RESUMO
BACKGROUND: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. OBJECTIVE: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named "Ana" and (2) characterize and evaluate user experiences of these innovative technologies. METHODS: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of ß chatbots were tested, and a total of 22 ß testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. RESULTS: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87% (n=221) of English users and 22.14% (n=62) of Spanish users returned to use Ana at least once; 18.49% (n=64) among the English version users and 18.57% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the "smiley" and "loved" emojis, and negative ranking comprised the "neutral," "sad," and "mad" emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06%; Spanish: n=41, 77.35%) versus the former (English: n=23, 35.93%; Spanish: n=12, 22.64%). CONCLUSIONS: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19-related information.
RESUMO
La OMS coloca a Chile entre los países con mayor carga de morbilidad por enfermedades psiquiátricas (23,2%) en el mundo. La depresión mayor y los trastornos por consumo de alcohol ocupan el primer y segundo lugar en las discapacidades atribuidas entre adultos. Casi un tercio de la población mayor de 15 años ha sufrido un trastorno psiquiátrico en su lapso de vida y un 22,2% ha tenido uno durante el año pasado. Los trastornos de ansiedad son los más prevalentes, seguidos por depresión mayor y trastornos por consumo de alcohol. Solo el 38,5% de quienes han sido diagnosticados reciben algún tipo de servicio de salud mental, ya sea de un especialista o un médico de atención primaria. En niños y adolescentes, la prevalencia de cualquier trastorno psiquiátrico es de 22,5% (19,3% para niños y 25,8% para niñas). Estos trastornos son principalmente de ansiedad y disruptivos. La prevalencia es más alta entre niños de cuatro a once años de edad (27,8%) que entre aquellos de 12 a 18 años, y esta diferencia se debe principalmente a trastornos disruptivos. La prevalencia de trastornos de ansiedad es la segunda más alta, aunque menos asociada con discapacidades, mientras que muchos niños y adolescentes con trastornos afectivos están discapacitados y solo un quinto de las personas con necesidad de servicios buscan alguna forma de asistencia. Casi un cuarto de aquellos que usan los servicios no presentaron diagnóstico psiquiátrico durante el año pasado. La comorbilidad ocurre en el 27% de aquellas personas que presentan trastornos, pero solo el 7% tienen tres o más diagnósticos. No abordar la brecha de tratamiento en salud mental tiene serias implicaciones en la salud pública.
WHO places Chile among countries with greater morbidity burden for psychiatric diseases in the world (23,2%). Major depression and alcohol consumption disorders hold the first and second place in disabilities attributed to adults. Almost a third of the population older than 15 years have suffered a psychiatric disorder during life span and 22,2% persons have had one in the last year. Anxiety disorders have more prevalence, followed by major depression and alcohol consumption disorders. Only 38,5% of those diagnosed receive some type of mental health care, by an specialist or a primary health care physician. In children and adolescent, prevalence of any psychiatric disorder is 22,5% (19,3% for boys and 25,8% for girls). These disorders are mainly disruptive and of anxiety. Prevalence is higher for children between 4 to 11 years (27,8%) than between 12 and 18 years, and this difference is due mainly to disruptive disorders. Prevalence of anxiety disorders is the second highest, even though less associated with disabilities, while many children and adolescents with affective disorders are disabled and only a fifth of persons with health care needs look for some form of care. Almost a fourth of those that use health care services did not present psychiatric diagnosis during last year. Co morbidity occurs in 27% of those with disorders, but only 7% have three or more diagnosis. Not addressing treatment gap in mental health has serious implications in public health.
A OMS coloca o Chile entre os países com maior carga de morbidade por enfermidades psiquiátricas (23,2%) no mundo. A depressão maior e os transtornos por consumo de álcool ocupam o primeiro e segundo lugar nas descapacidades atribuidas entre adultos. Quase um terço da população maior de 15 anos tem sofrido um transtorno psiquiátrico em seu lapso de vida e cerca de 22,2% tiveram um durante o ano passado. Os transtornos de ansiedade são os mais prevalentes, seguidos por depressão maior e transtornos por consumo de álcool. Somente 38,5% daqueles que foram diagnosticados recebem algum tipo de serviço de saúde mental, seja de um especialista ou de um médico de atenção primária. Em crianças e adolescentes, a prevalência de qualquer transtorno psiquiátrico é de 22,5% (19,3% para meninos e 25,8% para meninas). Estes transtornos são principalmente de ansiedade e disruptivos. A prevalência é mais alta entre meninos de quatro a onze anos de idade (27,8%) do que entre aqueles de 12 a 18 anos, e esta diferença se deve principalmente a transtornos disruptivos. A prevalência de transtornos de ansiedade é a segunda mais alta, embora menos associada com descapacidades, enquanto muitos meninos e adolescentes com transtornos afetivos estão descapacitados e somente um quinto das pessoas com necessidade de serviços busca alguma forma de assistência. Quase um quarto daqueles que usam os serviços não apresentou diagnóstico psiquiátrico durante o ano passado. A comorbidade ocorre em 27% daquelas pessoas que apresentam transtornos, porém só 7% têm três ou mais diagnósticos. Não abordar a lacuna de tratamento em saúde mental tem sérias implicações para a saúde pública.
