The Use of Chatbots as Supportive Agents for People Seeking Help with Substance Use Disorder: A Systematic Review.

INTRODUCTION: The use of chatbots in healthcare is an area of study receiving increased academic interest. As the knowledge base grows, the granularity in the level of research is being refined. There is now more targeted work in specific areas of healthcare, for example, chatbots for anxiety and depression, cancer care, and pregnancy support. The aim of this paper is to systematically review and summarize the research conducted on the use of chatbots in the field of addiction, specifically the use of chatbots as supportive agents for those who suffer from a substance use disorder (SUD). METHODS: A systematic search of scholarly databases using the broad search criteria of ("drug" OR "alcohol" OR "substance") AND ("addiction" OR "dependence" OR "misuse" OR "disorder" OR "abuse" OR harm*) AND ("chatbot" OR "bot" OR "conversational agent") with an additional clause applied of "publication date" ≥ January 01, 2016 AND "publication date" ≤ March 27, 2022, identified papers for screening. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to evaluate eligibility for inclusion in the study, and the Mixed Methods Appraisal Tool was employed to assess the quality of the papers. RESULTS: The search and screening process identified six papers for full review, two quantitative studies, three qualitative, and one mixed methods. The two quantitative papers considered an adaptation to an existing mental health chatbot to increase its scope to provide support for SUD. The mixed methods study looked at the efficacy of employing a bespoke chatbot as an intervention for harmful alcohol use. Of the qualitative studies, one used thematic analysis to gauge inputs from potential users, and service professionals, on the use of chatbots in the field of addiction, based on existing knowledge, and envisaged solutions. The remaining two were useability studies, one of which focussed on how prominent chatbots, such as Amazon Alexa, Apple Siri, and Google Assistant can support people with an SUD and the other on the possibility of delivering a chatbot for opioid-addicted patients that is driven by existing big data. DISCUSSION/CONCLUSION: The corpus of research in this field is limited, and given the quality of the papers reviewed, it is suggested more research is needed to report on the usefulness of chatbots in this area with greater confidence. Two of the papers reported a reduction in substance use in those who participated in the study. While this is a favourable finding in support of using chatbots in this field, a strong message of caution must be conveyed insofar as expert input is needed to safely leverage existing data, such as big data from social media, or that which is accessed by prevalent market leading chatbots. Without this, serious failings like those highlighted within this review mean chatbots can do more harm than good to their intended audience.

Losing a Loved One During the Covid-19 Pandemic: An On-Line Survey Looking at the Effects on Traumatic Stress, Coping and Post-Traumatic Growth.

The Covid-19 pandemic has had a devastating effect across the world. In the UK alone, the death toll is 132,742, with 207 people dying the previous day and a total of 6,825,074 cases of Covid-19 thus far (September 1st, 2021). The aim of this study was to look at post-traumatic stress, coping skills and post-traumatic growth in relatives, who lost a loved one during the pandemic. Some 185 individuals took part in a Qualtrics survey. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised, the Coping Assessment for Bereavement and Loss (CABLE) and the Post-Traumatic Growth Questionnaire. There were two major findings. First, there were very high levels of post-traumatic stress, with 94.6% of the sample scoring above the threshold of 33 for a diagnosis of post-traumatic stress disorder (PTSD). Second, levels of post-traumatic growth were very low. Losing a relative during the Covid-19 pandemic may lead to more PTSD. The circumstances surrounding many Covid deaths, may have long term negative consequences for the bereaved relatives.

A systematic review exploring how young people use online forums for support around mental health issues.

Background: Young people increasingly look towards the Internet for support. Online forums have been developed to provide mental health support, but they have received little attention in the research to date. Aims: To summarise the existing literature examining how individuals use online forums to obtain support for mental health difficulties. Methods: A systematic review of electronic databases was conducted to identify empirical literature in this area. The papers that met the inclusion criteria and satisfied quality assessment review were analysed for key themes. Results: Twenty-one papers were found. Three common themes in the papers were associated with opportunities of the technology: (1) Providing stand alone or complementary informal support, (2) Providing informational, emotional and infomotional support, and (3) Making use of the specific practical opportunities afforded by forum technology. A further three themes were associated with challenges: (1) Managing the expectations of forum users, (2) Ensuring service user safety, and (3) Navigating the technical challenges associated with forums. Conclusions: The paper highlights the potential for individuals to access dynamic and responsive support within online forums. Additionally, it reflects upon the major areas that mental health professionals need to be aware of when entering into this arena.

Correction: "You Sort of Go Down a Rabbit Hole...You're Just Going to Keep on Searching": A Qualitative Study of Searching Online for Pregnancy-Related Information During Pregnancy.

[This corrects the article DOI: 10.2196/jmir.6302.].

"You Sort of Go Down a Rabbit Hole...You're Just Going to Keep on Searching": A Qualitative Study of Searching Online for Pregnancy-Related Information During Pregnancy.

BACKGROUND: The Web is becoming increasingly popular for gaining information on medical or health issues; with women in particular likely to search online for this type of information and support. Despite the increased use of the Web for health-related information, we need to question whether the Web and the ease of seeking health information that it provides leads to more (patient) empowerment. As well as being a time of joy and expectations, pregnancy can be a worrying time for women, especially first time mums-to-be, with unfamiliar experiences and symptoms and concerns for the baby as well as the self. OBJECTIVE: Our aim was to explore how and why pregnant women use the Web to gain information and support during pregnancy and what they consider a reliable source. METHODS: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences of currently pregnant women who use the Web to gain information and support during their pregnancy. Sixteen pregnant women took part in a semistructured interview, either face-to-face or via telephone. The interviews took place from January to March 2016, all participants were from England, and the health professionals are all employed by the National Health Service (NHS). Qualitative analytical procedures were employed using inductive thematic analysis supported by NVivo software (QSR International). RESULTS: Pregnant women found reassurance from the experiences of others. This reassurance resulted in them feeling less alone, as well as enabling them to normalize any symptoms or experiences they were undergoing. The women understood that caution was needed at times while reading the stories of others, acknowledging the potential for extreme cases or worst case scenarios. This is particularly pertinent to the Web, as this wide range of stories may not be as easily accessible if stories where confined to those in a woman's offline social circle. The interviews provide insights into how and why pregnant women search online for information and perhaps more so, support while pregnant. CONCLUSIONS: Searching for health information and advice online during pregnancy is viewed as quick, easy, and accessible. The affordances of the Web have provided women the opportunity to go online as a first port of call. Knowing they were not alone and reading the experiences or symptoms of other pregnant women enabled women to normalize their experience and was ultimately reassuring for pregnant women.

The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review.

BACKGROUND: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient's mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. OBJECTIVE: The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. METHODS: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. RESULTS: A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. CONCLUSIONS: The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions.

Assessing the Efficacy of Mobile Health Apps Using the Basic Principles of Cognitive Behavioral Therapy: Systematic Review.

BACKGROUND: Cognitive behavioral therapy (CBT) in its basic principle has developed itself as a stand-alone, substantial method of therapy. With effective application in therapy for a range of mental health issues, the spread of CBT methods to Web-based therapy sources is evident. The development of mobile phone apps using CBT principles is increasing within the research area. Despite the move to Web-based methods of therapy, it is argued that these methods lack the same efficacy of face-to-face therapy sessions. OBJECTIVE: The aim of this review was to assess extent research findings with regard to the effectiveness of CBT-related mobile health (mHealth) apps. By assessing only studies employing a randomized controlled trial design, the review aimed to determine app efficacy within the highly regarded method of investigation. METHODS: A comprehensive literature search was conducted across several databases. Search results were filtered, and results were subject to strict inclusion and exclusion criteria because of the nature of the review. Where possible, analysis of effect size was calculated and results reported. RESULTS: A total of 8 studies investigating the effectiveness of mHealth CBT-related apps across a range of mental health issues were reviewed. Three studies used the app against a control group, and 5 studies used the app intervention against another form of treatment or intervention. A range of effect sizes were seen across all included studies (d=-0.13 to 1.83; 0.03-1.44), with the largest effects often being seen when comparing the data from pre- to posttest for the app engaged group. CONCLUSIONS: The studies reviewed support the use of mHealth apps containing CBT principles for a range of mental health issues. However, the effectiveness over longer time periods should be assessed. Researchers and professionals should seek to collaborate effectively when creating new apps to enhance their effectiveness as a treatment for the general public.

Blogging as a viable research methodology for young people with arthritis: a qualitative study.

BACKGROUND: The development of services that are responsive to the needs of users is a health policy priority. Finding ways of engaging young people in research to gain insights into their particular experiences, perspectives, and needs is vital but challenging. These data are critical to improving services in ways that meet the needs of young people. OBJECTIVE: Our aim was to evaluate Web-based blogging as a viable method for understanding the daily experiences and condition management strategies of young people with juvenile arthritis. METHODS: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences and perspectives of young people regarding the management of their condition and its daily impact. In collaboration with a group of young people with arthritis, a custom website was developed. This website provided the opportunity for young people (aged 11-19) with arthritis from a United Kingdom pediatric hospital to contribute blogs. It was designed so that young people were free to write about whatever was important to them, but the site also included some structure and prompts to facilitate the writing of blogs. Qualitative analytical procedures were employed, supported by NVivo software. RESULTS: Engagement in the study by young people was variable in terms of their participation rates, frequency of website visits, and the length of their blogs. Young people used the site in different ways, some responding to the website categories and prompts that the team created, while others used it as a diary to record their experiences and thoughts. In line with principles of qualitative inquiry, the data collection was participant-led. Young people were in control of what, how much, and how often they wrote. However, some young people expressed difficulty regarding knowing what they should blog about. For a number of reasons, discussed here, the blogs may also not be fully reflective of experiences and perspectives of the participants. However, the data obtained provided insights into young people's experiences of living with arthritis and their use of medicines in the context of their daily lives. CONCLUSIONS: Web-based research with young people presents opportunities and challenges for researchers. Web-based blogging methodology has the potential to give young people and parents the space and empowerment to express their own ideas and concerns. However, this project suggests that it might not be the best way to engage a large diverse group of young people and might most effectively be combined with other approaches. Despite these limitations, the study provided valuable data about the experience and impact of living with a long-term condition from the perspectives of young people with arthritis.

Loneliness and mental health at the early stages of the Covid-19 pandemic in England.

The current researchers carried out a large online survey on 18 March 2020 and unintentionally provided a 'snap shot' of how the British population was responding in the early stages of the Covid-19 pandemic. This paper aims to investigate the relationship between loneliness and mental health at the early stages of the global crisis. This cross-sectional study was carried out using Prolific, an online participant recruitment platform that allowed 1608 responses in just 2 hr. Participants completed measures of Personal Well-being, Psychological Distress, Flourishing and Loneliness. Numerous associations between loneliness and mental health were found. A multiple regression found that 43% of the variance in loneliness can be accounted for by age, psychological distress and flourishing. Responses were also categorised into three groups: the non-lonely (n = 311), averagely lonely (n = 1054) and the severely lonely (n = 243), with analysis indicating that poorer well-being was associated with increased loneliness. Due to the cross sectional nature of this research, determining the direction of causality is not possible. It remains uncertain whether increased loneliness negatively impacted on mental health, whether poor mental health lead to increased loneliness, or both in fact. Current findings suggest that severely lonely individuals may be particularly vulnerable to psychological distress and that individuals with poor mental health may be especially prone to loneliness. Individuals experiencing loneliness and/or poor mental health will almost certainly need additional support during and beyond the pandemic.

The Therapeutic Goals Set by University Students in an Anonymous Web-Based Therapy and Support Setting.

The interest in student mental health and wellbeing has increased in recent years. Additionally, there is a rising volume of students seeking support. Numerous online resources have been developed to meet this need, including anonymous web-based therapy. To date, there has been little focus upon how students may utilise such a service, and this study examines routine evaluation data (solicited from a Goal-based Outcome Measure) from a United Kingdom based service provider. Over the course of one academic year (2018-2019), 211 students articulated therapeutic goals within Kooth Student, a web-based therapy and support service for individuals in higher education. These goals were examined for key trends. The students identified a total of 625 goals to work on in therapy, with individuals setting an average of three goals each. The most common goals focused upon obtaining additional support within the service and exploring their emotions. The results suggested that female students were more likely to move towards achieving their goals, with goals that did move shifting an average of 7.74 on a 10-point scale. Practical goals that focused upon getting more help, both inside and outside the service, were most likely to be achieved. In contrast, self-help/self-care goals were less likely to be achieved. These results provide a helpful insight into how students made use of therapy and highlight the importance of the interaction that web-based services have with other provision (web-based and in-person). They also demonstrate the challenge of capturing meaningful outcome data in anonymous services.

A Theory of Change for Web-Based Therapy and Support Services for Children and Young People: Collaborative Qualitative Exploration.

BACKGROUND: Web-based counseling and support has become increasingly commonplace for children and young people (CYP). Currently, there is limited research that focuses on the mechanisms of change within complex telepsychology platforms, a factor that makes designing and implementing outcome measures challenging. OBJECTIVE: This project aims to articulate a theory of change (ToC) for Kooth, a web-based therapy and support platform for CYP. METHODS: A collaborative qualitative research design involving professional staff, academic partners, and young people was used to develop the ToC. The following three major reflective phases were engaged: a scoping workshop involving professional staff and academic partners, a series of explorative projects were completed to inform the development of the ToC, and the draft ToC was reviewed for coherence by key stakeholders (young people, online professionals, and service managers). RESULTS: A collaboratively developed ToC was presented. This was divided into the conditions that lead to individuals wanting to access web-based therapy and support (eg, individuals wanting support there and then or quickly), the mode of service delivery (eg, skilled and experienced professionals able to build empathetic relationships with CYP), and the observed and reported changes that occur as a consequence of using the service (eg, individuals being better able to manage current and future situations). CONCLUSIONS: Developing the ToC helps to shed light on how web-based therapy and support services aid the mental health and well-being of CYP. Furthermore, it helps to understand the development of positive virtual ecosystems and can be used to devise evaluative tools for CYP telepsychology providers.

Online peer to peer support: Qualitative analysis of UK and US open mental health Facebook groups.

OBJECTIVE: This research aimed to gain further understanding of how open Facebook groups are used for online peer to peer support and identify any similarities and/or differences between UK and US groups. METHOD: A systematic search of mental health related open Facebook groups was conducted using relevant key words. The posts from 14 UK and 11 US groups were acquired over a three month period and content thematically analysed using Nvivo. RESULTS: Findings support previous research which evidences that online peer to peer support is beneficial for users seeking mental health information. Said support can increase feelings of connectedness, reduce feelings of isolation, and provide a platform for comparison of perspectives relating to personal experiences. Group membership may offer hope and increase feelings of empowerment in those using Facebook groups as a support mechanism. There was similar discourse seen throughout both UK and US posts in regards to gender inequality, lack of awareness and stigmatisation. CONCLUSIONS: The study highlights the positive impact of shared personal experiences, and offers a greater understanding of the benefits of online peer to peer support for mental health and wellbeing. There is evidence that, whilst mental health is becoming a more widely discussed topic, in both the UK and US, it remains negatively perceived. Questions are posed for group administrators and health professionals relating to their utilisation and moderation of such online peer to peer support networks.

"I Feel Like A Neurotic Mother at Times"-a mixed methods study exploring online health information seeking behaviour in new parents.

BACKGROUND: In contemporary society, due to the exponential growth of technology and the online platform, data acquisition has never been so effortless. Subsequent accessibility to health information has been reported as having many positive and negative effects. Health anxiety is the apprehension of experiencing or developing an ailment due to symptomology misinterpretation. One such lifetime occurrence which causes increased anxiety is becoming a new parent. New parents often use the online platform to seek information which will educate them on how best to care for their child and to keep their child's health at the optimum level. METHODS: The online Pregnancy Questionnaire used within this study was inclusive of the Short HAI Health Anxiety Inventory (HAI) and was tailored for both pregnant women and new parents. This study focuses specifically on the results provided by the new parents. The research was disseminated and advertised on social media platforms such as Facebook, Twitter and a purpose-built website named "A Healthy Search" which provided all information relevant to the study and participation. Quantitative data were analysed using a regression and qualitative data were thematically analysed. RESULTS: Results shows that medical complications in pregnancy did not significantly predict health anxiety however medical care within the past year did. It can also be seen that frequency of searching online for self, did not significantly predict health anxiety, yet searching online for child did significantly predict health anxiety. Anxiety specific to pregnancy ceases when gravidity comes to an end and feelings of health anxiety then tend to be transferred from the mother (parent) to the child when one becomes a new parent. New parents strive to expand their own knowledge base, in regards to typical and atypical symptomology, so that they are better equipped to monitor development, care for, and make decisions on behalf of their child. The online platform was used as opposed to offline provisos due to inexperience, judgement and anonymity. Online health information seeking behaviour also has the probability of both increasing and decreasing levels of anxiety in new parents. CONCLUSIONS: This research recognised and reinforced positive and negative aspects of online health information seeking behaviour. It is recommended that further research be carried out into relevant, efficacious interventional techniques that may relieve health anxiety within new parents as contemporary technology has become a pivotal aspect of life.

Implementations of Virtual Reality for Anxiety-Related Disorders: Systematic Review.

BACKGROUND: Although traditional forms of therapy for anxiety-related disorders (eg, cognitive behavioral therapy, CBT) have been effective, there have been long-standing issues with these therapies that largely center around the costs and risks associated with the components comprising the therapeutic process. To treat certain types of specific phobias, sessions may need to be held in public, therefore risking patient confidentiality and the occurrence of uncontrollable circumstances (eg, weather and bystander behavior) or additional expenses such as travel to reach a destination. To address these issues, past studies have implemented virtual reality (VR) technologies for virtual reality exposure therapy (VRET) to provide an immersive, interactive experience that can be conducted privately and inexpensively. The versatility of VR allows various environments and scenarios to be generated while giving therapists control over variables that would otherwise be impossible in a natural setting. Although the outcomes from these studies have been generally positive despite the limitations of legacy VR systems, it is necessary to review these studies to identify how modern VR systems can and should improve to treat disorders in which anxiety is a key symptom, including specific phobias, posttraumatic stress disorder and acute stress disorder, generalized anxiety disorder, and paranoid ideations. OBJECTIVE: The aim of this review was to establish the efficacy of VR-based treatment for anxiety-related disorders as well as to outline how modern VR systems need to address the shortcomings of legacy VR systems. METHODS: A systematic search was conducted for any VR-related, peer-reviewed articles focused on the treatment or assessment of anxiety-based disorders published before August 31, 2017, within the ProQuest Central, PsycINFO, and PsycARTICLES databases. References from these articles were also evaluated. RESULTS: A total of 49 studies met the inclusion criteria from an initial pool of 2419 studies. These studies were a mix of case studies focused solely on VRET, experimental studies comparing the efficacy of VRET with various forms of CBT (eg, in vivo exposure, imaginal exposure, and exposure group therapy), and studies evaluating the usefulness of VR technology as a diagnostic tool for paranoid ideations. The majority of studies reported positive findings in favor of VRET despite the VR technology's limitations. CONCLUSIONS: Although past studies have demonstrated promising and emerging efficacy for the use of VR as a treatment and diagnostic tool for anxiety-related disorders, it is clear that VR technology as a whole needs to improve to provide a completely immersive and interactive experience that is capable of blurring the lines between the real and virtual world.

Empirical Evidence for the Outcomes of Therapeutic Video Games for Adolescents With Anxiety Disorders: Systematic Review.

BACKGROUND: Extant evidence suggests that the proportion of adolescents suffering from anxiety disorders (ADs) has increased by up to 70% since the mid-1980s, with experience of anxiety at this stage associated with significant negative short- and long-term life outcomes. The existing therapeutic interventions (eg, cognitive behavioral therapy, CBT; attention bias modification, ABM) have proven to have clinically measurable benefits in reducing anxiety, but their efficacy is often compromised by social and practical barriers. The growing discrepancy between demand for, and access to, clinical interventions for anxiety has led to the development of a range of eHealth (health care practice supported by electronic processes and communication) and mHealth (versions of eHealth using mobile devices) interventions. One such protocol is therapeutic games, which aim to provide clinical frameworks in dynamic, adaptable, and personalized virtual environments. Although some evidence exists to suggest therapeutic games are associated with reductions in subjective anxiety and observed stress reactivity, there is currently, to our knowledge, no systematic review of the adherence to, and effectiveness of, therapeutic games for adolescent anxiety. OBJECTIVE: The aim of this review was to establish the effectiveness of therapeutic games in making clinically measurable reductions in anxiety symptoms in adolescent samples. METHODS: A systematic search of the existing academic literature published between 1990 and July 2017 was conducted using the databases Journal of Medical Internet Research, Journal Storage, Psychology Articles, Psychology Info, ScienceDIRECT, and Scopus. Records linked to empirical papers on therapeutic games for anxiety using adolescent samples were evaluated. RESULTS: A total of 5 studies (N=410 participants) met the inclusion criteria, and 3 gamified anxiety interventions for adolescents were identified. The papers included a mixture of randomized controlled trials, quasi-experimental studies, and usability studies comprising quantitative and qualitative measures, with varying degrees of mixed methods. Extant evidence shows potential for therapeutic games to create clinically measurable reductions in symptoms of anxiety in adolescent samples, though findings are complicated in some cases by a low sample size, and in other cases by research design and methodological complications, including anxiety reductions in control groups caused by a control-game selection. CONCLUSIONS: Although research in this field appears to be extremely limited, as demonstrated by the small number of papers meeting the inclusion criteria for this review, early findings suggest that therapeutic games have potential in helping to engage adolescents with anxiety and lead to clinically measurable reductions in symptoms.

Predictors of health anxiety during pregnancy.

BACKGROUND: The internet has become a quick, easy and accessible source for health-related information. Women are more likely to search for health information online and this likelihood increases further during pregnancy. Searching online for health-related information can have both positive and negative impacts upon levels of health anxiety during pregnancy. This research initially explored how health impacts heath anxiety during pregnancy. Secondly, the sources of offline support that predict health anxiety and thirdly, how online health seeking behaviour predicts health anxiety. METHODS: The sample consisted of 159 pregnant women who completed an online questionnaire to investigate significant predictors of health anxiety during pregnancy. RESULTS: Multiple regression analyses showed health anxiety increased during pregnancy when medical complications had been experienced in a previous pregnancy and if under medical treatment for a non-pregnancy related condition. Interestingly, health anxiety was not affected by medical complications in the current pregnancy. Knowing when you have had enough information and repeating searches were significant predictors of levels of health anxiety, whereas using the same or different sources was not. CONCLUSIONS: For many the internet is a convenient platform for information however the information is not always accurate, reliable or helpful. Relevant health care professionals should continue to sign-post pregnant women to validated health information websites with the aim to reassure women during pregnancy. Further research in this area would benefit from exploring how women use the internet when pregnant and devising guidelines which can be followed and recommended when doing so.

Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support.

BACKGROUND: The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. OBJECTIVE: The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). METHODS: Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. RESULTS: The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do. CONCLUSIONS: This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective).

The Role of Pharmacists in Caring for Young People With Chronic Illness.

PURPOSE: To explore the perceived and potential roles of pharmacists in the care of young people aged 10-24 years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals, and lay advocates. METHODS: A sequential mixed methods study design comprises the following: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners; and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. RESULTS: The high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were developing generic health care skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information; and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider health care team. CONCLUSIONS: This study has led to the identification of specific enhancements to pharmacy services for young people, which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication.

Pharmacy students' perceptions of natural science and mathematics subjects.

OBJECTIVE: To determine the level of importance pharmacy students placed on science and mathematics subjects for pursuing a career in pharmacy. METHOD: Two hundred fifty-four students completed a survey instrument developed to investigate students' perceptions of the relevance of science and mathematics subjects to a career in pharmacy. Pharmacy students in all 4 years of a master of pharmacy (MPharm) degree program were invited to complete the survey instrument. RESULTS: Students viewed chemistry-based and biology-based subjects as relevant to a pharmacy career, whereas mathematics subjects such as physics, logarithms, statistics, and algebra were not viewed important to a career in pharmacy. CONCLUSION: Students' experience in pharmacy and year of study influenced their perceptions of subjects relevant to a pharmacy career. Pharmacy educators need to consider how they can help students recognize the importance of scientific knowledge earlier in the pharmacy curriculum.

Moral development of first-year pharmacy students in the United Kingdom.

OBJECTIVE: To investigate the moral development of pharmacy students over their first academic year of study at a university in the United Kingdom. METHODS: Pharmacy students completed Defining Issues Test (DIT) at the start of their first year (phase 1) and again at the end of their first year (phase 2) of the program. RESULTS: Pharmacy students (N=116) had significantly higher moral reasoning at the beginning of their first year than by the end of it. Scores differed by students' gender and age; however, these findings differed between phase 1 and phase 2. CONCLUSION: First-year pharmacy students in the United Kingdom scored lower on moral reasoning than did pharmacy students in the United States and Canada.