Implementation of peer support for people with severe mental health conditions in high-, middle- and low-income-countries: a theory of change approach.

BACKGROUND: Stakeholder engagement is essential to the design, implementation and evaluation of complex mental health interventions like peer support. Theory of Change (ToC) is commonly used in global health research to help structure and promote stakeholder engagement throughout the project cycle. Stakeholder insights are especially important in the context of a multi-site trial, in which an intervention may need to be adapted for implementation across very different settings while maintaining fidelity to a core model. This paper describes the development of a ToC for a peer support intervention to be delivered to people with severe mental health conditions in five countries as part of the UPSIDES trial. METHODS: One hundred thirty-four stakeholders from diverse backgrounds participated in a total of 17 workshops carried out at six UPSIDES implementing sites across high-, middle- and low-income settings (one site each in India, Israel, Uganda and Tanzania; two sites in Germany). The initial ToC maps created by stakeholders at each site were integrated into a cross-site ToC map, which was then revised to incorporate additional insights from the academic literature and updated iteratively through multiple rounds of feedback provided by the implementers. RESULTS: The final ToC map divides the implementation of the UPSIDES peer support intervention into three main stages: preparation, implementation, and sustainability. The map also identifies three levels of actors involved in peer support: individuals (service users and peer support workers), organisations (and their staff members), and the public. In the UPSIDES trial, the ToC map proved especially helpful in characterising and distinguishing between (a) common features of peer support, (b) shared approaches to implementation and (c) informing adaptations to peer support or implementation to account for contextual differences. CONCLUSIONS: UPSIDES is the first project to develop a multi-national ToC for a mental health peer support intervention. Stakeholder engagement in the ToC process helped to improve the cultural and contextual appropriateness of a complex intervention and ensure equivalence across sites for the purposes of a multi-site trial. It may serve as a blueprint for implementing similar interventions with a focus on recovery and social inclusion among people with mental ill-health across diverse settings. TRIAL REGISTRATION: ISRCTN26008944 (Registration Date: 30/10/2019).

Self-compassion, mental health shame and work motivation in German and Japanese employees.

In Germany, more than two-thirds of employees report mental health issues, while in Japan, more than half of the country's workforce are mentally distressed. Although both countries are socio-economically developed in similar ways, their cultures differ strongly. This article investigates mental health constructs among German and Japanese employees. A cross-sectional design was employed in which 257 German and 165 Japanese employees completed self-report scales regarding mental health problems, mental health shame, self-compassion and work motivation. T-tests, correlation and regression analyses were conducted. Results show that German employees have significantly higher levels of mental health problems, mental health shame, self-compassion and work motivation than Japanese employees. While many correlations were similar, mental health problems were associated with intrinsic motivation in Germans, but not in Japanese. Shame was associated with both intrinsic and extrinsic motivation in Japanese, but not in Germans. Self-compassion - defined as a complex of compassion, humanity, care and unconditional, compassionate love - was associated with gender and age in Japanese, but not in German employees. Lastly, regression analysis uncovered that self-compassion was the strongest predictor of mental health problems in Germans. In Japanese employees, mental health shame is the strongest predictor of mental health problems. Results can guide managers and psychologists in internationalised organisations to effectively approach employee mental health.

Challenges when going on excursions with children with medical complexity in Japan.

BACKGROUND: With advances in medical technology, the number of children with medical complexity (CMC) has increased. Excursions with such children encourage their social participation and have been shown to have a positive impact on their caregivers. However, the first-hand experience of the excursions has not yet been evaluated regarding the difficulties faced by CMC and their caregivers during preparation, transportation, and in the local area. METHODS: Semi-structured interviews were conducted with eight informal and eight formal caregivers of CMC who attended an excursion to Tokyo Disney Land (TDL) via video conference. We investigated challenges that they had experienced through the excursion, performing inductive thematic analysis. RESULTS: Three themes were identified: the preparation stage (Theme 1), problems encountered while traveling to the theme park (Theme 2), and problems at the theme park (Theme 3). In the preparation stage, three subthemes, i.e. preparation for the trip, cooperation with related parties, and researching about the theme park and asking for help, are reported. Theme 2 includes four subthemes: activities of daily living, respiratory care, luggage, and weather changes. Theme 3 has three subthemes: activities of daily living, physical condition management, and issues for the theme parks. CONCLUSIONS: We found that securing the power supply, location, and time for daily procedures are challenges in realizing excursions for CMC, but with sufficient preparation, it is possible in Japan without major difficulty.

Emotional impacts of excursions on parents of children with medical complexity.

BACKGROUND: Parents of children with medical complexity (CMC) have extra child-raising responsibilities because of the time commitments necessary for care, and their social participation is often compromised. Experiencing leisure excursions with such children may be a solution to some of these problems but the first-hand experience of excursions in regard to their psychological impact on the caregivers of CMC remains to be appraised. METHODS: Semi-structured interviews were conducted, via video conference, with eight informal and eight formal caregivers of CMC who attended an excursion to Tokyo Disney Land (TDL). We investigated the psychological changes that they had experienced through the excursion, performing inductive thematic analysis. RESULTS: Three themes were identified among parents and five were identified among medical professionals. Themes reported by the parents were: Increased trust in the public and society (Theme 1); confidence for other challenges (Theme 2), and connection with other parents in the non-medical settings (Theme 3). Themes reported by medical professionals were: Expanding the initiative to other CMC (Theme 1); feeling bonded with other caregivers within the working group (Theme 2); information exchange across different working groups (Theme 3), positive responses from CMC (Theme 4); families' confidence to go out (Theme 5). CONCLUSIONS: This study showed that the excursion to TDL led to positive psychological changes in both medical professionals and parents of CMC, enhancing trust, connection, and confidence. The promising results of this study suggest a need for further research about the impact of an excursion on caregivers of CMC.

Motivation of UK graduate students in education: self-compassion moderates pathway from extrinsic motivation to intrinsic motivation.

Academic motivation is recognised as a key factor for academic success and wellbeing. Highly motivated students actively engage with academic activities and maintain good wellbeing. Despite the importance of motivation in education, its relationship with engagement and wellbeing remains to be evaluated. Accordingly, this study explored the relationships between motivation, engagement, self-criticism and self-compassion among UK education postgraduate students. Of 120 postgraduate students approached, 109 completed three self-report scales regarding those constructs. Correlation, regression and moderation analyses were performed. Intrinsic and extrinsic motivation were positively associated with engagement, whereas amotivation was negatively associated with it. Engagement positively predicted intrinsic motivation. Self-criticism and self-compassion moderated the pathway from extrinsic motivation to intrinsic motivation: higher self-criticism weakened the pathway, while higher self-compassion strengthened it. Findings suggest the importance of engagement in relation to cultivating intrinsic motivation of education students. Moreover, enhancing self-compassion and reducing self-criticism can help transfer extrinsic to intrinsic motivation.

A longitudinal study of mental health in healthcare workers in Japan during the initial phase of COVID-19 pandemic: comparison with the general population.

The COVID-19 pandemic negatively impacted the mental health of people in Japan. Healthcare workers (HCWs) especially suffered from poor mental health, engaging with COVID-19 patients while protecting themselves from infection. However, a long-term assessment of their mental health in comparison to the general population remains to be conducted. This study evaluated and compared changes in mental health between these two populations over a six-month period. Measures of mental health, loneliness, hope and self-compassion were completed at baseline and at six-month follow-up. Two-way MANOVA (Time x Group) identified that no interaction effects were present. However, at baseline, HCWs had higher levels of mental health problems and loneliness, and lower levels of hope and self-compassion than the general population. Furthermore, a higher level of loneliness was found in HCWs at six months. These findings highlight strong feelings of loneliness in HCWs in Japan. Interventions such as digital social prescribing are recommended.

An assessment of adherence to the WHO-delineated good manufacturing practice by the pharmaceutical companies in Kabul, Afghanistan.

BACKGROUND: Afghanistan, a low-income landlocked country, is continuously suffering from domestic war and conflicts; the country struggles to provide quality healthcare services, including affordable medicinal products in the required quantity. Moreover, the quality standards of domestic pharmaceutical companies have not been established yet. One of the internationally recognized guidelines for monitoring manufacturing processes in pharmaceutical companies is Good Manufacturing Practice (GMP), recommended by World Health Organization (WHO). Therefore, this study aimed to assess whether a pharmaceutical company in Kabul, Afghanistan adheres to the GMP standards established by WHO. METHOD: A descriptive cross-sectional study was conducted to assess the WHO-delineated GMP compliance of 25 pharmaceutical companies in Kabul, Afghanistan. The inspection checklist was developed by Afghanistan's National Medicine and Healthcare Products Regulatory Authority (NMHRA) using the WHO-delineated GMP guidelines. In addition, direct observation, interviews with respective delegates, and documentation reviews were conducted to collect research data. RESULT: Only 38.33% (1.14 ± 1.08) of GMP contents were complied. Personnel 66.67% (2 ± 1.15) and materials 58.67% (1.76 ± 1.11) were the most commonly complied components, whereas the product recall 12.98% (0.39 ± 0.85), quality assurance 16.44% (0.49 ± 0.81) and quality control laboratory 28.35% (0.85 ± 1.12) were the least complied ones. CONCLUSION: None of the GMP components was fully adhered to by the pharmaceutical companies in Kabul, Afghanistan. Quality control and assurance should be implemented immediately, including validation and qualification practices.

Disaster response among hospital nurses dispatched to evacuation centers after the Great East Japan Earthquake: a thematic analysis.

BACKGROUND: Disaster relief operations involve a variety of components of healthcare efforts. The post-disaster recovery is a key component of hospital preparedness. This study aimed to investigate the role of hospital nurses in the disaster area and their challenges during the relief efforts after the Great East Japan Earthquake in 2011. METHODS: Semi-structured interviews were conducted with ten nurses who worked in a general public hospital before the Great East Japan Earthquake and were dispatched to the evacuation centers after the disaster. A qualitative approach with the thematic analysis method was employed. Three research queries (RQs) were prepared before the interview. RESULTS: The study participants played administrative roles as city employees in addition to performing nursing services as healthcare providers in evacuation centers. The first RQ on their challenges in evacuation centers gave us four themes: criticism by the evacuees, conflicts between multiple roles, difficulties in performing the first experience, and anxiety in working. The second RQ asking about motivation to accomplish disaster relief efforts raised three themes of carrying out the nursing role, acceptance by evacuees, and strengths of human connections. Two themes of awareness of disaster medicine and professional growth were raised from the third RQ of gains from the experiences in the evacuation centers. CONCLUSIONS: The hospital nurses in the disaster area performed multiple roles in the relief efforts in the evacuation centers, which developed a psychological burden on them. A sense of competence supported the motivation to accomplish the disaster relief activities and professional growth as a specialist in disaster medicine. A study limitation is missing hospital nurses who resigned during the relief efforts. Further study is warranted to refine the disaster preparedness of hospital operations.

COVID-19: challenges faced by Nepalese migrants living in Japan.

BACKGROUND: Worldwide, COVID-19 has exacerbated the vulnerability of migrants, impacting many facets of their lives. Nepalese make up one of the largest groups of migrants residing in Japan. Crises, such as the ongoing COVID-19 pandemic could disproportionately affect migrants from low- and middle-income countries like Nepal, widening health and economic inequalities. An in-depth, comprehensive assessment is needed to appraise the diverse problems they encounter. Drawing upon qualitative interviews, this study aimed to identify challenges faced by Nepalese migrants in Japan as a consequence of the COVID-19 pandemic and to discuss their needs to counter these challenges. METHODS: This qualitative study employed an interpretivist approach to appraise the first-hand experience of Nepalese migrants living in Japan. Fourteen participants (8 males and 6 females, aged 21 to 47 years old) were recruited to participate in semi-structured in-depth telephone interviews (45-60 min) regarding: (a) their perceived current physical and mental health, (b) problems faced as a result of the COVID-19 pandemic, and (c) perception of available and necessary support structures. Purposive and snowball sampling techniques were used to recruit the participants. Interviews were recorded, transcribed, and thematically analyzed. RESULTS: Six themes were identified: 1) experiencing psychosomatic symptoms, 2) adoption of new healthy behaviors, 3) financial hardship, 4) family concerns, 5) reflections on discrimination and 6) reflections of existing support and expectations of support systems. The findings of our study illustrate the specific impact of COVID-19 among Nepalese migrants regarding their unstable employment conditions, perceived lack of social support, possible obligation to send money home, difficulty in accessing services due to the language barrier, and a lack of effective governmental support from Nepal. Pandemic-related adversity has negatively impacted migrants' mental well-being, exacerbating their vulnerability. CONCLUSIONS: Comprehensive and timely support should be provided to the vulnerable migrant population. Effective coordination among relevant parties in both countries, including the governments concerned, should be facilitated.

Systematic Review of Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes.

BACKGROUND: The benefit of self-monitoring of blood glucose in reducing HbA1c in non-insulin-treated participants remains unclear. HbA1c may be improved in this population with said self-monitoring. OBJECTIVE: The aim of this study was to conduct meta-analyses of glycemic control in non-insulin-treated participants with Type 2 diabetes: self-monitoring of blood glucose versus usual care, structured versus unstructured self-monitoring of blood glucose, and use of self-monitoring of blood glucose readings by clinicians to adjust (or modify) therapy versus usual care. METHODS: MEDLINE, Embase, and Cochrane Central were electronically searched to identify articles published from January 1, 2000, to June 30, 2020. Trials investigating changes in HbA1c were selected. Screening was performed independently by two investigators. Two investigators extracted HbA1c at baseline and follow-up for each trial. RESULTS: Nineteen trials involving 4,965 participants were included. Overall, self-monitoring of blood glucose reduced HbA1c. Preplanned subgroup analysis showed that using self-monitoring of blood glucose readings to adjust therapy contributed significantly to the reduction. No significant improvement in HbA1c was shown in self-monitoring of blood glucose without therapy adjustment. The same difference was observed in structured versus unstructured self-monitoring of blood glucose. DISCUSSION: HbA1c is improved with clinician therapy modification based on structured self-monitoring of blood glucose readings. Implications are for clinicians to prescribe structured self-monitoring of blood glucose to modify therapy based on the readings and not prescribe unstructured self-monitoring of blood glucose. Participants with suboptimal glycemic control may benefit most. A self-monitoring of blood glucose regimen that improves clinical and cost-effectiveness is presented. Future studies can investigate this regimen specifically.

Videoconferencing for Home Care Delivery in Japan: Observational Study.

BACKGROUND: Telemedicine has been increasingly used in many health care fields, including home care, where patients receive medical care at home. Owing to the current COVID-19 crisis, the value of telemedicine via videoconferencing is more recognized, particularly in allowing immobile patients to continue receiving care. However, the efficacy of telemedicine in home care settings in Japan remains to be fully appraised. OBJECTIVE: This study aims to identify the use and impact of telemedicine in a singular home care delivery setting in Japan. METHODS: A retrospective observational study was conducted using patient and other administrative records from a home care clinic. We considered patients who were involved in videoconferencing with home care physicians and telepresenters serving patients during 2018 and 2019. We extracted sociodemographic data of the patients and details of the videoconferencing and descriptively illustrated some specific cases. RESULTS: In a home care clinic in Japan, videoconferencing was conducted in 17 cases (involving 14 patients) over a 2-year period. Of all the cases, 12% (2/17) required emergency transfers and were hospitalized. A total of 88% (15/17) of cases remained; 71% (12/17) of cases were found to need extra medication or to go to a medical facility for consultation, whereas 18% (3/17) of cases were found not to be in need of urgent attention and were asked to rest. Problematic symptoms subsequently improved in 82% (14/17) of cases, and only 6% (1/17) of cases were later hospitalized. CONCLUSIONS: Telemedicine was deemed effective for assessing patients' conditions in the home care setting in situations where home visits by a physician cannot be carried out. Our findings indicate that consultations via videoconferencing are safe and effective, suggesting more active use of videoconferencing in other clinical contexts.

Mental health of medical workers in Japan during COVID-19: Relationships with loneliness, hope and self-compassion.

The current pandemic of the coronavirus disease 2019 (COVID-19) has negatively impacted medical workers' mental health in many countries including Japan. Although research identified poor mental health of medical workers in COVID-19, protective factors for their mental health remain to be appraised. Accordingly, this study aimed to investigate relationships between mental health problems, loneliness, hope and self-compassion among Japanese medical workers, and compare with the general population. Online self-report measures regarding those four constructs were completed by 142 medical workers and 138 individuals in the general population. T-tests and multiple regression analysis were performed. Medical workers had higher levels of mental health problems and loneliness, and lower levels of hope and self-compassion than the general population. Loneliness was the strongest predictor of mental health problems in the medical workers. Findings suggest that Japanese medical workplaces may benefit from targeting workplace loneliness to prevent mental health problems among the medical staff.

Adolescent Social Anxiety, School Satisfaction, Family Emotional Support, and School Absenteeism: Findings from Young-HUNT3 and Norwegian National Education Data.

Background: Adolescents grappling with social anxiety may experience poor school satisfaction, resorting to school-related avoidance behaviors, exemplified by absenteeism, as a coping mechanism. Understanding the role of family support in alleviating the adverse effects of social anxiety on school satisfaction is imperative for fostering supportive educational settings. Although there is literature regarding how school satisfaction promotes positive adolescent outcomes, empirical knowledge on the interrelation between social anxiety, school satisfaction, and family emotional support is limited. This study investigates the association between social anxiety, family emotional support, school satisfaction, and school absenteeism within the theoretical framework of the stage-environment fit theory to offer insight into how family emotional support can moderate the influence of social anxiety on school-related outcomes. Methods: Utilizing a population-based sample of 1861 upper secondary school pupils from the Trøndelag Young Health study "Young-HUNT3 study", we employed an index of moderated mediation to examine the role of family emotional support in moderating the association between social anxiety and school-related avoidance behavior related to school satisfaction. Results: Family emotional support had moderated mediation association for school absenteeism (ß = 0.128, 95% CI 0.019, 0.278) and extracurricular activity (ß = -0.003, 95% CI -0.008, -0.000). Conclusions: This urges further investigation into the specific mechanisms and individual differences influencing these relationships, aiming to deepen our understanding of adolescents' experiences and inform comprehensive strategies for promoting their well-being within school communities.

Evaluation of a Problem-Solving Program on Developmental Disorders: A Qualitative Appraisal.

Background In Japan, effective educational methods to promote understanding of developmental disorders (DD) among young people have not been established, something that is necessary for an inclusive society. Aims This paper aimed to identify both the positive aspects and areas for improvement in a problem-solving program for middle and high school students on the topic of DD called inochi Gakusei Innovators Program (i-GIP). The study also sought to determine the changes in attitudes toward DD that occurred as a result of participating in the program. Method Semi-structured interviews were conducted online, with middle and high school students who participated in i-GIP, university students who helped manage the program, and cooperators with DD or their families. Inductive thematic analysis was conducted, and codes and themes were identified. Results Positive aspects of i-GIP included its project-based learning approach, raising awareness and understanding of developmental disorders, and the proactive attitude of the students. Areas for improvement in the program were identified, including program administration and addressing challenges related specifically to DD. Changes in attitudes and behavior toward DD were reported, along with improvements in interpersonal relationships. Conclusions and implications This study suggests that incorporating a project-based approach can be a useful manner to learn about DD among young people.

The Implementation of Recommender Systems for Mental Health Recovery Narratives: Evaluation of Use and Performance.

BACKGROUND: Recommender systems help narrow down a large range of items to a smaller, personalized set. NarraGive is a first-in-field hybrid recommender system for mental health recovery narratives, recommending narratives based on their content and narrator characteristics (using content-based filtering) and on narratives beneficially impacting other similar users (using collaborative filtering). NarraGive is integrated into the Narrative Experiences Online (NEON) intervention, a web application providing access to the NEON Collection of recovery narratives. OBJECTIVE: This study aims to analyze the 3 recommender system algorithms used in NarraGive to inform future interventions using recommender systems for lived experience narratives. METHODS: Using a recently published framework for evaluating recommender systems to structure the analysis, we compared the content-based filtering algorithm and collaborative filtering algorithms by evaluating the accuracy (how close the predicted ratings are to the true ratings), precision (the proportion of the recommended narratives that are relevant), diversity (how diverse the recommended narratives are), coverage (the proportion of all available narratives that can be recommended), and unfairness (whether the algorithms produce less accurate predictions for disadvantaged participants) across gender and ethnicity. We used data from all participants in 2 parallel-group, waitlist control clinical trials of the NEON intervention (NEON trial: N=739; NEON for other [eg, nonpsychosis] mental health problems [NEON-O] trial: N=1023). Both trials included people with self-reported mental health problems who had and had not used statutory mental health services. In addition, NEON trial participants had experienced self-reported psychosis in the previous 5 years. Our evaluation used a database of Likert-scale narrative ratings provided by trial participants in response to validated narrative feedback questions. RESULTS: Participants from the NEON and NEON-O trials provided 2288 and 1896 narrative ratings, respectively. Each rated narrative had a median of 3 ratings and 2 ratings, respectively. For the NEON trial, the content-based filtering algorithm performed better for coverage; the collaborative filtering algorithms performed better for accuracy, diversity, and unfairness across both gender and ethnicity; and neither algorithm performed better for precision. For the NEON-O trial, the content-based filtering algorithm did not perform better on any metric; the collaborative filtering algorithms performed better on accuracy and unfairness across both gender and ethnicity; and neither algorithm performed better for precision, diversity, or coverage. CONCLUSIONS: Clinical population may be associated with recommender system performance. Recommender systems are susceptible to a wide range of undesirable biases. Approaches to mitigating these include providing enough initial data for the recommender system (to prevent overfitting), ensuring that items can be accessed outside the recommender system (to prevent a feedback loop between accessed items and recommended items), and encouraging participants to provide feedback on every narrative they interact with (to prevent participants from only providing feedback when they have strong opinions).

Suicide Interventions in Spain and Japan: A Comparative Systematic Review.

(1) Background: This systematic review presents an overview of psychological interventions in suicide published between 2013 and 2023 in Spain and Japan, sparked by Spain's alarming recent increase in suicide rates and the potential exemplar of Japan's reduction efforts. (2) Methods: Following the PRISMA checklist, the databases Web of Science, Scopus, PubMed, and PsycInfo were searched using the terms [("suicide" OR "suicidal behavior" OR "suicidal attempt" OR "suicidal thought" OR "suicidal intention") AND ("prevention" OR "intervention" OR "psychosocial treatment" OR "Dialectical Behavior Therapy" OR "Cognitive Therapy" OR "psychotherap*")] AND [("Spain" OR "Spanish") OR ("Japan" OR "Japanese")]. We included articles published in peer-reviewed academic journals, written in English, Spanish, and Japanese between 2013 and 2023 that presented, designed, implemented, or assessed psychological interventions focused on suicidal behavior. (3) Results: 46 studies were included, concerning prevention, treatment, and training interventions. The risk of bias was low in both Spanish and Japanese studies, despite the lack of randomization of the samples. We identified common characteristics, such as psychoeducation and coping skills. Assertive case management was only highlighted in Japan, making an emphasis on active patient involvement in his/her care plan. (4) Conclusions: The findings will help professionals to incorporate into their interventions broader, more comprehensive approaches to consider more interpersonal components.

Perception and appropriation of a web-based recovery narratives intervention: qualitative interview study.

Introduction: Mental health recovery narratives are widely available to the public, and can benefit people affected by mental health problems. The NEON Intervention is a novel web-based digital health intervention providing access to the NEON Collection of recovery narratives. The NEON Intervention was found to be effective and cost-effective in the NEON-O Trial for people with nonpsychosis mental health problems (ISRCTN63197153), and has also been evaluated in the NEON Trial for people with psychosis experience (ISRCTN11152837). We aimed to document NEON Intervention experiences, through an integrated process evaluation. Methods: Analysis of interviews with a purposive sample of intervention arm participants who had completed trial participation. Results: We interviewed 34 NEON Trial and 20 NEON-O Trial participants (mean age 40.4 years). Some users accessed narratives through the NEON Intervention almost daily, whilst others used it infrequently or not at all. Motivations for trial participation included: exploring the NEON Intervention as an alternative or addition to existing mental health provision; searching for answers about mental health experiences; developing their practice as a mental health professional (for a subset who were mental health professionals); claiming payment vouchers. High users (10 + narrative accesses) described three forms of appropriation: distracting from difficult mental health experiences; providing an emotional boost; sustaining a sense of having a social support network. Most participants valued the scale of the NEON Collection (n = 659 narratives), but some found it overwhelming. Many felt they could describe the characteristics of a desired narrative that would benefit their mental health. Finding a narrative meeting their desires enhanced engagement, but not finding one reduced engagement. Narratives in the NEON Collection were perceived as authentic if they acknowledged the difficult reality of mental health experiences, appeared to describe real world experiences, and described mental health experiences similar to those of the participant. Discussion: We present recommendations for digital health interventions incorporating collections of digital narratives: (1) make the scale and diversity of the collection visible; (2) provide delivery mechanisms that afford appropriation; (3) enable contributors to produce authentic narratives; (4) enable learning by healthcare professionals; (5) consider use to address loneliness.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

BACKGROUND: Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. METHOD: Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. RESULTS: 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. DISCUSSION: Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.