Applying technology to promote sexual and reproductive health and prevent gender based violence for adolescents in low and middle-income countries: digital health strategies synthesis from an umbrella review

Aim: Adolescents in low-and-middle-income countries (LMICs) are facing numerous developmental, sexual and reproductive health (SRH) challenges including exposure to multidimensional violence. Gender-based violence (GBV) specifically intimate partner violence (IPV) are both highly prevalent in LMICs and are strongly linked with poor SRH outcomes. However, GBV and IPV interventions have not yet been adequately integrated in SRH due to individual, social, cultural, service, and resource barriers. To promote long-term SRH, a more holistic approach that integrates GBV and IPV, and adolescent development needs is imperative. Digital health has the potential to address multiple service setup, provision, and addressing access barriers through designing and providing integrated SRH care. However, there are no guidelines for an integrated digital SRH and development promotion for adolescents in LMICs. Methods: An umbrella review was conducted to synthesize evidence in three inter-related areas of digital health intervention literature: (i) SRH, (ii) GBV specifically IPV as a subset, and (iii) adolescent development and health promotion. We first synthesize findings for each area of research, then further analyze the implications and opportunities to inform approaches to develop an integrated intervention that can holistically address multiple SRH needs of adolescents in LMICs. Articles published in English, between 2010 and 2020, and from PubMed were included. Results: Seventeen review articles met our review inclusion criterion. Our primary finding is that application of digital health strategies for adolescent SRH promotion is highly feasible and acceptable. Although effectiveness evidence is insufficient to make strong recommendations for interventions and best practices suggestions, some user-centered design guidelines have been proposed for web-based health information and health application design for adolescent use. Additionally, several digital health strategies have also been identified that can be used to further develop integrated GBV-IPV-SRH-informed services to improve adolescent health outcomes. We generated several recommendations and strategies to guide future digital based SRH promotion research from our review. Conclusions: Rigorous research that focuses on intervention effectiveness testing using a combination of digital health strategies and standardized albeit contextualized outcome measures would be important. Methodological improvement such as adoption of longitudinal experimental design will be crucial in generating evidence-based intervention and practice guidelines for adolescents in LMICs. Keywords: Gender-based violence, Intimate partner violence, Sexual and reproductive health, Low-and-middle - income countries, mHealth, Digital health, Adolescents Development, Revie

Opinions and perceptions of Indigenous mental health applications from service providers and youth samples: a pilot study

Objective To evaluate opinions and perceptions around managing mental health and the relevance of available mental health applications (apps) for Indigenous youth populations by surveying values of Indigenous service providers and youth samples in a regional area, in order to better target online mental health information. Method Participants were 15 Indigenous youths (6 males, 9 females) with a mean (SD) age of 16.93 (2.37), and 30 Indigenous service providers (6 males, 24 females) with a mean age (SD) of 34.59 (12.26). Participants were recruited through a Queensland regional Indigenous community organisation, and given a face-to-face survey, (developed with Indigenous community members) during a social event. The survey asked how participants improve their mental health, their knowledge of current Indigenous mental health applications, and their perceived importance of values presented in those applications. Results Although Indigenous youth were not familiar with existing mental health apps, overall, participants agreed with the values presented in available mental health apps. Compared to Indigenous youth, service providers overall perceived presented values as significantly more important, and specifically found ‘Nature in the design’, ‘Themes of strength’, and ‘Themes of community’ to be most important. Regarding content, service providers and youth had different strategies for bolstering mental health with Indigenous sports stars the least popular in both groups. There were no statistical gender differences in thematic importance for bolstering mental health. Conclusions Mental health applications are little utilised by Indigenous youth so awareness needs to increase. In addition, these are viewed differently between service providers and youth. This may have relevance for uptake and usage of these apps within the mental health service delivery

Digital technologies to support mental health among young people

The aim of this study was to describe how digital technologies can support young people in mental health services. An explorative mixed methods study was conducted in three phases. First, a systematic literature review was carried out between 2011 and 2013, followed by a meta-analysis of three studies to examine the effectiveness of a virtual reality intervention used in specialized psychiatric care. Second, the use of an electronic diary (e-diary) was explored among young people (n=89) who were clients of adolescent psychiatric outpatient clinics between 2008 and 2010 due to depressive symptoms. Third, the use of web-based community services aimed at young people (n=2,193) in 2018 was explored. In the second and third stages, quantitative data were analyzed with descriptive analysis and qualitative data with inductive thematic analysis. No quality evidence for or against virtual reality usage among people with serious mental health problems was found in the systematic review and meta- analysis. The young people’s long-term use of the e-diary was low, and nearly half of the participants did not use it at all. Those who did use the e-diary had previous experiences in mental health services and had more severe symptoms of depression than those who did not use it. Most of the young people who used digital technologies during treatment at the adolescent psychiatric outpatient clinics and in the community were females. According to the study results, digital technologies were most often used in the evenings and during the school year. Young people openly discussed their mental health and their personal issues such as relationships, identity, social life, health and illnesses, and self-perception. Digital technologies have the potential to help young people monitor their behavior, symptoms, and experiences and get support when they need it. When developing and implementing mental health support based on digital technologies, it is important to consider the different mental health and gender-specific needs of young people, as well as their readiness to use digital technologies to support their own mental health and well-being.Digitaaliset teknologiat nuorten mielenterveyden tukena Tämän tutkimuksen tavoitteena oli kuvata, miten digitaalisia teknologioita voidaan käyttää nuorten mielenterveyden tukena mielenterveyspalveluissa. Tutkimus toteutettiin kolmessa vaiheessa. Ensimmäisessä vaiheessa systemaattinen kirjallisuuskatsaus tehtiin vuosina 2011–2013, jonka jälkeen tehtiin meta-analyysi kolmesta tutkimuksesta, joissa tutkittiin virtuaalitodellisuusintervention tehokkuutta psykiatrian erityispalveluissa. Toisessa vaiheessa sähköisen päiväkirjan (e-päiväkirjan) käyttöä tutkittiin nuorisopsykiatrian poliklinikoilla masennusoireiden takia vuosina 2008–2010 asiakkaina olleiden nuorten (n=89) keskuudessa. Kolmannessa vaiheessa tutkittiin vuonna 2018 nuorille (n=2,193) suunnattujen verkkopohjaisten palvelujen käyttöä. Toisessa ja kolmannessa vaiheessa kvantitatiivisia tietoja analysoitiin kuvailevalla analyysillä ja kvalitatiivisia tietoja induktiivisella temaattisella analyysillä. Systemaattisen katsauksen ja meta-analyysin perusteella virtuaalitodellisuus-interventioiden hyödyistä tai haitoista vakavien mielenterveysongelmien hoidossa ei löytynyt laadukasta näyttöä. Nuorten pitkäaikainen e-päiväkirjan käyttö oli vähäistä ja lähes puolet osallistujista eivät käyttäneet sitä lainkaan. E-päiväkirjaa käyttäneillä oli aiempaa kokemusta mielenterveyspalveluista ja heillä oli vakavampia masennusoireita kuin heillä, jotka eivät sitä käyttäneet. Nuoret, jotka käyttivät digitaalisia teknologioita nuorisopsykiatrisen polikliinisen hoidon aikana tai verkkopohjaisissa palveluissa, olivat pääasiassa naispuolisia. Tämän tutkimuksen tulosten mukaan digitaalisia teknologioita käytettiin useimmiten iltaisin ja kouluvuoden aikana. Nuoret keskustelivat avoimesti mielenterveydestään ja henkilökohtaisista asioistaan, kuten ihmissuhteistaan, identiteetistään, sosiaalisesta elämästään, terveydestään ja sairauksistaan sekä miten he näkivät ja kokivat itsensä. Digitaaliset teknologiat luovat mahdollisuuksia auttaa nuoria seuraamaan käyttäytymistään, oireitaan tai kokemuksiaan sekä saamaan tukea, silloin kun he sitä tarvitsevat. Digitaaliseen teknologiaan perustuvaa tukea kehitettäessä ja toteutettaessa on tärkeää ottaa huomioon nuorten erilaiset mielenterveys- ja sukupuolikohtaiset tarpeet sekä heidän valmiutensa käyttää digitaalista teknologiaa oman mielenterveyden ja hyvinvoinnin tukemiseen

Technology Based Mental Health Support Strategies for Youth

The purpose of this study was to investigate youth mental health concerns and technology based support strategies from the perspective of local youth. Semi-structured focus group interviews were conducted with a group of youth who attend area high schools and postsecondary institutions. The youth were asked two main questions: 1) What mental health problems do you think youth are experiencing? 2) What are some support strategies that youth can use, particularly in the school system, that are technology based? During the second focus group interview the youth were given a list of their responses and asked to organize them into themes or categories using a concept map. Ten thematic categories were created by the youth: Preventions, Mental Health Factors/States, Bullying, Self image, Technology, Mental Health Disorders, Negative Coping, Positive Coping, Interventions, and Technology Based Interventions. Implications for counseling, the school system, and research are discussed

Tackling food marketing to children in a digital world: trans-disciplinary perspectives. Children’s rights, evidence of impact, methodological challenges, regulatory options and policy implications for the WHO European Region

There is unequivocal evidence that childhood obesity is influenced by marketing of foods and non-alcoholic beverages high in saturated fat, salt and/or free sugars (HFSS), and a core recommendation of the WHO Commission on Ending Childhood Obesity is to reduce children’s exposure to all such marketing. As a result, WHO has called on Member States to introduce restrictions on marketing of HFSS foods to children, covering all media, including digital, and to close any regulatory loopholes. This publication provides up-to-date information on the marketing of foods and non-alcoholic beverages to children and the changes that have occurred in recent years, focusing in particular on the major shift to digital marketing. It examines trends in media use among children, marketing methods in the new digital media landscape and children’s engagement with such marketing. It also considers the impact on children and their ability to counter marketing as well as the implications for children’s rights and digital privacy. Finally the report discusses the policy implications and some of the recent policy action by WHO European Member States

Sports betting and advertising

Summary: Reviews the growth of sports betting and the accompanying proliferation of sports betting advertising, with particular focus on its integration into sporting events and broadcasts.It draws on lessons from the advertising of other potentially harmful products, and synthesises research into gambling advertising and the promotion of sports betting. Key messages Sports betting has grown substantially and is emerging as a significant contributor to problem gambling, especially among younger adult males. There is considerable community opposition to the prolific promotion of gambling through sport, especially related to potential negative impacts for children, adolescents, young men and problem gamblers. Research into the advertising of other harmful products suggests advertising increases uptake and consumption, especially in the adolescent starter market. Research into sports betting advertising suggests it can shape gambling attitudes, intentions and behaviours, and impacts most negatively on existing problem gamblers and sports bettors

Influences on the Uptake of and Engagement With Health and Well-Being Smartphone Apps: Systematic Review

Background: The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. Objective: This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. Methods: We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Results: Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Conclusions: Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps

Using a gamified monitoring app to change adolescents' snack intake : the development of the REWARD app and evaluation design

Background: As the snacking pattern of European adolescents is of great concern, effective interventions are necessary. Till now health promotion efforts in children and adolescents have had only limited success in changing adolescents' eating patterns and anthropometrics. Therefore, the present study proposes an innovative approach to influence dietary behaviors in youth based on new insights on effective behavior change strategies and attractive intervention channels to engage adolescents. This article describes the rationale, the development, and evaluation design of the 'Snack Track School' app. The aim of the app is to improve the snacking patterns of Flemish 14- to 16-year olds. Methods: The development of the app was informed by the systematic, stepwise, iterative, and collaborative principles of the Intervention Mapping protocol. A four week mHealth intervention was developed based on the dual-system model with behavioral change strategies targeting both the reflective (i.e., active learning, advance organizers, mere exposure, goal-setting, monitoring, and feedback) and automatic processes (i.e., rewards and positive reinforcement). This intervention will be evaluated via a controlled pre-post design in Flemish schools among 1400 adolescents. Discussion: When this intervention including strategies focused on both the reflective and automatic pathway proves to be effective, it will offer a new scientifically-based vision, guidelines and practical tools for public health and health promotion (i.e., incorporation of learning theories in intervention programs)