Caribbean, however, usability testing should be conducted to improve user satisfaction and increase engagement.

Shadow mentoring: a cost-benefit review for reform.

Shadow mentoring relationships are those outside of traditional mentoring roles and are an unseen yet critical component of trainee retention that is rarely acknowledged. In this paper, we detail the costs and benefits of shadow mentoring and propose mechanisms to ensure that shadow mentoring is acknowledged as a vital contribution to scientific communities.

Recommendations for design of a mobile application to support management of anxiety and depression among Black American women.

Black American women experience adverse health outcomes due to anxiety and depression. They face systemic barriers to accessing culturally appropriate mental health care leading to the underutilization of mental health services and resources. Mobile technology can be leveraged to increase access to culturally relevant resources, however, the specific needs and preferences that Black women feel are useful in an app to support management of anxiety and depression are rarely reflected in existing digital health tools. This study aims to assess what types of content, features, and important considerations should be included in the design of a mobile app tailored to support management of anxiety and depression among Black women. Focus groups were conducted with 20 women (mean age 36.6 years, SD 17.8 years), with 5 participants per group. Focus groups were led by a moderator, with notetaker present, using an interview guide to discuss topics, such as participants' attitudes and perceptions towards mental health and use of mental health services, and content, features, and concerns for design of a mobile app to support management of anxiety and depression. Descriptive qualitative content analysis was conducted. Recommendations for content were either informational (e.g., information to find a Black woman therapist) or inspirational (e.g., encouraging stories about overcoming adversity). Suggested features allow users to monitor their progress, practice healthy coping techniques, and connect with others. The importance of feeling "a sense of community" was emphasized. Transparency about who created and owns the app, and how users' data will be used and protected was recommended to establish trust. The findings from this study were consistent with previous literature which highlighted the need for educational, psychotherapy, and personal development components for mental health apps. There has been exponential growth in the digital mental health space due to the COVID-19 pandemic; however, a one-size-fits-all approach may lead to more options but continued disparity in receiving mental health care. Designing a mental health app for and with Black women may help to advance digital health equity by providing a tool that addresses their specific needs and preferences, and increase engagement.

Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study.

BACKGROUND: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. OBJECTIVE: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. METHODS: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants' visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants' acceptance of the app. RESULTS: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. CONCLUSIONS: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype.

A systematic review of telehealth interventions for managing anxiety and depression in African American adults.

BACKGROUND: Although the difference in prevalence of mental illness is less than 7%, African American adults utilize mental health services at less than half the rate of their white counterparts. Evidence from past studies showed that telehealth interventions for anxiety and depression are effective in reducing symptoms. The objective of this systematic review is to survey the available peer-reviewed literature for studies that used telehealth interventions, specifically tailored for African American adults, to reduce anxiety or depression, and determine their effectiveness. METHODS: A comprehensive literature search was conducted using the PubMed, PsycINFO, Scopus, and Web of Science electronic databases for relevant articles published from January 1970 to December 2019. RESULTS: Three independent studies were identified. The findings showed significant reduction of depressive symptoms post-intervention (all P<0.05). However, effectiveness of telehealth intervention compared to face-to-face was not determined. None of the studies assessed the effectiveness of telehealth interventions to reduce anxiety. CONCLUSIONS: The results highlight the need for additional research into the effectiveness of using telehealth modalities to manage anxiety and depression in African American adults. This systematic review has been registered in the PROSPERO international prospective register of systematic reviews (registration number: CRD42018104469; registration date: 09 August 2018).

The Acceptability of Text Messaging to Help African American Women Manage Anxiety and Depression: Cross-Sectional Survey Study.

BACKGROUND: The rates of mental illness among African American women are comparable with the general population; however, they significantly underutilize mental health services compared with their white counterparts. Previous studies revealed that interventions delivered via text messaging are effective and can be used to increase access to services and resources. More insight into whether or not this modality is acceptable for use to deliver mental health care to help African American women manage anxiety and depression is needed. OBJECTIVE: This exploratory study aimed to gain insight into the acceptability of using text messaging to help African American women manage anxiety and depression. METHODS: A self-administered Web-based survey was launched in June 2018 and closed in August 2018. Eligible participants were African American women (18 years or older) who reside in the United States. Participants were recruited through convenience sampling (eg, email sent via listservs and social media posts). Respondents were provided an anonymous link to the questionnaire. The survey consisted of 53 questions on the following subjects: sociodemographic characteristics, attitudes toward seeking professional psychological help, mobile phone use, and acceptability of using a mobile phone to receive mental health care. RESULTS: The results of this exploratory study (N=101) showed that fewer than half of respondents endorsed the use of text messaging to communicate with a professional to receive help to manage anxiety (49/101, 48.5%) and depression (43/101, 42.6%). Approximately 51.4% (52/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with anxiety would be helpful. Similarly, 48.5% (49/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with depression would be helpful. Among participants who agreed that text messaging would be helpful, more than 80% noted being comfortable with its use to receive help for managing anxiety (approximately 86%, 45/52) and depression (approximately 82%, 40/49; highly significant positive association, all P<.001). More than 50% of respondents (56/101, 55.4%) indicated having concerns about using text messaging. No statistically significant associations were found between age and agreement with the use of text messaging to communicate with a professional to receive help for managing anxiety (P=.26) or depression (P=.27). CONCLUSIONS: The use of text messaging was not highly endorsed by African American women as an acceptable mode of communication with a professional to help them manage anxiety or depression. Concerns around privacy, confidentiality, and the impersonal feel of communicating about sensitive issues via text messages must be addressed for this modality to be a viable option. The findings of this study demonstrated the need for further research into the use of mobile technology to provide this population with more accessible and convenient options for mental health care.

Acceptability of Telemedicine to Help African American Women Manage Anxiety and Depression.

African American women experience rates of mental illness comparable to the general population, however they significantly underutilize mental health services. Past studies have shown that telemedicine is effective, and can be used to increase access to services. To assess the acceptability of using mobile video calls, a web-based survey was launched to solicit response from African American women. The results of this exploratory study (N=102) showed high acceptance of the use of video calls to communicate with a professional to receive help to manage anxiety and depression (> 70% endorsed). Statistically significant associations were found between age and agreement with the use of video calls, with younger women (< 50 years) more likely to indicate acceptance (p's < .05). The findings of this study demonstrated the need for additional research into the use of telemedicine to provide African American women with more accessible and convenient options for mental health care.

The Use of Culturally-Tailored Telehealth Interventions in Managing Anxiety and Depression in African American Adults: A Systematic Review.

This systematic review examined studies aimed at reducing anxiety or depression in African American adults through use of telehealth interventions. Three small independent studies were identified. The findings showed significant reduction of depressive symptoms post-intervention (all p values < .05). However, effectiveness of telehealth intervention compared to face-to-face was not determined. The results highlight the need for additional research into the effectiveness of using telehealth to manage anxiety and depression in this population.

Assessing the Satisfaction of Citizens Using Teleconsent in Clinical Research.

Researchers tested the functionality, and evaluated the feasibility of a telemedicine software, Doxy.me, to complete informed teleconsent sessions remotely with prospective research participants. Twenty healthy volunteers completed a teleconsent session, and web survey assessing overall experience and satisfaction with the Doxy.me software. There was a statistically significant correlation found between age and mean response for the overall reaction category (r = 0.398, p = 0.091) and the systems capabilities category (r = 0.380, p = 0.099). Results suggested that younger users are more satisfied than older users with using teleconsent as a modality for informed consenting. This information will be used to improve the software design and functionality of the Doxy.me software to make the teleconsent experience as simple and intuitive as possible.

Obesity, white blood cell counts, and platelet counts among police officers.

OBJECTIVE: To determine the association between several obesity indices (BMI, waist circumference, waist-to-hip and waist-to-height ratios, and abdominal height) and hematologic parameters [white blood cell (WBC) and platelet counts] among police officers. RESEARCH METHODS AND PROCEDURES: The authors conducted this cross-sectional study among 104 randomly selected officers (41 women and 63 men) from the Buffalo, NY, Police Department. Anthropometric measures were performed by clinic staff, and fasting blood samples were drawn for complete blood counts. Pearson's correlation, Student's t tests, ANOVA, analysis of covariance, and linear regression were used to assess the associations. RESULTS: Officers ranged in age from 26 to 61 years old and were predominantly white. Among women, current smokers had significantly higher WBC counts (7.4 x 10(3) cells/microL +/- 1.4) than former (5.2 x 10(3) cells/microL +/- 1.4) or never smokers (5.6 x 10(3) cells/microL +/- 1.5) (p = 0.002). Women had similar WBC counts but higher mean platelet counts than men (p = 0.005). Among women, abdominal height was positively associated with platelet count after adjustment for depression (p for trend = 0.039). Among women and men, a non-significant step-wise trend was observed between abdominal height and mean WBC counts before and after adjustment for smoking, race, and physical activity. No association was observed between obesity and platelet count among men. DISCUSSION: Abdominal height was significantly associated with increased platelet counts among female officers. No significant associations were observed between obesity and WBC or platelet counts among male officers.