Psychometric performance of the Mental Health Implementation Science Tools (mhIST) across six low- and middle-income countries.

BACKGROUND: Existing implementation measures developed in high-income countries may have limited appropriateness for use within low- and middle-income countries (LMIC). In response, researchers at Johns Hopkins University began developing the Mental Health Implementation Science Tools (mhIST) in 2013 to assess priority implementation determinants and outcomes across four key stakeholder groups-consumers, providers, organization leaders, and policy makers-with dedicated versions of scales for each group. These were field tested and refined in several contexts, and criterion validity was established in Ukraine. The Consumer and Provider mhIST have since grown in popularity in mental health research, outpacing psychometric evaluation. Our objective was to establish the cross-context psychometric properties of these versions and inform future revisions. METHODS: We compiled secondary data from seven studies across six LMIC-Colombia, Myanmar, Pakistan, Thailand, Ukraine, and Zambia-to evaluate the psychometric performance of the Consumer and Provider mhIST. We used exploratory factor analysis to identify dimensionality, factor structure, and item loadings for each scale within each stakeholder version. We also used alignment analysis (i.e., multi-group confirmatory factor analysis) to estimate measurement invariance and differential item functioning of the Consumer scales across the six countries. RESULTS: All but one scale within the Provider and Consumer versions had Cronbach's alpha greater than 0.8. Exploratory factor analysis indicated most scales were multidimensional, with factors generally aligning with a priori subscales for the Provider version; the Consumer version has no predefined subscales. Alignment analysis of the Consumer mhIST indicated a range of measurement invariance for scales across settings (R2 0.46 to 0.77). Several items were identified for potential revision due to participant nonresponse or low or cross- factor loadings. We found only one item, which asked consumers whether their intervention provider was available when needed, to have differential item functioning in both intercept and loading. CONCLUSION: We provide evidence that the Consumer and Provider versions of the mhIST are internally valid and reliable across diverse contexts and stakeholder groups for mental health research in LMIC. We recommend the instrument be revised based on these analyses and future research examine instrument utility by linking measurement to other outcomes of interest.

Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

INTRODUCTION: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system. METHODS: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data. RESULTS: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines. DISCUSSION: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.

Patterns of digital information and communication technology use among patients at primary health care centres in Colombia: Phase I of the DIADA project.

OBJECTIVE: Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medical information. METHODS: A survey was applied to adult patients who attended primary health care centers systems in 6 Colombian cities. The survey inquired about demographic characteristics, insurance, access to services, cell phone use, internet access, and the use of such technology to access health-related services and information. Data was collected and managed using REDCap. Summary statistics on each survey item were calculated and the differences between discrete variables were analyzed using chi-square. Multivariate analyses were performed using logistic regression analysis for binary dependent variables. RESULTS: A total of 1580 patients were surveyed across the six study sites. 93% of the patients reported they have a cell phone. Patients from urban healthcare centers showed a higher use of the Internet on their phone than less urban settings. Around half of the surveyed patients reported Internet use (49.7%). Among Internet users, 65% of participants use the Internet looking for health care information. Around one-third of patients use cellphones to arrange clinic visits. Around 24% of participants answered positively for both Whooley's questions. Of those who screened positive on the Whooley questions, 43% reported being moderately anxious, 47% reported being very anxious. 51% reported having moderate pain; 52% reported having severe pain. CONCLUSIONS: The patterns of technology use identified in this study are essential for developing future health interventions based on ICT. The design of ICT clinical interventions must take into account the cellphone payment plans, availability of internet connection, advantages, and disadvantages of messenger services, including SMS as a possible alternative to people who do not have smartphones.

A characterisation of social media users within the primary care system in Colombia and predictors of their social media use to understand their health.

INTRODUCTION: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour). METHODS: As part of a larger scale-up study, we surveyed 1580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour. RESULTS: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%). CONCLUSIONS: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.

Perspectives, Experiences, and Practices in the Use of Digital Information Technologies in the Management of Depression and Alcohol Use Disorder in Health Care Systems in Colombia.

Digital information technologies are increasingly used in the treatment of mental health disorders. Through this qualitative study, researchers illuminated perspectives, experiences, and practices among diverse stakeholders in the use of digital information technologies in the management of depression and alcohol use disorders in Colombia. In-depth interviews and focus groups were conducted in five primary care institutions across Colombia. Thematic analysis was used to analyze the data. The use of technology in the treatment of mental health disorders can facilitate the evaluation and diagnosis, treatment, and promotion and prevention of mental health disorders, as well as multiple nonmental health applications in the primary care setting. Potential barriers to the use of technology in this setting include challenges of digital literacy, access to technology, confidentiality, and financing. This study can inform the implementation of digital information technologies in the care of depression and problematic alcohol use within health care systems in Colombia.

Hydrocodone/acetaminophen and tramadol chlorhydrate combination tablets for the management of chronic cancer pain: a double-blind comparative trial.

OBJECTIVES: The purpose of this study was to compare the analgesic efficacy and tolerability of opioids hydrocodone and tramadol in the relief of cancer pain. METHODS: One hundred and eighteen patients with chronic cancer pain participated in a double-blind, randomized controlled trial. Sixty-two patients received hydrocodone and 56 patients received tramadol. RESULTS: Hydrocodone/acetaminophen was effective in relieving pain in 56.5% of the patients at the starting dose of 25 mg/2500 mg/d. An additional 14.5% of the patients responded to a double dose, and the remaining 29% of patients did not experience any pain relief from hydrocodone administration. One dose of tramadol at 200 mg/d produced pain relief in 62% of the patients and alleviated pain in another 11% of patients at a dose of 400 mg/d, and remaining 27% of patients did not experience pain relief from tramadol. No significant statistical difference in the analgesic efficacy of tramadol clorhydrate and hydrocodone/acetaminophen was found. The groups differed significantly in the incidence of side effects like nausea (P=0.03; relative risk (RR), 1.69; confidence interval (IC) 95%, 1.03-2.77), vomiting (P=0.02; RR, 2.21; IC 95%, 1.14-4.32), dizziness (P=0.03; RR, 2.12; IC 95%, 1.17-3.86), loss of appetite (P=0.02; RR, 3.27; IC 95%, 1.12-9.55) and weakness (P=0.019; RR, 7.75; IC 95%, 0.98-61.05). CONCLUSIONS: There was no superior analgesic efficacy with the administration of hydrocodone/acetaminophen when compared to patients receiving tramadol in the relief of cancer pain. Tramadol produced more mild side effects than hydrocodone.

Peroneal tendon subluxation and dislocation: detection on volume-rendered images--initial experience.

Institutional review board approval was received and informed consent was not required for this Health Insurance Portability and Accountability Act-compliant study. The purpose of this study was to retrospectively assess the time efficiency of three-dimensional volume-rendered images obtained from multi-detector row computed tomographic data for the diagnosis of peroneal tendon subluxation or dislocation by using the consensus interpretation of multiplanar reformatted (MPR) images as the reference standard. The reference standard was provided by two musculoskeletal radiologists, and two less experienced readers evaluated 37 images in 32 patients (24 men, eight women; mean age, 41 years; age range, 18-75 years) with acute calcaneal fractures. An analysis of variance was used to compare interpretation time, and the Wilcoxon signed rank test was used to analyze diagnostic difficulty. The average time required for diagnosis was significantly shorter with volume-rendered images than with MPR images (reader 1: 42 vs 78 seconds, P<.001; reader 2: 50 vs 69 seconds, P<.01).

Orthopedic hardware complications diagnosed with multi-detector row CT.

PURPOSE: To retrospectively evaluate multi-detector row computed tomography (CT) for the depiction of orthopedic hardware complications in the spine and appendicular skeleton. MATERIALS AND METHODS: This HIPAA-compliant study had institutional review board approval; patient informed consent was not required. Results of 114 multi-detector row CT studies performed because of possible hardware complications in 109 patients (57 men, 52 women; mean age, 44 years; age range, 12-82 years) were available for analysis. The CT studies were retrospectively reviewed and compared with clinical or surgical outcomes, which were used as the reference standard. In another experiment, detection of hardware complications on radiographs and multi-detector row CT images was compared between two readers for selected cases (18 positive and 26 negative) by using receiver operating characteristic (ROC) methods. RESULTS: For 91 (80%) of 114 multi-detector row CT studies, the complication status could be determined on the basis of clinical or surgical outcomes. Twenty-three multi-detector row CT studies were confirmed to be positive (revealing 10 cases of nonunion, five cases of hardware malplacement, three cases of hardware loosening, three perihardware fractures, and two chronic infections), and 57 were confirmed to be negative. There were three false-positive and eight false-negative multi-detector row CT studies. With clinical or surgical outcomes as the reference standard, the sensitivity, specificity, and positive and negative predictive values of multi-detector row CT were 74% (23 of 31 studies), 95% (57 of 60 studies), 88% (23 of 26 studies), and 88% (57 of 65 studies), respectively. Results of ROC analysis indicated that detection of hardware complications was much lower with radiography than with multi-detector row CT (area under ROC curve, 0.84 vs 1.00; F = 4.69, df = 1, 43; P < .05). CONCLUSION: Multi-detector row CT is an effective tool for depicting orthopedic hardware complications.