Electronic screening for lifestyle issues and mental health in youth: a community-based participatory research approach

Novembro 8, 2016 by Luis Neves in ESTUDOS E PUBLICAÇÕES, Jogo de Menores No Comments

Título: Electronic screening for lifestyle issues and mental health in youth: a community-based participatory research approach
Autores: Felicity Goodyear-Smith, Arden Corter, Hannah Suh
Ano: 2016

Abstract

Background

We previously developed YouthCHAT, a youth programme for electronic screening and intervention for lifestyle risk factors and mental health issues. Our aim was to tailor the YouthCHAT package for use in a clinic catering for disadvantaged youth, assess its acceptability and utility, and develop a framework to scale-up its implementation.

Methods

We used a community-based participatory research approach to implement YouthCHAT in a rural clinic in New Zealand. Modifications to the programme were developed using an iterative process involving clinicians and patients. Electronic YouthCHAT data were collated and descriptive statistics produced. Quantitative data from post-consultation youth surveys were analysed, with thematic analyses undertaken of free text responses and staff interviews. A generic implementation framework was developed with modifiable components.

Results

Thirty youth, predominantly female Māori, completed electronic screening then attended their clinician. Consultations included discussion of YouthCHAT responses, with joint problem-solving and decision-making regarding intervention. Twenty-seven (90 %) screened positive for at least one domain. Nineteen (67 %) had one to three issues. Sixteen (53 %) wanted help with at least one issue, either immediately or later. Patients gave YouthCHAT high acceptability ratings (M = 8.29/10), indicating it was easy to use, helped them think about and identify problems, talk with their doctor, and assisted their doctor to be aware of these issues. They liked that YouthCHAT kept them busy in the waiting room and gave them time to reflect on their responses, and what to discuss with their clinician. Clinicians felt that YouthCHAT was acceptable to their young patients because it was electronic and reinforced their privacy. They indicated YouthCHAT identified problems that would have not been identified in a normal consult, and improved consultations by making them faster. The clinic continues to use YouthCHAT post-study.

Conclusions

A community-based participatory approach was used to engage key stakeholders (patients and clinic staff) for ‘real life’ translation of an electronic mental health and lifestyle screening and intervention package into a specific youth clinic context. Patients and staff found the programme acceptable and useful, and a framework was developed for scaled up and sustainable tailored implementation in other settings.

References

1.

Auckland District Health Board. The integrated child and youth mental health and addiction direction 2013–2023. Auckland: ADHB; 2013. p. 22.Google Scholar
2.

Crengle S, Clark T, Robinson E, et al. The health and wellbeing of Māori New Zealand secondary school students in 2012. Te Ara Whakapiki Taitamariki: Youth’12. Auckland: The University of Auckland; 2013. p. 80.Google Scholar
3.

Clark T, Fleming T, Bullen P, et al. The health and wellbeing of New Zealand secondary school students in 2012. In: The University of Auckland, editor. Auckland, New Zealand; 2013Google Scholar
4.

Key J. Cabinet paper: measures to improve youth mental health. Wellington: Office of the Prime Minister; 2012. p. 10.Google Scholar
5.

World Health Organization. Comprehensive mental health action plan 2013–2020. Geneva: WHO; 2014. p. 50.Google Scholar
6.

Gibb SJ, Fergusson DM, Horwood LJ. Burden of psychiatric disorder in young adulthood and life outcomes at age 30. Br J Psychiatry. 2010;197(2):122–7.CrossRefPubMedGoogle Scholar
7.

Smith JP, Smith GC. Long-term economic costs of psychological problems during childhood. Soc Sci Med. 2010;71(1):110–5.CrossRefPubMedPubMedCentralGoogle Scholar
8.

Goodyear-Smith F, Arroll B, Coupe N. Asking for help is helpful: validation of a brief lifestyle and mood assessment tool in primary health care. Ann Fam Med. 2009;7(3):239–44.CrossRefPubMedPubMedCentralGoogle Scholar
9.

Goodyear-Smith F, Coupe N, Arroll B, et al. Case-finding of lifestyle and mental health problems in primary care: validation of the ‘CHAT’. Br J Gen Pract. 2008;58(546):26–31.CrossRefPubMedPubMedCentralGoogle Scholar
10.

Goodyear-Smith F, Warren J, Bojic M, et al. eCHAT for lifestyle and mental health screening in primary care. Ann Fam Med. 2013;11(5):460–6.CrossRefPubMedPubMedCentralGoogle Scholar
11.

Goodyear-Smith F, Warren J, Elley C. The eCHAT program to facilitate healthy changes in primary care populations. J Am Board Fam Med. 2013;26:177–82.CrossRefPubMedGoogle Scholar
12.

Humeniuk R, Ali R, Babor TF, et al. Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction. 2008;103(6):1039–47.CrossRefPubMedGoogle Scholar
13.

Christie G, Marsh R, Sheridan J, et al. The substances and choices scale (SACS)–the development and testing of a new alcohol and other drug screening and outcome measurement instrument for young people. Addiction. 2007;102(9):1390–8.CrossRefPubMedGoogle Scholar
14.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.CrossRefPubMedPubMedCentralGoogle Scholar
15.

Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.CrossRefPubMedGoogle Scholar
16.

Goodyear-Smith F, Arroll B, Tse S. Asian language school student and primary care patient responses to a screening tool detecting concerns about risky lifestyle behaviours. New Zealand Family Physician. 2004;31(2):84–9.Google Scholar
17.

McMullan M. Patients using the Internet to obtain health information: How this affects the patient– health professional relationship. Patient Educ Couns. 2006;63(1):24–8.CrossRefPubMedGoogle Scholar
18.

Guadagnoli E, Ward P. Patient participation in decision-making. Soc Sci Med. 1998;47(3):329–39.CrossRefPubMedGoogle Scholar
19.

Maly RC, Bourque LB, Engelhardt RF. A randomized controlled trial of facilitating information giving to patients with chronic medical conditions: effects on outcomes of care. J Fam Pract. 1999;48(5):356–63.PubMedGoogle Scholar
20.

Enguidanos S, Coulourides Kogan A, Keefe B, et al. Patient-centered approach to building problem solving skills among older primary care patients: problems identified and resolved. J Gerontol Soc Work. 2011;54(3):276–91.CrossRefPubMedGoogle Scholar
21.

Flicker S, Maley O, Ridgley A, et al. Using technology and participatory action research to engage youth in health promotion. Action Res. 2008;6(3):285–303.CrossRefGoogle Scholar
22.

Surry D, Stefurak J, Gray R. Technology integration in higher education social and organizational aspects. Hershey: Information Science Reference; 2011.CrossRefGoogle Scholar
23.

Patient Protection and Affordable Care Act. S Health Care Reform Legislation, 2010.Google Scholar
24.

King RC. Technology and the doctor/patient relationship. Postgrad Med J. 1987;63(741):591–2.CrossRefPubMedPubMedCentralGoogle Scholar
25.

Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984;252(21):2990–4.CrossRefPubMedGoogle Scholar
26.

Wax AL. Technology assessment and the doctor-patient relationship. VA law rev. 1996;82(8):1641–62.CrossRefPubMedGoogle Scholar
27.

Elley CR, Dawes D, Dawes M, et al. Screening for lifestyle and mental health risk factors in the waiting room: feasibility study of the Case-finding Health Assessment Tool. Can Fam Physician. 2014;60(11):e527–34.PubMedPubMedCentralGoogle Scholar
28.

Zhu S, Tse S, Goodyear-Smith F, et al. Health-related behaviors and mental health in Hong Kong employees. Occ Med 2016. doi: 10.1093/occmed/kqw13