Linking critical consciousness and health: The utility of the critical reflection about social determinants of health scale (CR_SDH).

INTRODUCTION: Critical consciousness (CC) theory has been proposed as a framework to inform health interventions targeting a wide variety of health conditions. Unfortunately, methodological limitations have made it difficult to test CC as a mediator of health outcomes. Specifically, standardized and widely accepted measures of health-related CC are needed. The goal of this study was to develop and test a measure of critical reflection on social determinants of health (SDH). This measure focused on critical reflection, an essential dimension of CC. METHODS: Community-based participatory research principles and a mixed methods design were used with three samples: (1) experts in SDH and CC, (2) 502 individuals completing online surveys, and (3) 602 men with histories of substance use disorder and incarceration. All participants were over 18 years of age. Analysis included descriptive frequencies, exploratory factor analyses (EFA), confirmatory factor analysis (CFA), generalized linear regression models, correlations, and Cronbach's alpha calculations. RESULTS: The Critical Reflection about SDH scale (CR_SDH) is a short, unidimensional, and reliable scale (α = 0.914). Construct validity was supported and known-groups validity showed that the scale discriminated different levels of CR_SDH based on political views, educational level, knowledge of health inequities, and gender. CONCLUSION: The CR_SDH is a standardized measure that can assess critical reflection about the impact of SDH on health among providers and consumers of health care. The CR_SDH can be used to identify critical reflection related training needs and inform decisions about development and testing of critical reflection related health interventions and health care policy.

Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review.

OBJECTIVE: It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations. METHOD: A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on 'Appraisal of Guidelines for Research & Evaluation II' (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline. RESULT: A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned. CONCLUSION: Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

Improving Recruitment Procedures for School-Based Surveys: Through the Lens of the Illinois Youth Survey.

BACKGROUND: Epidemiological surveys are designed to collect representative trend data. School-based surveys are important to utilize so systems can effectively create prevention and intervention programs to alter youths' perceptions and behaviors related to substance use. However, there are many barriers when implementing a school-based survey. METHODS: This mixed methods study sought to uncover 30 school personnel's challenges when making the decision to implement the Illinois Youth Survey (IYS). Through a descriptive and interpretive approach, participants' thoughts to improve future recruitment procedures and reduce barriers for implementation were analyzed. RESULTS: Results found challenges included: (1) time; (2) parent-opt out consent letter; (3) wording of the survey responses; (4) honesty of the students' responses; (5) importance and use of the data. Moreover, the most common suggestions to improve recruitment included: (1) sharing knowledge about trend data; (2) year-round communication with school personnel; (3) targeting school personnel groups; and (4) providing examples of data use. CONCLUSIONS: Findings can be used to improve recruitment procedures for others who have similar challenges. If schools, counties, and states have representative data they can more precisely tailor their programming to meet the needs of their population.

Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study.

BACKGROUND: Technology-assisted intervention and prevention strategies present opportunities for substance use-related research with emerging adults (EAs) and their peers. Emerging adulthood is a developmentally distinct period in which individuals between the ages of 18 and 29 years undergo unique emotional, cultural, developmental, and biological changes as they transition into adulthood. Crowdsourcing, or gathering feedback from a large group within web-based communities, offers researchers a unique and cost-effective way to obtain large amounts of information in a short period. OBJECTIVE: This paper presents market feedback obtained via Amazon's Mechanical Turk from EAs (N=458) on the acceptability and utility of brief intervention scripts for a smartphone app currently under development. The mobile app, Harbor, teaches friends of EAs with substance use problems effective and supportive strategies for helping their friend make changes in their substance use behavior. METHODS: We examined feedback on the wording of the intervention scripts and estimated the market size of EAs who may use this app. Furthermore, we calculated correlations between script ratings and measures of personal risky drinking (ie, Alcohol Use Disorder Identification Test) and the participants' use of confrontational, enabling, or supportive behaviors with an existing friend. RESULTS: Approximately half of our sample (208/458, 45.4%) indicated that they had a close friend for whom they had concerns about their substance use, suggesting a potentially high demand for an app such as Harbor. Initial findings suggest that peers who engage in less enabling behaviors with friends who have a substance use problem exhibited lower risky drinking behaviors overall (r206=-0.501; P<.001). Concerning acceptability, 98.0% (449/458) of the sample rated the scripts' dialogue as either somewhat, moderately, or extremely realistic (mean 3.92, SD 0.48) on 5-point Likert scale items. Finally, 95.4% (437/454) of respondents indicated that the scripts would be at least slightly helpful for training peers to help their friends with substance use issues. Finally, individuals who were better able to identify enabling language in enabling scripts self-reported fewer enabling behaviors toward their friend's substance use (r206=-0.236; P=.001). CONCLUSIONS: There exists a demonstrated level of desirability and acceptability among EAs for a mobile app such as Harbor. EAs who wish to engage in more supportive behaviors with their friends who engage in substance use and who are amenable to assisting their friends with sobriety likely would use and benefit from this app.