An emerging framework for digital mental health design with Indigenous young people: a scoping review of the involvement of Indigenous young people in the design and evaluation of digital mental health interventions.

BACKGROUND: Indigenous young people worldwide possess unique protective factors that support wellbeing. However, they experience mental illness at higher rates than their non-indigenous counterparts. Digital mental health (dMH) resources can increase access to structured, timely, and culturally tailored mental health interventions by reducing structural and attitudinal barriers to accessing treatment. The involvement of Indigenous young people in dMH resource development is recommended, however, no guidelines exist on how this can best be facilitated. METHODS: A scoping review examining processes to involve Indigenous young people in developing or evaluating dMH interventions was conducted. Studies reported between 1990 and 2023 involving Indigenous young people aged 12-24 years, originating from Canada, the USA, New Zealand, and Australia, in the development or evaluation of dMH interventions were eligible for inclusion. Following a three-step search process, four electronic databases were searched. Data were extracted, synthesized, and described under three categories: dMH intervention attributes, study design, and alignment with research best practice. Best practice recommendations for Indigenous research and participatory design principles derived from the literature were identified and synthesised. Included studies were assessed against these recommendations. Consultation with two Senior Indigenous Research Officers ensured Indigenous worldviews informed analysis. RESULTS: Twenty-four studies describing eleven dMH interventions met inclusion criteria. Studies included formative, design, pilot, and efficacy studies. Overall, most included studies demonstrated a high degree of Indigenous governance, capacity building, and community benefit. All studies adapted their research processes to ensure that local community protocols were followed and most aligned these within an Indigenous research paradigm. Formal agreements regarding existing and created intellectual property and implementation evaluations were rare. Outcomes were the primary focus of reporting, with limited detailed descriptions of governance and decision-making processes or strategies for managing predictable tensions between co-design stakeholders. CONCLUSIONS: This study identified recommendations for undertaking participatory design with Indigenous young people and evaluated the current literature against these criteria. Common gaps were evident in the reporting of study processes. Consistent, in-depth reporting is needed to allow assessment of approaches for this hard-to-reach population. An emergent framework, informed by our findings, for guiding the involvement of Indigenous young people in the design and evaluation of dMH tools is presented. TRIAL REGISTRATION: Available via osf.io/2nkc6.

Involvement of Indigenous young people in the design and evaluation of digital mental health interventions: a scoping review protocol.

BACKGROUND: Indigenous young people worldwide are at greater risk of developing mental health concerns due to ongoing inequity and disadvantage. Digital mental health (dMH) interventions are identified as a potential approach to improving access to mental health treatment for Indigenous youth. Although involvement in the development and evaluation of dMH resources is widely recommended, there is limited evidence to guide engagement of Indigenous young people in these processes. This scoping review aims to examine the methods used to involve Indigenous young people in the development or evaluation of dMH interventions. METHODS: Articles published in English, involving Indigenous young people (aged 10-24 years) in the development or evaluation of dMH interventions, originating from Australia, New Zealand, Canada and the USA will be eligible for inclusion. PubMed, Scopus and EBSCOhost databases (Academic Search Premiere, Computer and Applied Science complete, CINAHL, MEDLINE, APA PsychArticles, Psychology and Behavioural Sciences collection, APA PsychInfo) will be searched to identify eligible articles (from January 1990 onwards). Infomit and Google Scholar (limited to 200 results) will be searched for grey literature. Two reviewers will independently screen citations, abstracts and full-text articles. Study methods, methodologies, dMH intervention details, participant information and engagement, and dissemination methods will be extracted, analysed (utilising content analysis), and qualitatively assessed for alignment with best practice ethical guidelines for undertaking Indigenous health research. A narrative summary of findings will be presented. Reporting will follow the Consolidated Criteria for Strengthening Reporting of Health Research involving Indigenous peoples (CONSIDER) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. DISCUSSION: To date, there are no reviews which analyse engagement of Indigenous young people in the development and evaluation of dMH interventions. This review will appraise alignment of current practice with best practice guidelines to inform future research. It will highlight appropriate methods for the engagement of young people in study processes, providing guidance for health practitioners, policy makers, and researchers working in the field of Indigenous youth and dMH. SYSTEMATIC REVIEW REGISTRATION: Open Science Framework ( osf.io/2nkc6 ).

Digital Mental Health Resources for Asylum Seekers, Refugees, and Immigrants: Protocol for a Scoping Review.

BACKGROUND: Asylum seekers, refugees, and immigrants experience a number of risk factors for mental health problems. However, in comparison to the host population, these populations are less likely to use mental health services. Digital mental health approaches have been shown to be effective in improving well-being for the general population. Thus, they may provide an effective and culturally appropriate strategy to bridge the treatment gap for these populations vulnerable to mental health risks. OBJECTIVE: This paper aims to provide the background and rationale for conducting a scoping review on digital mental health resources for asylum seekers, refugees, and immigrants. It also provides an outline of the methods and analyses, which will be used to answer the following questions. What are the available digital mental health resources for asylum seekers, refugees, and immigrants? Are they effective, feasible, appropriate, and accepted by the population? What are the knowledge gaps in the field? METHODS: The scoping review methodology will follow 5 phases: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the results. Searches will be conducted in the following databases: EBSCOhost databases (CINAHL Plus with Full Text, MEDLINE with Full Text, APA PsycArticles, Psychology and Behavioral Sciences Collection, and APA PsycInfo), PubMed, and Scopus. Additionally, OpenGrey, Mednar, and Eldis will be searched for gray literature. All primary studies and gray literature in English concerning the use of information and communication technology to deliver services addressing mental health issues for asylum seekers, refugees, and immigrants will be included. RESULTS: This scoping review will provide an overview of the available digital mental health resources for asylum seekers, refugees, and immigrants and describe the implementation outcomes of feasibility, acceptability, and appropriateness of such approaches for those populations. Potential gaps in the field will also be identified. CONCLUSIONS: As of February 2020, there were no scoping reviews, which assessed the effectiveness, feasibility, acceptability, and appropriateness of the available digital mental health resources for asylum seekers, refugees, and immigrants. This review will provide an extensive coverage on a promising and innovative intervention for such populations. It will give insight into the range of approaches, their effectiveness, and progress in their implementation. It will also provide valuable information for health practitioners, policy makers, and researchers working with the population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/19031.

Evaluation of a three-phase implementation program in enhancing e-mental health adoption within Indigenous primary healthcare organisations.

BACKGROUND: A three-phase implementation program was carried out to support Indigenous primary healthcare organisations in Australia to integrate e-mental health approaches into the day-to-day practice. The present study aimed to evaluate the process and the effectiveness of the program. METHODS: A concurrent triangulation design was employed to collect and compare quantitative and qualitative data from organisations that participated in the implementation program (case studies) to those that participated in training only (non-case studies). Quantitative methods, i.e., t-tests and descriptive statistics, were used to measure outcomes relating to the frequency of e-mental health usage and levels of organisational readiness. Qualitative data were analysed separately, using theoretical thematic analysis, to gain an in depth understanding of the implementation process. The findings were integrated and interpreted within the implementation science literature. RESULTS: The case studies evidenced greater use of e-mental health approaches than the non-case studies. They also demonstrated increased organisational readiness over the course of the implementation program. The program helped organisations to work and improve on essential aspects within the organisation so that they better supported e-mental health adoption. The key areas addressed were Information Technology resources and infrastructure, leadership and support, policy and protocols around e-mental health utilisation and its integration into practice. CONCLUSIONS: By addressing and improving essential aspects relating to e-mental health implementation, the program helped organisations to increase organisational readiness and enhance uptake of e-mental health approaches.

Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated "Promoting Action on Research Implementation in Health Services" Framework: Qualitative Study.

BACKGROUND: Electronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches. OBJECTIVE: This study aimed to understand service providers' perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people. METHODS: Qualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who had undergone electronic mental health training workshops. RESULTS: Several factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training. CONCLUSIONS: The i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support.