Internet use, eHealth literacy and attitudes toward computer/internet among people with schizophrenia spectrum disorders: a cross-sectional study in two distant European regions.

BACKGROUND: Individuals with schizophrenia spectrum disorders use the Internet for general and health-related purposes. Their ability to find, understand, and apply the health information they acquire online in order to make appropriate health decisions - known as eHealth literacy - has never been investigated. The European agenda strives to limit health inequalities and enhance mental health literacy. Nevertheless, each European member state varies in levels of Internet use and online health information-seeking. This study aimed to examine computer/Internet use for general and health-related purposes, eHealth literacy, and attitudes toward computer/Internet among adults with schizophrenia spectrum disorders from two distant European regions. METHODS: Data were collected from mental health services of psychiatric clinics in Finland (FI) and Greece (GR). A total of 229 patients (FI = 128, GR = 101) participated in the questionnaire survey. The data analysis included evaluation of frequencies and group comparisons with multiple linear and logistic regression models. RESULTS: The majority of Finnish participants were current Internet users (FI = 111, 87%, vs. GR = 33, 33%, P < .0001), while the majority of Greek participants had never used computers/Internet, mostly due to their perception that they do not need it. In both countries, more than half of Internet users used the Internet for health-related purposes (FI = 61, 55%, vs. GR = 20, 61%). The eHealth literacy of Internet users (previous and current Internet users) was found significantly higher in the Finnish group (FI: Mean = 27.05, SD 5.36; GR: Mean = 23.15, SD = 7.23, P < .0001) upon comparison with their Greek counterparts. For current Internet users, Internet use patterns were significantly different between country groups. When adjusting for gender, age, education and disease duration, country was a significant predictor of frequency of Internet use, eHealth literacy and Interest. The Finnish group of Internet users scored higher in eHealth literacy, while the Greek group of never Internet users had a higher Interest in computer/Internet. CONCLUSIONS: eHealth literacy is either moderate (Finnish group) or low (Greek group). Thus, exposure to ICT and eHealth skills training are needed for this population. Recommendations to improve the eHealth literacy and access to health information among these individuals are provided.

Effectiveness of Social Media Interventions for People With Schizophrenia: A Systematic Review and Meta-Analysis.

BACKGROUND: Recent studies have shown that people with serious mental disorders spend time online for the purposes of disclosure, information gathering, or gaming. However, coherent information on the effects of social media on treatment for people with schizophrenia is still lacking. OBJECTIVE: Our aim was to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. METHODS: A systematic review and meta-analysis were undertaken to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. Ten databases were searched, while search parameters included English-only manuscripts published prior to June 25, 2015. Study appraisals were made independently by 2 reviewers, and qualitative and quantitative syntheses of data were conducted. RESULTS: Out of 1043 identified records, only two randomized studies of moderate quality (three records, total N=331, duration 12 months) met the inclusion criteria. Participants were people with schizophrenia spectrum or an affective disorder. Social media was used as part of Web-based psychoeducation, or as online peer support (listserv and bulletin board). Outcome measures included perceived stress, social support, and disease-related distress. At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress levels (P=.04) and showed a trend for a higher perceived level of social support (P=.06). However, those who reported more positive experiences with the peer support group also reported higher levels of psychological distress (P=.01). CONCLUSIONS: Despite using comprehensive searches from 10 databases, we found only two studies, whereas numerous reports have been published citing the benefits of social media in mental health. Findings suggest the effects of social media interventions are largely unknown. More research is needed to understand the effects of social media, for users with and without mental illness, in order to determine the impact on mental well-being ofsocial media use as well as its risks.

Exploring design requirements for repurposing dental virtual patients from the web to second life: a focus group study.

BACKGROUND: Since their inception, virtual patients have provided health care educators with a way to engage learners in an experience simulating the clinician's environment without danger to learners and patients. This has led this learning modality to be accepted as an essential component of medical education. With the advent of the visually and audio-rich 3-dimensional multi-user virtual environment (MUVE), a new deployment platform has emerged for educational content. Immersive, highly interactive, multimedia-rich, MUVEs that seamlessly foster collaboration provide a new hotbed for the deployment of medical education content. OBJECTIVE: This work aims to assess the suitability of the Second Life MUVE as a virtual patient deployment platform for undergraduate dental education, and to explore the requirements and specifications needed to meaningfully repurpose Web-based virtual patients in MUVEs. METHODS: Through the scripting capabilities and available art assets in Second Life, we repurposed an existing Web-based periodontology virtual patient into Second Life. Through a series of point-and-click interactions and multiple-choice queries, the user experienced a specific periodontology case and was asked to provide the optimal responses for each of the challenges of the case. A focus group of 9 undergraduate dentistry students experienced both the Web-based and the Second Life version of this virtual patient. The group convened 3 times and discussed relevant issues such as the group's computer literacy, the assessment of Second Life as a virtual patient deployment platform, and compared the Web-based and MUVE-deployed virtual patients. RESULTS: A comparison between the Web-based and the Second Life virtual patient revealed the inherent advantages of the more experiential and immersive Second Life virtual environment. However, several challenges for the successful repurposing of virtual patients from the Web to the MUVE were identified. The identified challenges for repurposing of Web virtual patients to the MUVE platform from the focus group study were (1) increased case complexity to facilitate the user's gaming preconception in a MUVE, (2) necessity to decrease textual narration and provide the pertinent information in a more immersive sensory way, and (3) requirement to allow the user to actuate the solutions of problems instead of describing them through narration. CONCLUSIONS: For a successful systematic repurposing effort of virtual patients to MUVEs such as Second Life, the best practices of experiential and immersive game design should be organically incorporated in the repurposing workflow (automated or not). These findings are pivotal in an era in which open educational content is transferred to and shared among users, learners, and educators of various open repositories/environments.

An analysis of online health information on schizophrenia or related conditions: a cross-sectional survey.

BACKGROUND: Around 20% of those who seek health information online, search specifically for mental health. However, little is known about the nature of the online health information offered by two European countries, Finland and Greece, which are characterized by markedly differing levels of Internet access and online health information seeking. This study aims to assess, describe and compare websites, written in two European, non-English languages (Finnish and Greek) that appear first after performing an online search concerning schizophrenia or related conditions. METHODS: The first 20 results from four search terms (searched in Finnish and Greek) in the Web search engine 'Google' were screened. A total of 160 websites were retrieved (80 Finnish, 80 Greek) and evaluated using a preformulated coding system which consisted of websites' indicators, such as: types, characteristics, accountability, interactivity, aesthetics and content. Differences between websites were evaluated with Chi-Square or Fisher's Exact tests for categorical data and independent t-tests for parametric data. RESULTS: Twenty-four Finnish and thirty-four Greek websites (36% in total) were included. Almost two-thirds (62%, n=36) were owned by an organization, compared to 17% (n=10) by an individual. In both countries, aesthetics had the highest score (possible range 0-4, mean = 2.6, SD = .62), while interactivity the lowest (range 0-5, mean = 1.79, SD = .87). There were no statistically significant differences among the accountability, interactivity and aesthetics scores of the Finnish and Greek websites. CONCLUSIONS: All assessed indicators suggest there is a need to improve Finnish and Greek online information about schizophrenia or related conditions. The poor website interactivity is of particular concern given the challenges faced by the target group. The findings can be used to guide the development and dissemination of online mental health information aimed at Finnish and Greek online health-seekers.

Adolescents' difficulties, strengths and feelings of insecurity: a cross-sectional descriptive survey in Finland.

The present study aimed to describe adolescents' self-reported emotional and behavioural strengths and difficulties, as well as their insecurity feeling. In addition, the aim was to examine the association with background characteristics, and explore the association between strengths and difficulties and insecurity factors. The study was conducted among 114 secondary school pupils in Finland, using an online questionnaire. Adolescents' emotional and behavioural difficulties and strengths, were mostly classified as normal. Strengths and Difficulties Questionnaire total score as well as internal and external score, were inversely associated with insecurity factors. Girls had significantly higher prosocial behavior compared to boys (P = 0.0007). The age of adolescents was found to be related to their internal difficulties (P = 0.02) and prosocial behavior (P = 0.01). Adolescent's perception of their family relations as poor was associated with external difficulties (P = 0.04). The current results, can be helpful for mental health professionals who work with adolescents in order to implement appropriate and needs specific mental health promotion interventions at individual but also community level. Finally, more research is needed to validate measures for insecurity. This will support mental health professionals in their clinical practice by providing them with all the important factors needed to support adolescents.

Technologies in Home-Based Digital Rehabilitation: Scoping Review.

BACKGROUND: Due to growing pressure on the health care system, a shift in rehabilitation to home settings is essential. However, efficient support for home-based rehabilitation is lacking. The COVID-19 pandemic has further exacerbated these challenges and has affected individuals and health care professionals during rehabilitation. Digital rehabilitation (DR) could support home-based rehabilitation. To develop and implement DR solutions that meet clients' needs and ease the growing pressure on the health care system, it is necessary to provide an overview of existing, relevant, and future solutions shaping the constantly evolving market of technologies for home-based DR. OBJECTIVE: In this scoping review, we aimed to identify digital technologies for home-based DR, predict new or emerging DR trends, and report on the influences of the COVID-19 pandemic on DR. METHODS: The scoping review followed the framework of Arksey and O'Malley, with improvements made by Levac et al. A literature search was performed in PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library. The search spanned January 2015 to January 2022. A bibliometric analysis was performed to provide an overview of the included references, and a co-occurrence analysis identified the technologies for home-based DR. A full-text analysis of all included reviews filtered the trends for home-based DR. A gray literature search supplemented the results of the review analysis and revealed the influences of the COVID-19 pandemic on the development of DR. RESULTS: A total of 2437 records were included in the bibliometric analysis and 95 in the full-text analysis, and 40 records were included as a result of the gray literature search. Sensors, robotic devices, gamification, virtual and augmented reality, and digital and mobile apps are already used in home-based DR; however, artificial intelligence and machine learning, exoskeletons, and digital and mobile apps represent new and emerging trends. Advantages and disadvantages were displayed for all technologies. The COVID-19 pandemic has led to an increased use of digital technologies as remote approaches but has not led to the development of new technologies. CONCLUSIONS: Multiple tools are available and implemented for home-based DR; however, some technologies face limitations in the application of home-based rehabilitation. However, artificial intelligence and machine learning could be instrumental in redesigning rehabilitation and addressing future challenges of the health care system, and the rehabilitation sector in particular. The results show the need for feasible and effective approaches to implement DR that meet clients' needs and adhere to framework conditions, regardless of exceptional situations such as the COVID-19 pandemic.

eHealth Literacy Among Health Sciences Students in Greece.

eÎUealth literacy is a necessary skill to find and make good use of online health information. However, the general public lacks this skill; it is essential for future health professionals to be able to guide and facilitate the public. The study aimed to examine the perceived eHealth literacy level of health sciences students in Greece. A cross-sectional, online survey was conducted (N=113 students). The questionnaire included socio-demographic data and the eHealth Literacy Scale (eHEALS). Participants' mean eHEALS score was 31.9 with medicine and dentistry students having the highest score (33.7) and other health and caring sciences students the lowest (29.8). There was no statistically significant difference at eHEALS score among participants of different academic year. However, there was a statistically significant difference at eHEALS score among University Departments (p=0.009). Further research in representative samples is required to assess specific needs and improve current educational curricula.

Secondary School Pupils' Mental Wellbeing Is Associated with Belonging to a Perceived Minority and Experiencing Discrimination.

Adolescents' mental health is a global issue and there is a growing interest in tackling mental health in schools. The study aimed to assess secondary school pupils' mental wellbeing and the factors related to their mental wellbeing (sociodemographic characteristics, perception of belonging to a minority, and discrimination). Data were collected from 12-17-year-old pupils of a Finnish secondary school via an online questionnaire. Data were analyzed with descriptive statistics and ANOVA for group comparisons. Participants' (Ν = 114) mental wellbeing scores were above average (47.5, max. 70). Worse family relations were independently associated with worse mental wellbeing. Additionally, significantly lower scores on mental wellbeing were found among pupils who thought they belonged to a minority due to appearance, sexual orientation, and/or chronic disease. Participants who had experienced discrimination had significantly lower mental wellbeing scores in comparison to those who never had such an experience. In conclusion, mental health promotion interventions which promote good family relations should be targeting different youth groups in order to address their specific needs. Thus, screening programs which identify pupils who are at risk or belong to minority groups are needed, in order to direct them to proper services when needed and/or implement mental health promotion interventions accordingly.

Mental Health Needs of Adolescents Assessed During the Years of Global Financial Crisis: a Systematic Review.

INTRODUCTION: Mental health issues during adolescence are common and worsen when financial crisis occur across the world. Identification of mental health needs as they are expressed by adolescents themselves is important for efficient mental health promotion interventions. AIM: This systematic review examined studies on the mental health needs among adolescents from their own perspective. METHODS: Four databases were searched between 2008-2018, starting with 2008 when the global financial crisis began. RESULTS: The seven studies that fulfilled the inclusion criteria used different data collection methods. Emotional and behavioral problems and hyperactivity were found, while adolescents' own perceptions also showed positive indicators for mental health. Most studies focus on specific adolescent populations, while the general adolescent population needs more attention as a target group for mental health interventions. CONCLUSION: Interventions should address the needs as they are identified by adolescents in order to promote their mental health. Researchers should develop an instrument which assesses exclusively the adolescents' mental health needs.

Connectivity to computers and the Internet among patients with schizophrenia spectrum disorders: a cross-sectional study.

PURPOSE: Information and communication technologies have been developed for a variety of health care applications and user groups in the field of health care. This study examined the connectivity to computers and the Internet among patients with schizophrenia spectrum disorders (SSDs). PATIENTS AND METHODS: A cross-sectional survey design was used to study 311 adults with SSDs from the inpatient units of two psychiatric hospitals in Finland. The data collection lasted for 20 months and was done through patients' medical records and a self-reported, structured questionnaire. Data analysis included descriptive statistics. RESULTS: In total, 297 patients were included in this study (response rate =96%). More than half of them (n=156; 55%) had a computer and less than half of them (n=127; 44%) had the Internet at home. Of those who generally had access to computers and the Internet, more than one-fourth (n=85; 29%) used computers daily, and >30% (n=96; 33%) never accessed the Internet. In total, approximately one-fourth of them (n=134; 25%) learned to use computers, and less than one-third of them (n=143; 31%) were known to use the Internet by themselves. Older people (aged 45-65 years) and those with less years of education (primary school) tended not to use the computers and the Internet at all (P<0.001), and younger people and those with higher education were associated with more active use. CONCLUSION: Patients had quite good access to use computers and the Internet, and they mainly used the Internet to seek information. Social, occupational, and psychological functioning (which were evaluated with Global Assessment of Functioning) were not associated with access to and frequency of computer and the Internet use. The results support the use of computers and the Internet as part of clinical work in mental health care.

'Schizophrenia' on Twitter: Content Analysis of Greek Language Tweets.

Twitter is an online space whose users can create and share ideas and information instantly. The term schizophrenia is frequently used in a stigmatizing way in Greek language. In Greece, Twitter is the tenth most popular website. Tweets related to schizophrenia in Greek language, have not been investigated. We aimed to examine schizophrenia Tweets in comparison with other illness (diabetes). Deductive content analysis was applied. Schizophrenia Tweets (n=239), tended to be more negative, medically inappropriate, sarcastic, and used non-medically than diabetes Tweets (n=205). Our findings confirm the frequent, non-medical misuse of the term 'schizophrenia' in online sources written in Greek language. These results show that mental health education interventions are needed to raise awareness among the general population, in order to eliminate stigmatizing behaviors. Future anti-stigma actions, could also raise awareness among Internet users about the importance of, avoiding using medical terms in negative or sarcastic ways, and eliminate any potential stigmatizing content.

Attitudes towards schizophrenia on YouTube: A content analysis of Finnish and Greek videos.

OBJECTIVE: To investigate attitudes towards schizophrenia and people with schizophrenia presented in YouTube videos. METHODS: We searched YouTube using the search terms "schizophrenia" and "psychosis" in Finnish and Greek language on April 3rd, 2013. The first 20 videos from each search (N = 80) were retrieved. Deductive content analysis was first applied for coding and data interpretation and it was followed by descriptive statistical analysis. RESULTS: A total of 52 videos were analyzed (65%). The majority of the videos were in the "Music" category (50%, n = 26). Most of the videos (83%, n = 43) tended to present schizophrenia in a negative way, while less than a fifth (17%, n = 9) presented schizophrenia in a positive or neutral way. Specifically, the most common negative attitude towards schizophrenia was dangerousness (29%, n = 15), while the most often identified positive attitude was objective, medically appropriate beliefs (21%, n = 11). All attitudes identified were similarly present in the Finnish and Greek videos, without any statistically significant difference. CONCLUSIONS: Negative presentations of schizophrenia are most likely to be accessed when searching YouTube for schizophrenia in Finnish and Greek language. More research is needed to investigate to what extent, if any, YouTube viewers' attitudes are affected by the videos they watch.

Facebook and Health Information: Content Analysis of Groups Related to Schizophrenia.

Facebook Groups is a space for connecting people with common interests. People with a psychiatric diagnosis use social networking sites. However Facebook Groups related to schizophrenia have not been investigated before. We aimed to examine Facebook Groups related to schizophrenia. Deductive content analysis was applied. Out of the included groups (N=32), the majority's principal objective was awareness creation (n=11, 34%) and support to those with schizophrenia and their caregivers (n=9, 28%). Monitoring the Facebook Groups' content related to schizophrenia and other mental disorders is essential, since it could be an important communication and support platform for people with the disorder and their caregivers.

'Schizophrenia' as a metaphor in greek newspaper websites.

Often, newspapers use the term 'schizophrenia' as a metaphor with negative connotations. The use of the term in Greek newspapers, has never been investigated. The aim of this study is to examine how the term 'schizophrenia' is used in Greek newspaper websites. For 2014, 'To Vima', 'Kathimerini', and 'Eleftherotypia', were the most popular newspaper websites. By searching the term 'schizophrenia' in Greek ('σχιζo&phi;ρενεια'), the first fifty results were collected from the three websites (N=150). Deductive content analysis was applied. Out of the included articles (N=140), the majority were news (n=39, 28%), while more than a third (n=48, 34%) reported schizophrenia as a metaphor. The metaphoric use of 'schizophrenia' indicated predominately incoherence/contradiction/split (n=43, 90%). Monitoring how schizophrenia is presented within popular media is crucial, since it could influence public perceptions regarding the disorder. Continual use of schizophrenia as a metaphor could contribute to maintaining the stigma attached to mental illness.