Advancing socioecological mental health promotion intervention: A mixed methods exploration of Phase 1 Agenda Gap findings.

Introduction: Protecting and promoting the mental health of youth under 30 years of age is a priority, globally. Yet investment in mental health promotion, which seeks to strengthen the determinants of positive mental health and wellbeing, remains limited relative to prevention, treatment, and recovery. The aim of this paper is to contribute empirical evidence to guide innovation in youth mental health promotion, detailing the early outcomes of Agenda Gap, an intervention centering youth-led policy advocacy to influence positive mental health for individuals, families, communities and society. Methods: Leveraging a convergent mixed methods design, this study draws on data from n = 18 youth (ages 15 to 17) in British Columbia, Canada, who contributed to pre- and post-intervention surveys and post-intervention qualitative interviews following their participation in Agenda Gap from 2020-2021. These data are supplemented by qualitative interviews with n = 4 policy and other adult allies. Quantitative and qualitative data were analyzed in parallel, using descriptive statistics and reflexive thematic analysis, and then merged for interpretation. Results: Quantitative findings suggest Agenda Gap contributes to improvements in mental health promotion literacy as well as several core positive mental health constructs, such as peer and adult attachment and critical consciousness. However, these findings also point to the need for further scale development, as many of the available measures lack sensitivity to change and are unable to distinguish between higher and lower levels of the underlying construct. Qualitative findings provided nuanced insights into the shifts that resulted from Agenda Gap at the individual, family, and community level, including reconceptualization of mental health, expanded social awareness and agency, and increased capacity for influencing systems change to promote positive mental health and wellbeing. Discussion: Together, these findings illustrate the promise and utility of mental health promotion for generating positive mental health impacts across socioecological domains. Using Agenda Gap as an exemplar, this study underscores that mental health promotion programming can contribute to gains in positive mental health for individual intervention participants whilst also enhancing collective capacity to advance mental health and equity, particularly through policy advocacy and responsive action on the social and structural determinants of mental health.

Mental Health Inequities Amid the COVID-19 Pandemic: Findings From Three Rounds of a Cross-Sectional Monitoring Survey of Canadian Adults.

Objectives: Adverse mental health impacts of the COVID-19 pandemic are well documented; however, there remains limited data detailing trends in mental health at different points in time and across population sub-groups most impacted. This paper draws on data from three rounds of a nationally representative cross-sectional monitoring survey to characterize the mental health impacts of COVID-19 on adults living in Canada (N = 9,061). Methods: Descriptive statistics were used to examine the mental health impacts of the pandemic using a range of self-reported measures. Multivariate logistic regression models were then used to quantify the independent risks of experiencing adverse mental health outcomes for priority population sub-groups, adjusting for age, gender, and survey round. Results: Data illustrate significant disparities in the mental health consequences of the pandemic, with inequitable impacts for sub-groups who experience structural vulnerability related to pre-existing mental health conditions, disability, LGBTQ2+ identity, and Indigenous identity. Conclusion: There is immediate need for population-based approaches to support mental health in Canada and globally. Approaches should attend to the root causes of mental health inequities through promotion and prevention, in addition to treatment.

Enhancing nurses' capacity to provide concurrent mental health and substance use disorder care: A quasi-experimental intervention study.

BACKGROUND: Patients experiencing concurrent disorders (i.e., co-occurring mental health and substance use disorders) are prevalent in mental health settings and their health and social outcomes are often poor. This reflects persistent stigma as well as inadequate preparatory training or continuing education for healthcare professionals, including nurses. OBJECTIVE: To explore the impacts of the 1-day 'Enhancing Concurrent Disorder Care Intervention' on nurses' and student nurses' capacity to deliver care, grounded in current evidence, to patients with concurrent disorders in inpatient mental health settings. DESIGN: A Quasi-experimental intervention design was used with pre- and postt-test components, guided by the STROBE checklist for observational studies. SETTINGS: Five acute mental health units across two hospitals in British Columbia, Canada, as well as two schools of nursing representing students completing clinical practicum rotations within these settings. PARTICIPANTS: Seventy-six nurses (Registered Nurses and Registered Psychiatric Nurses) and student nurses practicing in inpatient mental health care. METHODS: This educational intervention was informed by a pilot study, which included content validation from international concurrent disorder experts, and further refined through collaborative processes with lived experience and nurse partners. Intervention impacts were examined using online surveys conducted prior to the intervention and within two weeks post-intervention. Surveys assessed knowledge and attitudes about concurrent disorders using a validated instrument and questions developed by the study team. Descriptive statistics alongside paired and independent t-tests and two-way ANOVAs were used to compare survey scores before and after the intervention. RESULTS: Findings indicate that the intervention was effective in improving participants' knowledge and attitudes toward patients with concurrent disorders across participant groups. CONCLUSIONS: Enhancing care and outcomes for patients with concurrent disorders is a global priority. Brief educational interventions aimed at nurses can provide an effective, low-barrier mechanism to address knowledge gaps that contribute to harmful care and adverse outcomes.

Connectedness in the time of COVID-19: Reddit as a source of support for coping with suicidal thinking.

The COVID-19 pandemic is adversely impacting suicidality at a population level, with consequences resulting from a variety of pandemic-driven disruptions, including social activities and connectedness. This paper uses a single case study design to explore how members of the Reddit r/COVID19_support community create a sense of connectedness among those who have suicidal thoughts due to the pandemic. Data were gathered from posts to the r/COVID19_support subreddit forum from February 2020 through December 2020. The second step of Klonsky and May's (2015) Three-Step Theory (3ST) of suicide, connectedness as a key protective factor, was used as the theoretical framework. This study explored r/COVID19_support's constructed environment, users' dialogical interactions, and the four primary tenets of connectedness as proposed by Klonsky and May - Purpose and Meaning, Relationships, Religiosity, and Employment. Findings demonstrate a deep sense of connectedness for online community members. Relationships and Purpose and Meaning featured as the most salient sources of connectedness within this subreddit, whereas Religiosity was rarely discussed, and Employment was often spoken of in negative terms (i.e., creating mental distress, rather than facilitating connectedness). Contributors' responses offered various opportunities for connectedness both on- and off-line. Safe online spaces, such as r/COVID19_support, can serve as a protective factor amid suicidality, facilitating connectedness, and thereby helping to curtail suicidal thoughts from advancing to suicidal actions. This subreddit and similar online spaces can benefit specific populations who may otherwise find it challenging to access services or who wish to remain anonymous.

Reddit Users' Experiences of Suicidal Thoughts During the COVID-19 Pandemic: A Qualitative Analysis of r/Covid19_support Posts.

Background: The COVID-19 pandemic is having considerable impacts on population-level mental health, with research illustrating an increased prevalence in suicidal thoughts due to pandemic stressors. While the drivers of suicidal thoughts amid the pandemic are poorly understood, qualitative research holds great potential for expanding upon projections from pre-pandemic work and nuancing emerging epidemiological data. Despite calls for qualitative inquiry, there is a paucity of qualitative research examining experiences of suicidality related to COVID-19. The use of publicly available data from social media offers timely and pertinent information into ongoing pandemic-related mental health, including individual experiences of suicidal thoughts. Objective: To examine how Reddit users within the r/COVID19_support community describe their experiences of suicidal thoughts amid the COVID-19 pandemic. Methods: This study draws on online posts from within r/COVID19_support that describe users' suicidal thoughts during and related to the COVID-19 pandemic. Data were collected from creation of this subreddit on February 12, 2020 until December 31, 2020. A qualitative thematic analysis was conducted to generate themes reflecting users' experiences of suicidal thoughts. Results: A total of 83 posts from 57 users were included in the analysis. Posts described a range of users' lived and living experiences of suicidal thoughts related to the pandemic, including deterioration in mental health and complex emotions associated with suicidal thinking. Reddit users situated their experiences of suicidal thoughts within various pandemic stressors: social isolation, employment and finances, virus exposure and COVID-19 illness, uncertain timeline of the pandemic, news and social media, pre-existing mental health conditions, and lack of access to mental health resources. Some users described individual coping strategies and supports used in attempt to manage suicidal thoughts, however these were recognized as insufficient for addressing the multilevel stressors of the pandemic. Conclusions: Multiple and intersecting stressors have contributed to individuals' experiences of suicidal thoughts amid the COVID-19 pandemic, requiring thoughtful and complex public health responses. While ongoing challenges exist with self-disclosure of mental health challenges on social media, Reddit and other online platforms may offer a space for users to share suicidal thoughts and discuss potential coping strategies.

A portrait of the early and differential mental health impacts of the COVID-19 pandemic in Canada: Findings from the first wave of a nationally representative cross-sectional survey.

Evidence on the population-level mental health impacts of COVID-19 are beginning to amass; however, to date, there are significant gaps in our understandings of whose mental health is most impacted, how the pandemic is contributing to widening mental health inequities, and the coping strategies being used to sustain mental health. The first wave of a repeated cross-sectional monitoring survey was conducted between May 14-29, 2020 to assess the mental health impacts of the pandemic and to identify the disproportionate impacts on populations or groups identified as experiencing increased risks due to structural vulnerability and pre-existing health and social inequities. Respondents included a nationally representative probability sample (n = 3000) of Canadian adults 18 years and older. Overall, Canadian populations are experiencing a deterioration in mental health and coping due to the pandemic. Those who experience health, social, and/or structural vulnerabilities due to pre-existing mental health conditions, disability, income, ethnicity, sexuality, and/or gender are more likely to endorse mental health deterioration, challenging emotions, and difficulties coping. This monitoring study highlights the differential mental health impacts of the pandemic for those who experience health, social, and structural inequities. These data are critical to informing responsive, equity-oriented public health, and policy responses in real-time to protect and promote the mental health of those most at risk during the pandemic and beyond.

Assessing the impacts of the Agenda Gap intervention for youth mental health promotion through policy engagement: a study protocol.

BACKGROUND: Mental health challenges are a leading health concern for youth globally, requiring a comprehensive approach incorporating promotion, prevention and treatment within a healthy public policy framework. However, the broad enactment of this vision has yet to be realized. Further, mental health promotion evidence specific to youth is still emerging and has not yet focused at a policy level. This is a critical gap, as policy is a key mental health promotion lever that can alter the social and structural conditions that contribute to shaping youth mental health outcomes for all youth, across the full spectrum of need. Responsive to this research and intervention priority, our prototype study intervention-the Agenda Gap-is comprised of an innovative, multi-media engagement intervention, developed in collaboration with youth. This intervention aims to equip youth and build capacity for them to lead meaningful policy change reflective of the mental health needs of diverse communities of youth, including those who experience structural vulnerability and who would not typically have had their voice represented in policymaking processes. METHODS: This study will use a multiple case study design and mixed methods grounded in a realist approach and will be conducted in three sites across two Canadian provinces (British Columbia and Alberta). In an earlier phase of this research, we collaboratively designed the prototype intervention with youth, community and policy partners. In this phase of the study, the intervention will be implemented and further tested with new groups of youth collaborators (n = 10-15/site). Outcome data will be collected through realist qualitative interviews, validated questionnaires [i.e., Child and Youth Resilience Measure (CYRM-12), General Self-Efficacy (GSE) Scale, and the Critical Consiousness Scale (CCS)] and additional survey items developed by our study team. Analysis will focus on identification of key context-mechanism-outcome configurations to provide comprehensive insights into how this intervention works, for whom, and in what context. DISCUSSION: This study is unique in its "upstream" focus on youth-engaged policymaking as a tool for improving the social and structural conditions that influence youth mental health across socioecological levels. Through the implementation and testing of the Agenda Gap intervention with diverse youth, this study will contribute to the evidence base on youth-engaged policymaking as a novel and innovative, mental health promotion strategy.

Leveraging Nurses to Improve Care for Patients with Concurrent Disorders in Inpatient Mental Health Settings: A Scoping Review.

Objective: Several challenges have been identified for patients with concurrent disorders and the providers that care for them, contributing to a pressing need for interventions to improve outcomes, particularly within inpatient mental health settings. Methods: A systematic search of peer-reviewed literature was conducted using four online databases: CINAHL, MEDLINE (Ovid), PsycInfo and Web of Science. Articles were selected based on inclusion criteria and additional articles were identified through hand searches. Study details were charted and qualitative synthesis was conducted. Results: Thirty two articles met inclusion criteria. A substantial focus within the literature was education, with higher levels of education shown to improve healthcare provider attitudes and practices. Within this overarching focus, four themes were identified: 1) education as an intervention to improve attitudes and increase confidence and knowledge; 2) strategies to support practice change, including interventions aimed at clinical leaders and methods to address substance use among inpatients; 3) frameworks to guide care; and 4) opportunities to expand nursing scope of practice. Conclusions: Given the substantial evidence indicating that education improves nurses' knowledge, attitudes and practices, there is great promise in expanding educational intervention opportunities for nurses to improve care and outcomes for patients with concurrent disorders-a priority patient population.

Equipping youth for meaningful policy engagement: an environmental scan.

To better address the mental health and substance use crises facing youth globally, a comprehensive approach, inclusive of mental health promotion is needed. A key component of mental health promotion is policy intervention to address the social and structural determinants of health. Importantly, youth should be engaged in these efforts to maximize relevancy and impact. Yet, while there is growing interest in the inclusion of youth in the policymaking process, there is a paucity of guidance on how to do this well. This environmental scan reports findings from a comprehensive search of academic and grey literature that was conducted using the electronic databases: CINAHL, ERIC, MEDLINE, PsycINFO, Google Scholar, and Google. Search terms included variations of 'youth*', 'educat*', 'engage*', 'policy' and 'policy training'. Thirteen English language training programmes met inclusion criteria. Analysis identified marked differences in programme philosophy and focus by geographic region and highlights the need for enhanced evaluation and impact measurement moving forward. This paper makes a needed contribution to the evidence-base guiding this key mental health promotion strategy, which holds the potential to address critical gaps in approaches to youth mental health and substance use.

Reducing patient and provider knowledge gaps: An evaluation of a community informed hepatitis C online course.

OBJECTIVES: Hepatitis C (HCV) knowledge gaps are associated with lower levels of engagement in (HCV) care which contributes to HCV-related morbidity and mortality. Knowledge gaps may be exacerbated by rapid changes in HCV care/treatment. Cost-effective, timely and easy-to-implement education is needed to address knowledge gaps and foster HCV engagement. METHODS: We developed a free, one-hour, online course for patients and providers. Online and facilitated course events were evaluated. Outcome measures included: pre/post-scores, perceived knowledge gains and increased capacity to educate/encourage engagement in HCV care. RESULTS: Total pre-post-test gains were significant (p < .001) across groups. Over 50% of participants reported: perceived knowledge gains of "A lot" or higher; the course increased their capacity to educate and encourage client engagement in care by "A lot" or higher. CONCLUSIONS: The evaluation confirmed ongoing patient and provider HCV knowledge gaps, significantly reduced those gaps, and increased provider's capacity to educate and encourage client engagement in HCV care. PRACTICE IMPLICATIONS: The course is an effective tool to address knowledge gaps that might lower engagement in care. It is available to patients to use in the privacy of their own home or for providers for their personal use, to use with individuals or patient groups.

Reasons for Nonattendance across the Hepatitis C Disease Course.

This descriptive qualitative study examined the patient, provider, and institutional factors contributing to nonattendance for hepatitis C (HCV) care throughout the disease course. Eighty-four patients and health and social care providers were interviewed. Thematic analysis of the data yielded 6 interrelated nonattendance themes: self-protection, determining the benefits, competing priorities, knowledge gaps, access to services, and restrictive policies. Factors within the themes varied with the disease course, type of provider/service, and patient context. Nonattendance could span months to years and most frequently began at diagnosis where providers either advised that followup was not necessary or did not recommend any followup. The way services were organized (low barrier access) and delivered (nonjudgmental approach) and higher HCV knowledge levels of patients and providers encouraged attendance. This is the first study to explore the reasons for nonattendance for HCV care throughout the disease course and validate them from multiple perspectives. There are missed opportunities for providers to encourage attendance throughout the disease course beginning at diagnosis. Interventions required include development of integrated health and social service delivery models; mechanisms to improve knowledge dissemination of the disease, its management, and treatment; and implementation of standardized followup protocols for liver disease monitoring in primary care.

Patient perceptions of helpful communication in the context of advanced cancer.

AIMS AND OBJECTIVES: Based on a secondary analysis of data from a large qualitative study on cancer care communication, we address the question: what do patients with advanced cancer identify as helpful in their communication encounters with health care providers? BACKGROUND: Communication is of critical importance to the care of patients with advanced cancer. A better understanding of what such patients identify as helpful in their communication encounters with nurses and other health care providers seems critical to creating evidence-informed recommendations for best practices. DESIGN: Secondary analysis of qualitative interview data. METHODS: Data from 18 participants interviewed individually and 16 focus group participants, with advanced cancer in the palliative phase of care. Interpretive description methodology informed data collection and analysis. RESULTS: Findings suggest four key elements are critically important to consider in communications with patients in an advanced or palliative phase - respecting the importance of time, demonstrating caring, acknowledging fear and balancing hope and honesty in the provision of information. CONCLUSIONS: Communication is an important element in the provision of advanced cancer care. RELEVANCE TO CLINICAL PRACTICE: Findings emphasise the complex meanings inherent in cancer care communication and identify central themes that are fundamental to effective cancer care communication.

Living with the stigma of hepatitis C.

Stigma poses significant challenges to those with chronic hepatitis C (CHC), their social networks, communities, and society. This study's purpose was to identify and describe how people lived with CHC and made self-care decisions. Data are presented from interviews and daily recordings of 26 study participants. Experiences of stigma were attributed primarily to misconceptions about the cause and transmission of the disease and its association with illicit drug use. Perceptions and responses to stigma were context-dependent, flexible, and varied over time. Stigma created barriers to access of health services and undermined the social supports required to address self-care needs and illness management. The extent and severity of stigma suggests that interventions to reduce or eliminate stigma will require individual, structural, and systemic changes. Further study is required to clarify the relationship between the trajectory of CHC and the experience and responses to stigma.

The construction of hepatitis C as a chronic illness.

The purpose of the article is to present one aspect of the findings of a descriptive, exploratory investigation of the self-care decision making of 33 adults diagnosed with chronic hepatitis C (Hep C), specifically how they experienced living with this disease as a chronic illness. The findings were interpreted from a social constructivist perspective in which Hep C was viewed as both a biomedical entity and a social construction. The authors will suggest that although Hep C is constructed by people with the disease as a chronic illness, the care of this disease is often based on an acute model that acknowledges its chronicity only in terms of the persistence of the virus. The article points to the need for a model of Hep C care that incorporates the dimensions of the chronic illness experience.

The context of health care communication in chronic illness.

Patient-professional communication is a critically important element of effective chronic illness care. However, the dynamics of health care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct "disease worlds" among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further analysis of the interactional dynamics associated with chronic conditions.

Health care communication issues in multiple sclerosis: an interpretive description.

Communication between persons with chronic illness and their professional health care providers is a critical element of appropriate health care. As the field of health care communication evolves, it becomes apparent that aspects of the illness experience shared by those affected by specific diseases might be a source of particular insight into what constitutes effective or appropriate communications. This interpretive description of health care communication issues in multiple sclerosis was based on qualitative secondary analysis of a set of in-depth interviews and focus groups conducted with 12 persons with longstanding MS experience. Analysis of their accounts illustrates an intricate interplay between common features within the disease trajectory and the communications that are perceived as helpful or unhelpful to living well with this chronic illness. From the analysis of these findings, the authors draw interpretations regarding what might be considered communication competencies for those who care for patients with this disease.

A qualitative evaluation of an HIV/AIDS respite care service in Victoria, Canada.

The Victoria AIDS Respite Care Society (VARCS) has provided respite care to people living with HIV/AIDS (PLWAs) since 1991. In 1998, an evaluation of VARCS services was undertaken to gain a better understanding of the VARCS model of community-based care. The evaluation was comprised of four components including an examination of the historical evolution of VARCS, an account of the community development processes used, a description of VARCS services, and an analysis of the impact and outcomes of VARCS services. This article highlights qualitative findings from the impact and outcomes component of this study. Guided by principles of participatory action research, this project included interviews with 85 participants. Eight themes emerged from the analysis that appeared to speak to the qualitative impact and outcomes of VARCS service. Actions taken by VARCS as a result of the evaluation findings are discussed as are the study limitations.