Collaboration with community connectors to improve primary care access for hardly reached people: a case comparison of rural Ireland and Australia.

BACKGROUND: This study presents a way for health services to improve service access for hardly reached people through an exploration of how staff can find and collaborate with citizens (referred to as connectors) who span socio-cultural boundaries in their community. The study explored the local socio-cultural contexts of connectors' boundary spanning activities and if they are health related; boundary spanning occurring between connectors and health professionals at the interface of health systems and community; and the opportunities and barriers to actively seeking out and collaborating with community connectors to access marginalised and hardly reached people. METHODS: We conducted a qualitative case comparison from rural Ireland and Australia. Following purposive snow-ball sampling techniques to recruit participants, semi-structured interviews were conducted with 34 community informants, 21 healthcare staff and 32 connectors. Transcripts were coded and analysed using an inductive approach to ascertain categories and overall themes. RESULTS: We found a diverse sample of connectors relating to heterogenous, small and locally distinct groups of hardly reached people. Overall 26 connectors were active at the interface between health services and the community, with variation in how this occurred between cases. The majority (21) described one or more health related activities with hardly reached people. All connectors expressed a willingness to develop a relationship with local health services on issues they identified as relevant. Barriers to collaborations between connectors and health services related to bureaucracy, workload, and burnout. CONCLUSIONS: Collaborating with connectors has potential as one strategy to improve access to health services for hardly reached people. To enact this, health staff need to identify local socio-cultural boundaries and associated connectors, facilitate two-way connections at the boundary between health services and community and enable collaboration by attending to activities in the community, at the interface between health services and community, and within the health system.

Community boundary spanners as an addition to the health workforce to reach marginalised people: a scoping review of the literature.

BACKGROUND: Health services in high-income countries increasingly recognise the challenge of effectively serving and engaging with marginalised people. Effective engagement with marginalised people is essential to reduce health disparities these populations face. One solution is by tapping into the phenomenon of boundary-spanning people in the community-those who facilitate the flow of ideas, information, activities and relationships across organisation and socio-cultural boundaries. METHODS: A scoping review methodology was applied to peer-reviewed articles to answer the question: "How do health services identify, recruit and use boundary spanners and what are the outcomes?" The review was conducted in seven databases with search terms based on community-based boundary spanning, marginalised people and health services. FINDINGS: We identified 422 articles with the screening process resulting in a final set of 30 articles. We identified five types of community-based boundary spanning: navigators, community health workers, lay workers, peer supporters and community entities. These range from strong alignment to the organisation through to those embedded in the community. We found success in four domains for the organisation, the boundary spanner, the marginalised individuals and the broader community. Quantifiable outcomes related to cost-savings, improved disease management and high levels of clinical care. Outcomes for marginalised individuals related to improved health knowledge and behaviours, improved health, social benefits, reduced barriers to accessing services and increased participation in services. We identified potential organisational barriers to using boundary spanners based on organisational culture and staff beliefs. CONCLUSIONS: Community boundary spanners are a valuable adjunct to the health workforce. They enable access to hard to reach populations with beneficial health outcomes. Maintaining the balance of organisational and community alignment is key to ongoing success and diffusion of this approach.

A qualitative exploration of online forums to support resilience of rural young people in Australia.

Introduction: Prevention and early intervention are crucial strategies for improving young people's mental health and well-being. Building resilience is a key component of these strategies, especially among young individuals in rural areas who face well-documented mental health disparities. This study aimed to investigate how online mental health forums can contribute to enhancing individual resilience in young rural users. Methods: A sample of forum posts (n = 1,000) made by Australian rural users (18-25 years) on an online peer support mental health forum were qualitatively analyzed. The analysis was guided by themes derived from the literature on indicators of rural resilience. Results: Analysis of forum posts showed evidence of rural resilience in forum users. Online peer support forums offered a virtual space for individuals to establish social connections, experience a sense of belonging, share information, acquire knowledge, and offer mutual support. There were indications of increased self-efficacy among forum users, as they demonstrated their ability to implement strategies for better managing their mental health. Discussion: These findings significantly contribute to our understanding of how online forums can enhance resilience factors that are beneficial for young people living in rural communities. In the context of prevention and early intervention, this study illustrates the intricate connections between forum design and user activity with resilience outcomes, providing valuable insights into the underlying causal mechanisms. Consequently, it emphasizes the importance of incorporating such digital interventions as integral components of mental health service ecosystems.

Leveraging stylometry analysis to identify unique characteristics of peer support user groups in online mental health forums.

Online peer support mental health forums provide an effective and accessible form of support, augmenting scarce clinical and face-to-face assistance. However, to enhance their effectiveness, it is essential to understand the unique characteristics of peer support user groups, and how they participate, contribute and communicate in these forums. This paper proposes and tests a novel approach that leverages stylometry analysis to uncover the unique characteristics of peer support user groups in such forums. Our approach identifies how each group empowers and supports other users, and what distinguishes them from others. The analysis shows that emotion-related words are crucial in identifying and distinguishing user groups based on their writing style. Comparative analysis of emotion expressions across user groups also uncovers the significance of emotional content in these forums in promoting mental well-being. Valued 'senior contributors' were more likely than all other groups including trained community guides to use a wide range of both positive and negative emotions in their posts. These findings have significant implications for improving the training of peer-mentors and moderators, scaling forum services, and improving guidelines for emotional expression among peer support users. Our approach presents an objective approach to differentiating the characteristics and communication patterns of valued senior contributors, mentors, and guides, enabling service providers to foster the kinds of communication that supports positive outcomes for distressed users.

Online Mental Health Forums and Rural Resilience: Mixed Methods Study and Logic Model.

BACKGROUND: Rural mental health is a growing area of concern internationally, and online mental health forums offer a potential response to addressing service gaps in rural communities. OBJECTIVE: The objective of this study was to explore and identify pathways by which online peer support mental health forums help to build resilience for rural residents experiencing mental ill-health by contributing to overcoming their specific contextual challenges. METHODS: We developed a Theoretical Resilience Framework and applied it to 3000 qualitative posts from 3 Australian online mental health forums and to data from 30 interviews with rural forum users. RESULTS: Drawing on the findings and an abductive approach, a logic model was developed to illustrate links between the resilience resources built and enabling features of forums that make them spaces that facilitate resilience. CONCLUSIONS: The study demonstrated that online forums make valuable contributions to social well-being and access to a range of timely support services for rural people experiencing mental ill-health, and, while doing so, involve users in the processes of resilience building. The study provides a new way for practitioners to frame the work of and value produced by forums. It gives a logic model that can be used in evaluation and audit as it facilitates a causal framing of how forums, as an intervention, link with resilience outcomes. Ultimately, the study contributes to developing new knowledge about how rural resilience building can be conceptualized and measured while showing how forums are part of contemporary health service provision in rural places.

Resilience in Web-Based Mental Health Communities: Building a Resilience Dictionary With Semiautomatic Text Analysis.

BACKGROUND: Resilience is an accepted strengths-based concept that responds to change, adversity, and crises. This concept underpins both personal and community-based preventive approaches to mental health issues and shapes digital interventions. Online mental health peer-support forums have played a prominent role in enhancing resilience by providing accessible places for sharing lived experiences of mental issues and finding support. However, little research has been conducted on whether and how resilience is realized, hindering service providers' ability to optimize resilience outcomes. OBJECTIVE: This study aimed to create a resilience dictionary that reflects the characteristics and realization of resilience within online mental health peer-support forums. The findings can be used to guide further analysis and improve resilience outcomes in mental health forums through targeted moderation and management. METHODS: A semiautomatic approach to creating a resilience dictionary was proposed using topic modeling and qualitative content analysis. We present a systematic 4-phase analysis pipeline that preprocesses raw forum posts, discovers core themes, conceptualizes resilience indicators, and generates a resilience dictionary. Our approach was applied to a mental health forum run by SANE (Schizophrenia: A National Emergency) Australia, with 70,179 forum posts between 2018 and 2020 by 2357 users being analyzed. RESULTS: The resilience dictionary and taxonomy developed in this study, reveal how resilience indicators (ie, "social capital," "belonging," "learning," "adaptive capacity," and "self-efficacy") are characterized by themes commonly discussed in the forums; each theme's top 10 most relevant descriptive terms and their synonyms; and the relatedness of resilience, reflecting a taxonomy of indicators that are more comprehensive (or compound) and more likely to facilitate the realization of others. The study showed that the resilience indicators "learning," "belonging," and "social capital" were more commonly realized, and "belonging" and "learning" served as foundations for "social capital" and "adaptive capacity" across the 2-year study period. CONCLUSIONS: This study presents a resilience dictionary that improves our understanding of how aspects of resilience are realized in web-based mental health forums. The dictionary provides novel guidance on how to improve training to support and enhance automated systems for moderating mental health forum discussions.

Dating apps as public health 'problems': cautionary tales and vernacular pedagogies in news media.

ABSTRACT In this paper we examine how popular media reporting positions dating and hookup app use as a 'social problem' that impacts on health and wellbeing. The paper adopts a mixed-methods media studies approach to create and analyse a dataset of over 6,000 international news articles published within a 12-month period, drawing on thematic content analysis and inductive and deductive techniques. These analyses are framed in relation to online consultations with Australian sexual health professionals and app users. Applying Briggs and Hallin's theory of biocommunicability (2007) - which proposes that contemporary health professionals' scientific framing of public health problems are, in part, shaped by popular media discourses - we identify a significant category of supportive discussions of safer app use within social news and lifestyle reporting. This discursive space features what we have termed 'vernacular pedagogies' of app use, revealing app users' safety strategies, and their experiences of pleasure and playfulness. We argue that an analysis of popular media can provide valuable insights into how everyday experiences of safety, risk and wellbeing are being shaped and contested with dating and hookup app use, and that these insights can be used to develop meaningful health promotion strategies.

Boundary spanning practices of community connectors for engaging 'hardly reached' people in health services.

Global health policies direct health services to improve access and health outcomes of people who are 'hardly reached' by services. The institutionalised nature of health services with associated professional and organisational boundaries create ongoing challenges to achieving this policy aim. We present an approach to this challenge by exploring how health services can tap into the existing boundary spanning activities of community members we term as 'community connectors' who undertake valuable boundary work within the community to include people who are hardly reached. We address the research questions: what are the behaviours and characteristics of community connectors?; to what extent are they motivated to help out with health?; and how can health service personnel identify community connectors? We conducted an instrumental case study during 2017 in Victoria, Australia in the catchment area of a rural health service. Interviews with 17 key informants and eight staff members led to a further 15 interviews with community connectors. We identified the three key roles of 'noticer and responder', 'connector' and 'provider' that make connectors a valuable asset for health services. Community connectors seek opportunities to negotiate new boundaries with health services that support their boundary spanning with people hardly reached and also enable health services to transgress their own boundaries and access people who are hardly reached. We conclude that by paying attention to their own production, maintenance and transgression of boundaries, health services can apply this approach, noting that the local and iterative nature of identifying community connectors means that each cohort of community connectors will be unique as determined by local boundaries and relationships.