Gender sensitivity of the COVID-19 mental health research in Europe: a scoping review.

BACKGROUND: The integration of sex and gender aspects into the research process has been recognized as crucial to the generation of valid data. During the coronavirus pandemic, a great deal of research addressed the mental state of hospital staff, as they constituted a population at risk for infection and distress. However, it is still unknown how the gender dimension was included. We aimed to appraise and measure qualitatively the extent of gender sensitivity. METHODS: In this scoping review, we searched MEDLINE, EMBASE, CINAHL PsycINFO and Social Sciences Citation Index (SSCI) from database inception to November 11, 2021. All quantitative studies with primary data published in English, German, or Spanish and based in the European Union were selected. Included studies had to have assessed the mental health of hospital staff using validated psychometric scales for depression, anxiety, PTSD symptoms, distress, suicidal behavior, insomnia, substance abuse or aggressive behavior. Two independent reviewers applied eligibility criteria to each title/abstract reviewed, to the full text of the article, and performed the data extraction. A gender sensitivity assessment tool was developed and validated, consisting of 18 items followed by a final qualitative assessment. Two independent reviewers assessed the gender dimension of each included article. RESULTS: Three thousand one hundred twelve studies were identified, of which 72 were included in the analysis. The most common design was cross-sectional (75.0%) and most of them were conducted in Italy (31.9%). Among the results, only one study assessed suicidal behaviors and none substance abuse disorders or aggressive behaviors. Sex and gender were used erroneously in 83.3% of the studies, and only one study described how the gender of the participants was determined. Most articles (71.8%) did not include sex/gender in the literature review and did not discuss sex/gender-related findings with a gender theoretical background (86.1%). In the analysis, 37.5% provided sex/gender disaggregated data, but only 3 studies performed advanced modeling statistics, such as interaction analysis. In the overall assessment, 3 papers were rated as good in terms of gender sensitivity, and the rest as fair (16.7%) and poor (79.2%). Three papers were identified in which gender stereotypes were present in explaining the results. None of the papers analyzed the results of non-binary individuals. CONCLUSIONS: Studies on the mental health of hospital staff during the pandemic did not adequately integrate the gender dimension, despite the institutional commitment of the European Union and the gendered effect of the pandemic. In the development of future mental health interventions for this population, the use and generalizability of current evidence should be done cautiously.

Exploring the perspectives and practices of humanitarian actors towards the Participation Revolution in humanitarian digital health responses: a qualitative study.

BACKGROUND: As crises escalate worldwide, there is an increasing demand for innovative solutions to enhance humanitarian outcomes. Within this landscape, digital health tools have emerged as promising solutions to tackle certain health challenges. The integration of digital health tools within the international humanitarian system provides an opportunity to reflect upon the system's paternalistic tendencies, driven largely by Global North organisations, that perpetuate existing inequities in the Global South, where the majority of crises occur. The Participation Revolution, a fundamental pillar of the Localisation Agenda, seeks to address these inequities by advocating for greater participation from crisis-affected people in response efforts. Despite being widely accepted as a best practice; a gap remains between the rhetoric and practice of participation in humanitarian response efforts. This study explores the extent and nature of participatory action within contemporary humanitarian digital health projects, highlighting participatory barriers and tensions and offering potential solutions to bridge the participation gap to enhance transformative change in humanitarian response efforts. METHODS: Sixteen qualitative interviews were conducted with humanitarian health practitioners and experts to retrospectively explored participatory practices within their digital health projects. The interviews were structured and analysed according to the Localisation Performance Measurement Framework's participation indicators and thematically, following the Framework Method. The study was guided by the COREQ checklist for quality reporting. RESULTS: Varied participatory formats, including focus groups and interviews, demonstrated modest progress towards participation indicators. However, the extent of influence and power held by crisis-affected people during participation remained limited in terms of breadth and depth. Participatory barriers emerged under four key themes: project processes, health evidence, technology infrastructure and the crisis context. Lessons for leveraging participatory digital health humanitarian interventions were conducting thorough pre-project assessments and maintaining engagement with crisis-affected populations throughout and after humanitarian action. CONCLUSION: The emerging barriers were instrumental in shaping the limited participatory reality and have implications: Failing to engage crisis-affected people risks perpetuating inequalities and causing harm. To advance the Participation Revolution for humanitarian digital health response efforts, the major participatory barriers should be addressed to improve humanitarian efficiency and digital health efficacy and uphold the rights of crisis-affected people.

Localisation of digital health tools used by displaced populations in low and middle-income settings: a scoping review and critical analysis of the Participation Revolution.

BACKGROUND: Forced displacement is a crucial determinant of poor health. With 31 people displaced every minute worldwide, this is an important global issue. Addressing this, the Participation Revolution workstream from the World Humanitarian Summit's Localisation commitments has gained traction in attempting to improve the effectiveness of humanitarian aid. Simultaneously, digital health initiatives have become increasingly ubiquitous tools in crises to deliver humanitarian assistance and address health burdens. OBJECTIVE: This scoping review explores how the localisation agenda's commitment to participation has been adopted within digital health interventions used by displaced people in low-and-middle-income countries. METHODS: This review adopted the Arksey and O'Malley approach and searched five academic databases and three online literature repositories with a Population, Concept and Context inclusion criteria. Data were synthesised and analysed through a critical power lens from the perspective of displaced people in low-and-middle-income-countries. RESULTS: 27 papers demonstrated that a heterogeneous group of health issues were addressed through various digital health initiatives, principally through the use of mobile phones. The focus of the literature lay largely within technical connectivity and feasibility assessments, leaving a gap in understanding potential health implications. The varied conceptualisation of the localisation phenomenon has implications for the future of participatory humanitarian action: Authorship of reviewed literature primarily descended from high-income countries exposing global power dynamics leading the narrative. However, power was not a central theme in the literature: Whilst authors acknowledged the benefit of local involvement, participatory activities were largely limited to informing content adaptations and functional modifications within pre-determined projects and objectives. CONCLUSION: With over 100 million people displaced globally, effective initiatives that meaningfully address health needs without perpetuating harmful inequalities are an essential contribution to the humanitarian arena. The gap in health outcomes evidence, the limited constructions of health, and the varying and nuanced digital divide factors are all indicators of unequal power in the digital health sphere. More needs to be done to address these gaps meaningfully, and more meaningful participation could be a crucial undertaking to achieve this. Registration The study protocol was registered before the study (10.17605/OSF.IO/9D25R) at https://osf.io/9d25r .

The application of AMSTAR2 in 32 overviews of systematic reviews of interventions for mental and behavioural disorders: A cross-sectional study.

'A measurement tool to assess systematic reviews, version 2' (AMSTAR2) is a 16-item tool to critically appraise systematic reviews (SRs) of healthcare interventions. This study aimed to assess the methods and outcomes of AMSTAR2 appraisals in overviews of SRs of interventions for mental and behavioural disorders. The cross-sectional study was conducted using 32 overviews of SRs selected from three electronic databases in January 2021. Data items included overview and SR characteristics and AMSTAR2 appraisal methods and outcomes. Data were extracted by two authors independently and narratively synthesised using descriptive statistics (means ± SD and relative frequencies). SR characteristics were compared based on AMSTAR2 appraisal outcomes using chi-square tests. The 32 overviews appraised SRs of predominantly non-pharmacological interventions for mental disorders. AMSTAR2 appraisals were reported as confidence ratings in 25/32 overviews or individual item scores in 24/32 overviews. Most SRs/overview were non-Cochrane (mean = 94%), included RCTs only (mean = 77%) and were published before AMSTAR2 release (mean = 79%). The confidence ratings derived in 25 overviews for 349 SRs were predominantly critically low (68%). Confidence ratings were similar for SRs with RCTs only versus RCTs+non-RCTs or SRs published before versus after AMSTAR2 release, while Cochrane SRs received more high+moderate than low+critically low confidence ratings (p < 0.01). Confidence ratings derived based on AMSTAR2 do not differentiate among SRs of healthcare interventions except for Cochrane SRs that fulfil the criteria for high confidence ratings. AMSTAR2 items should be consulted to avoid common weaknesses in future SRs.

Health Literacy Needs Among Unemployed Persons: Collating Evidence Through Triangulation of Interview and Scoping Review Data.

Background: Unemployed persons are at high risk for low health literacy. Most studies addressing health literacy of unemployed persons focus on risk factors for low health literacy or correlates of health literacy, but studies on needs of unemployed persons regarding health literacy are scarce. We aimed to obtain better understanding of health literacy needs of unemployed adults by triangulating the results from a scoping review on health literacy needs in unemployed adults and additional in-depth qualitative interviews. Methods: Scoping review: We searched six databases up to January 2021 as well as gray literature for relevant studies following PRISMA-ScR guidelines. Titles, abstracts, and full texts were screened independently by two researchers. Qualitative study: Ten participants of a job-reintegration program in Germany were interviewed following a guideline covering topics including health issues of interest to the participants, their sources of health-related information and the barriers/facilitators they experience when accessing health services. Results: Scoping review: After screening 2,966 titles and abstracts, 36 full texts were considered, and five articles fulfilled the inclusion criteria. Four focused on mental health literacy and outcomes, while the fifth assessed information-seeking practices. One additional report on health literacy was identified via the gray literature search. Awareness of one's condition was identified as a facilitator for mental health help-seeking, while fear of harmful effects of medication prevented help-seeking. Qualitative study: Participants were interested in and were generally well-informed about health topics such as nutrition and physical activity. The main challenge perceived was translating the knowledge into practice in daily life. GPs and the social services providers played an important role as a source of health information and advice. Regarding mental health, similar barriers, facilitators and needs were identified through triangulation of findings of the scoping review with those of the interviews. Conclusions: There is need to address health literacy needs of long-term unemployed persons that go beyond mental health literacy. Public health interventions should not only aim at improving health literacy scores, but also focus on how to help participants translate health literacy into practice. Population groups of interest should also be involved in all processes of designing interventions.