Using Quality Improvement To Implement Substance Use Disorders Services In Primary Health Care In Kenya: Impact And Experiences Of A Blended Course Among Health Workers Using The NextGenU Online Model

Background: Worldwide, mental and substance use disorders (SUD) account for over 183.9 million disability adjusted life years. While interventions do exist they are not readily implemented, especially in low- and middle-income countries, due to a lack of available human resources, monetary resources, stigma, and difficulties in changing practice patterns. Quality Improvement (QI) has been reported in literature to successfully improve health services and systems through small-scale, iterative change cycles. Objectives: This study assessed the impact of the NextGenU.org online blended course in terms of integrating, improving and sustaining mental health services using quality improvement methods in primary health care in Kenya. It also analyzed the experience of participants who completed the NextGenU.org online blended course. Method: A mixed-methods study was conducted, incorporating both qualitative focus groups (FGD) and key informant interviews (KII), and quantitative statistical measures. Data came from the Computer-Based and Alcohol Training Assessment in Kenya (eDATA K), which was implemented in collaboration with the University of British Columbia (UBC) and African Mental Health Foundation (AMHF). FGDs and KIIs were analyzed using NVivo through a constant-comparison method, to identify themes emerging from the data. A second coder analyzed the data to ensure reliability and validity. Quantitative analysis was conducted to analyze the course completion rates. Additionally, the researcher incorporated their own notes from observations made during fieldwork over the course of a 12-week practicum with AMHF to triangulate the results. Results: Overall, 27 screeners and clinicians completed the NextGenU.org online blended course. There were two FGDS and two KIIs conducted in Makueni county during July - September 2015. In terms of the staff’s experience in completing the online course many participants noted strong facilitators such as: the certificates, desire for knowledge, personal motivations, relevant material, and case studies. The limited amount of space, computers, and restrictions on Internet access acted as barriers. Participants perceived their knowledge of QI methods, leadership, and time management to have increased from completing the course. Perceived self-efficacy also increased, as staff believed their ability to be a leader, manage time and deal with errors and mistakes within the workplace improved. There was also a positive shift in stigma associated with SUD. Most importantly, the integration and improvement in mental health services was maintained even though staff discussed common challenges, such as heavy workload and limited time. Some participants reported that some people in management roles should have been more supportive, as their limited involvement acts as a barrier to greater integration of services, while other where thankful of the management support. Conclusion: This is one of the first studies of using QI methods to integrate, improve and sustain mental health services in the primary health care system in Kenya. Based upon the experiences described in the FGDs and KIIs, the blended online course was perceived to be acceptable, feasible and successful. The results indicate that quality improvement continues to be integrated in Makueni overall improving mental health services

Alcohol, assault and licensed premises in inner-city areas

This report contains eight linked feasibility studies conducted in Cairns during 2010. These exploratory studies examine the complex challenges of compiling and sharing information about incidents of person-to-person violence in a late night entertainment precinct (LNEP). The challenges were methodological as well as logistical and ethical. The studies look at how information can be usefully shared, while preserving the confidentiality of those involved. They also examine how information can be compiled from routinely collected sources with little or no additional resources, and then shared by the agencies that are providing and using the information.Although the studies are linked, they are also stand-alone and so can be published in peer-reviewed literature. Some have already been published, or are ‘in press’ or have been submitted for review. Others require the NDLERF board’s permission to be published as they include data related more directly to policing, or they include information provided by police.The studies are incorporated into the document under section headings. In each section, they are introduced and then presented in their final draft form. The final published form of each paper, however, is likely to be different from the draft because of journal and reviewer requirements. The content, results and implications of each study are discussed in summaries included in each section.Funded by the National Drug Law Enforcement Research Fund, an initiative of the National Drug StrategyAlan R Clough (PhD) School of Public Health, Tropical Medicine and Rehabilitation Sciences James Cook UniversityCharmaine S Hayes-Jonkers (BPsy, BSocSci (Hon1)) James Cook University, Cairns.Edward S Pointing (BPsych) James Cook University, Cairns

Improving Diabetes Self-Management (DSM) Among Patients with Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Patient-Centered Education Model

Problem: Type 2 Diabetes Mellitus or T2DM is an epidemic of enormous proportions affecting many individuals globally. Considering the significant burden and adverse outcomes when uncontrolled diabetes and poor self-management remain unaddressed, it is critical to find ways in which clinicians or nurses can help motivate patients to participate in their care. The problem of patients with uncontrolled diabetes at the Davis Street Primary Care Clinic (DSPCC) has been ongoing; in fact, from the 2021 Uniform Data System (UDS) measure update, rates of patients with uncontrolled diabetes (measured by HbA1c values \u3e7%) have gone up from 55% to 80%, which has now quadrupled from the Clinic\u27s target goal of 20%. Problems identified include patients\u27 inability to monitor home blood glucose routinely, sedentary lifestyle, poor diet intake, alcohol drinking and smoking, non-compliance with medication administration, and inability to follow up with their PCPs and referrals. Intervention: This DNP project aimed to increase knowledge and practice by 50% and decrease participants\u27 weight through Diabetes Self-Management (DSM) education within eight (8) weeks. As there are various ways DSM education is delivered, this DNP project utilized educational presentations, weekly diabetes support group meetings, and individual counseling among ten (10) patients with uncontrolled diabetes. Furthermore, the seven (7) Self-Care Behaviors formulated by the American Association of Diabetes Educators (AADE7) were introduced to participants. Measures: The data collected included the DSM knowledge and practice using a questionnaire answerable with a Likert scale, weight measurement. Pre-test and Post-test were done to assess the knowledge of participants regarding the Seven (7) Self-Care Behaviors. The outcomes were evaluated by comparing the pre-survey and post-survey data on the 4th and 8th weeks. Results: In the baseline assessment, data shows that most participants are very negligent in managing their diabetes where the average score for all ten (10) participants was observed to be 1.97. Most of them never check their blood sugar levels regularly with care and attention, record their blood regularly, follow dietary recommendations of the doctor or diabetes specialist, and go to their appointments. It also shows that most participants have no to little knowledge about the seven (7) self-care behaviors in managing their diabetes. After the eight (8) weeks of intervention, there are more than 3 (\u3e3) point increase in the average scores of the participants, indicating that their knowledge about self-managing their diabetes has improved. In addition, the participants have decreased more than five (5) lbs of their weight from the 1st week to the 8th week of intervention. Conclusion: The intervention of educational presentations, diabetes support groups and individual counseling for 8 weeks have increased the knowledge of the eight (8) out of ten (10) patients with uncontrolled type 2 Diabetes Mellitus (T2DM) by 50% with regards to blood sugar checking, blood sugar results recording, and adherence to dietary recommendations. Seven (7) out of 10 participants have increased their knowledge by 50% with regards to the areas of healthy eating, being active, taking medications, healthy coping, problem-solving, reducing risks or complications, and monitoring blood sugar. The participant’s weight has also improved. Keywords: diabetes self management, diabetes self-management education, dsme, diabetes education, uncontrolled diabete

헬스케어 서비스에서 데이터 기반 커뮤니케이션을 위한 디자인 연구

학위논문(박사)--서울대학교 대학원 :융합과학기술대학원 융합과학부(디지털정보융합전공),2020. 2. 이중식.스마트폰과 웨어러블 기기의 보급으로 인해 환자 생성 건강 데이터(Patient-Generated Health Data; PGHD)가 크게 증가하였고, 이는 의사-환자 의사 소통을 개선하여 데이터 중심으로 발전 할 수있는 새로운 기회를 제공했다. PGHD를 사용한 데이터 중심 커뮤니케이션을 통해 환자와 의사는 기존 임상 데이터를 보완하여 이해의 차이를 메울 수 있으며, 환자 건강에 대한 포괄적인 관점도 획득할 수 있다. 그러나, 이러한 새로운 유형의 데이터와 기술을 기존 의료 커뮤니케이션에 통합하는 데에는 여전히 어려움이 남아 있다. 환자는 종종 데이터 수집에 대한 참여와 동기를 잃어버리며, 이에 따라 수집한 데이터는 불완전해지는 문제가 발생한다. 또한 PGHD가 온전하게 수집 되더라도 의사와 환자는 의료 관행에서 이러한 데이터를 활용하는 데 어려움을 겪게 된다. 또한, 시간과 정보의 부족으로 인해 현재 워크 플로우에서 환자와 의사 모두가 PGHD를 통해 협업하는 것은 매우 어려운 일로 알려져 있다. HCI 연구 관점에서, PGHD를 활용 한 데이터 중심 통신을 지원하는 시스템을 설계하면 이러한 과제를 해결할 수 있는 잠재력이 있으며, 이는 데이터 수집(collection), 표현(representation), 해석(interpretation) 및 협업(collaboration)의 네 가지 설계 공간(design space)에서 추가적인 탐색을 요구한다. 따라서, 이 논문에서는 시스템 설계 및 현장 배포 연구를 수행하여, 각 설계 공간에서 해결되지 않은 질문을 탐색하고 경험적 연구 결과 및 설계 지침을 제공하는 것을 목표로 한다. 먼저, 데이터 수집에 대한 설계 공간의 연구로서, 접근성 높은 데이터 추적 도구가 환자가 다양한 유형의 PGHD, 특히 식사 데이터를 수집하는 데 어떤 도움을 줄 수 있는지에 대해 연구하고자 하였다. 이를 위해, 접근성 높은 데이터 추적 도구인 mFood Logger을 디자인한 후, 20 명의 환자와 6 명의 임상의를 대상으로 실증적 연구를 수행했다. 그 결과, 환자와 임상의가 데이터 기반 커뮤니케이션을 위해 원하는 데이터 유형이 무엇인지 파악할 수 있었고, 임상적 맥락에서 데이터를 수집 할 때의 난점과 기회를 발견했다. 둘째, 임상의를 위한 데이터 표현을 파악하기 위해, 18명의 다양한 이해 관계자(e.g., 임상의, EMR 개발자)와 참여적 디자인(participatory design) 프로세스를 통해 PGHD를 표시하는 DataMD를 설계하고 구현했다. 참여적 디자인 워크샵을 통해 알아낸 것은, 의료적 상황의 제약 때문에 임상의가 원하는 데이터 표현 방식이 효율성과 친숙함으로 수렴된다는 점이었다. 임상의는 학습에 걸리는 시간 문제로 인해 새로운 시각화 방법을 사용하지 않았고, 한 번에 많은 양의 데이터를 보고 싶어했다. 이러한 요구 사항을 고려하여, 다양한 유형의 PGHD가 한 눈에 보여지며, 여러 가지 임상 상황을 고려한, DataMD를 설계하고 구현했다. 셋째, 데이터 기반 커뮤니케이션의 중요한 측면으로서, 환자를 위한 데이터 해석 전략을 제시하여 효과적인 데이터 해석을 돕는 설계 지침을 제공합니다. 20명의 만성 질환 환자와의 인터뷰를 통해, 환자들이 PGHD를 해석할 때, 논리적 증거가 아닌 자신의 과거 경험에 강하게 의존한다는 점을 밝혀냈다. 환자들은 자신의 신념과 경험에 따라 여러 데이터 사이의 관계를 가정하며, 이를 확인하기 위해 네 가지의 데이터 해석 전략을 구사했다. 이러한 이해는 설계자와 연구원이 데이터 해석을 지원하는 시스템 설계를 발전시키는 데 도움이 될 수 있다. 마지막으로, 데이터를 통한 협업을 지원하기 위해 앞선 연구에서 디자인한 시스템을 기반으로 PGHD를 공유하고 활용함으로써, 임상의와 환자가 어떻게 협업하는지를 조사하고자 했다. 환자의 데이터 수집 및 해석을 돕는 앱인 MyHealthKeeper와 임상의를 위한 인터페이스인 DataMD로 구성된 통합 시스템을 임상 현장에 배포했다. 80명의 외래환자와의 임상시험 결과에 따르면 PGHD를 통한 협력으로 환자가 행동 변화에 성공할 수있었다. 또한, 앱 사용 로그에 따르면 환자는 직접적인 상호 작용 없이도 임상의와 원격으로 협업 할 수도 있는 것으로 나타났다. 이러한 결과를 바탕으로, 이 연구에서는 임상의와 환자 사이의 협력을 지원할 수있는 주요 기회가 기존 임상 워크플로우에 PGHD 사용을 통합하는 것에 있음을 제시한다. 앞선 연구들을 통해, 데이터 기반 커뮤니케이션을 위한 디자인이 환자와 의사가 PGHD를 통해 협업하는 데 도움이 될 수 있음을 발견했다. PGHD가 네 개의 설계 공간 내에서 기존 의사-환자 통신을 데이터 중심 통신으로 개선 할 수있는 방법을 개념화함으로써, 이 연구는 환자와 의사 간의 데이터 기반 커뮤니케이션을 위한 디자인이 어떻게 도출되어야 하는지에 대한 새로운 시각을 제공할 것으로 기대한다. 이 작업은 HCI, CSCW과 건강 정보학 커뮤니티의 경험적 이해를 높이고, 실용적인 설계 지침을 제공하며, 이론적 확장에 기여한다. 또한, 이 연구는 향후 다른 분야에서 데이터 기반 커뮤니케이션을 지원하는 시스템의 설계가 어떻게 이뤄져야 하는지에 대한 기초를 제공한다.The prevalence of smartphones and wearable devices has led to a dramatic increase in patient-generated health data (PGHD). The growing interest in PGHD has offered new opportunities to improve doctor-patient communication to become more data-driven. Data-driven communication using PGHD enables patients and physicians to fill in gaps between understandings by supplementing existing clinical data, as well as providing a more comprehensive picture of ongoing patient health. However, challenges in integrating such new types of data and technologies into existing healthcare communications remain. Patients often lose their engagement and motivation in data collection, resulting in incomplete data. Even if PGHD is wholly collected, physicians and patients encounter challenges in utilizing such data--representation and interpretation--in healthcare practices. Furthermore, it is challenging for both patients and physicians to collaborate through PGHD in the current workflow due to the lack of time and information overload. From the HCI research perspective, designing a system supporting data-driven communication utilizing PGHD has the potential to address such challenges, which calls for further exploration in four design spaces: data collection, representation, interpretation, and collaboration. Therefore, in this dissertation work, I aim to explore unsolved questions in each design space by conducting a series of design and deployment studies and provide empirical findings and design guidelines. In the design space of data collection, I investigated how the semi-automated tracking tool can support patients to track various types of PGHD, especially food journaling. With the design of mFood Logger, a semi-automated data tracking tool, I conducted an empirical study with 20 patients and 6 clinicians. I identified desired data types for data-driven communication from the patients' and clinicians' sides and uncovered the challenges and opportunities in collecting data within clinical contexts. I was able to understand the feasibility and acceptability of PGHD in clinical practices, as well as clinicians' presence--either remotely or in-person--as an enabler that encourages patients to keep tracking PGHD in the longer-term. Incorporating critical topics regarding data collection from the literature and findings from my work, I discuss the applicability of PGHD and data tracking modes. To support data representation for clinicians, I designed and implemented DataMD that displays PGHD, considering situational constraints through a participatory design process with 18 various stakeholders (e.g., clinicians, EMR developers). Through the participatory design workshop, I found that the ways of data representation that clinicians desired converged to efficiency and familiarity due to the situational constraints. Clinicians wanted to see a large amount of data at once, avoiding using novel visualization methods due to the issue of learnability. Considering those requirements, I designed and implemented DataMD, in which various types of PGHD are represented with considerations of clinical contexts. I discussed the role of data representation in data-driven communication. As the critical aspect of data-driven communication, I present different data-interpretation strategies from patients, providing design guidelines to help effective data-interpretation. By conducting interviews with 20 chronic disease patients, I found that they shaped their interests and assumptions by incorporating prior experiences rather than logical evidence. I also identified four data-interpretation strategies: finding evidence to confirm assumptions, discrediting data to preserve initial assumptions, discovering new insights, and deferring drawing hasty conclusions from data. These understandings help designers and researchers advance the design of systems to support data-interpretation. Lastly, to support collaboration via data, I demonstrate how clinicians and patients collaborate by sharing and utilizing PGHD based on the system I designed. I deployed the integrated system consisting of a patient app, MyHealthKeeper, and a clinician interface, DataMD. I investigated how the system could support collaboration via data. Clinical outcomes revealed that collaboration via PGHD led patients to succeed in behavior change. App usage log also showed that patients could even remotely collaborate with clinicians without direct interactions. Findings from these studies indicate that the key opportunities to facilitate collaboration between clinicians and patients are the integration of data prescriptions into the clinician's workflow and intervention based on natural language feedback generated within clinical contexts. Across these studies, I found that the design for data-driven communication can support patients and physicians to collaborate through PGHD. By conceptualizing how PGHD could improve the existing doctor-patient communication to data-driven communication within four design spaces, I expect that this work will shed new light on how the design should be derived for data-driven communication between patients and physicians in the real world. Taken together, I believe this work contributes to empirical understandings, design guidelines, theoretical extensions, and artifacts in human-computer interaction, computer-supported cooperative work, and health informatics communities. This work also provides a foundation for future researchers to study how the design of the system supporting data-driven communication can empower various users situated in different contexts to communicate through data in other domains, such as learning, beyond the context of healthcare services.1 Introduction 1 1.1 Background 1 1.2 Motivation 4 1.3 Topics of Interest 5 1.3.1 Design Spaces 5 1.3.2 Research Scope 11 1.4 Thesis Statements and Research Questions 13 1.5 Thesis Overview 15 1.6 Contribution 18 1.6.1 Empirical research contributions 18 1.6.2 Artifacts contributions 18 1.6.3 Theoretical contributions 19 2 Conceptual Background & Related Work 20 2.1 Data-driven Communication in Healthcare Services 20 2.1.1 Concept of Doctor-Patient Communication 21 2.1.2 Brief History of Patient-Centered Approach 25 2.1.3 Emergence of Patient-Generated Health Data 27 2.2 Four Design Spaces for Data-Driven Communication 30 2.2.1 Data collection 34 2.2.2 Data Representation 41 2.2.3 Data Interpretation 47 2.2.4 Collaboration via Data 50 3 Data Collection: Study of mFood Logger 54 3.1 Motivation 55 3.2 Preliminary Work & Tool Design 57 3.2.1 Clinical Requirements for Data Collection 57 3.2.2 Design of Data Collection Tool: mFood Logger 60 3.3 Study Design 63 3.3.1 Participants 63 3.3.2 StudyProcedure 64 3.4 Results 69 3.4.1 PatientSide 69 3.4.2 ClinicianSide 76 3.5 Limitations & Conclusion 80 3.6 Chapter 3 Summary 81 4 Data Representation: Design of DataMD 83 4.1 Motivation 84 4.2 Preliminary Work 86 4.2.1 Workflow Journey Maps 87 4.2.2 DesignGoals 89 4.3 Study Design 90 4.3.1 Participants 91 4.3.2 ParticipatoryDesignworkshop 91 4.4 Results 92 4.4.1 DesignRequirements 92 4.4.2 Implementation: DataMD 98 4.5 Limitations & Conclusion 102 4.6 Summary of Chapter4 102 5 Data Interpretation: Data-Interpretation Strategies 103 5.1 Motivation 103 5.2 Study Design 106 5.2.1 Participants 106 5.2.2 Study Procedure 108 5.2.3 Data Analysis 110 5.3 Results 111 5.3.1 Change of Interest in Data 111 5.3.2 Assumptions on Relationships between Data Types 113 5.3.3 Data-InterpretationStrategy 117 5.4 Limitations & Conclusion 124 5.5 Summary of Chapter5 125 6 Collaboration via Data: Deployment Study 126 6.1 Motivation 127 6.2 System Design 128 6.2.1 MyHealthKeeper: Patient App 128 6.2.2 DataMD: Clinician Interface 132 6.3 Study Design 133 6.3.1 Participants 134 6.3.2 Procedure 135 6.4 Data Analysis 138 6.4.1 Statistical Analysis of Clinical Outcomes 139 6.4.2 App Usage Log 139 6.4.3 Observation Data Analysis 139 6.5 Results 140 6.5.1 Behavior Change 140 6.5.2 Data-Collection & Journaling Rate 144 6.5.3 Workflow Integration & Communication Support 146 6.6 Limitations & Conclusion 150 6.7 Summary of Chapter6 151 7 Discussion 152 7.1 Towards a Design for Data-Driven Communication 152 7.1.1 Improve Data Quality for Clinical Applicability 153 7.1.2 Support Accessibility of Data Collection 154 7.1.3 Understand Clinicians Preference for Familiar Data Representation. 157 7.1.4 Embrace Lived Experience for Rich Data Interpretation 158 7.1.5 Prioritize Workflow Integration for Successful Data-Driven Communication 163 7.1.6 Consider Risks of Using Patient-Generated Health Data in Clinical Settings 165 7.2 Opportunities for Future Work 166 7.2.1 Leverage Ubiquitous Technology to Design Data CollectionTools 166 7.2.2 Provide Data-Interpretation Guidelines for People with Different Levels of Literacy and Goals 169 7.2.3 Consider Cultural Differences in Data-Driven Communication 170 8 Conclusion 173 8.1 Summary of Contributions 173 8.2 Future Directions 175 8.3 Final Remarks 176Docto

A New Kind of Therapeutic Relationship: Exploring Factors that Influence the Effectiveness of Computer-Delivered Interventions for Alcohol Use Disorders

Computer-delivered interventions (CDI) for alcohol use comprise a relatively new treatment for individuals struggling with problematic drinking. While CDIs for alcohol misuse have proliferated over the last decade, much remains unknown about factors that influence their effectiveness. This study evaluated the performance of Overcoming Addictions (OA), a CDI based on the principles of SMART Recovery (SR). Subjects were drawn from a sample of 189 participants enrolled in a randomized clinical trial (RCT) that compared three and six-month outcomes for two interventions for problematic alcohol use: control participants were enrolled in SR meetings (face to face and/or online); experimental participants also had access to OA. Primary analyses of between group differences were conducted to detect an additive effect of OA. Further, this study explored variables thought to mediate the effectiveness of OA, and CDIs for problematic alcohol use more generally. Within the experimental group, analyses were conducted to examine whether participants amount of experience navigating the Internet accounted for any variance associated with positive outcomes; also, the study examined the mediating effect of two other closely related variables: participants\u27 sense of how easy the website was to use, and whether participants were satisfied with the amount of content on the website. Primary analysis indicated that both the control and experimental groups showed significant improvement across outcome variables, although no additional benefit of OA was detected. Finally, no evidence was found to support the hypotheses for the identified variables thought to mediate the effectiveness of OA. Implications of this null finding are discussed

The development and evaluation of a web-based diet and diabetes education programme for children with type 1 diabetes

PhD ThesisDiabetes education is one of the essential components of standard diabetes care. Rapid advances in technology have made the internet a viable mode for the delivery of educational interventions to young people with type 1 diabetes (T1D). The main purpose of this study was to develop a web-based education programme to assist in diabetes management and to provide support for children with T1D in Malaysia. The data were collected in three phases using a mix method approach. Participants were children with T1D living in Malaysia (n=64), their parents (n=12), the clinicians (n=3) and Malaysian‟ children living in Newcastle (n=12). In Phase one, the data were collected using both qualitative and quantitative methods to understand the experiences and challenges which children face living with diabetes and to identify regularly consumed carbohydrate-rich foods. In Phase two, data were gathered by a semi-structured interview and an open-ended questionnaire with healthy children in Newcastle to elicit views and general usability of the programme. In the final Phase, Phase three, children with T1D and their families were recruited and introduced to the programme and guided in its use at home. Semi-structured interviews were conducted with children, parents and clinicians, and the questionnaires were used with children in order to gain participants‟ views, experiences and acceptance of the system. Children used the programme for a period of six months. Most children reported using the programme to obtain information about carbohydrate content of the food and drink they consumed and adjusting their insulin accordingly. They also reported they had made changes in their food choices based on the information and knowledge they obtained from the programme. Most of them did not record their blood glucose regularly in the programme. The majority felt confident in managing their diet, insulin, and monitoring their blood glucose, however, a few reported lack of confidence and difficulty managing their diabetes. Clinicians indicated that the programme was feasible to use in the clinic setting to teach and review children‟ blood glucose and dietary intake, and to support children when they faced any problems related to their diabetes. The clinicians believed that the programme had the most application for children as a self-education and self-management system. Overall, participants described the programme as useful, accessible and beneficial for managing diet and diabetes. This study demonstrated feasibility of using the web-based education programme. Further research is required to determine the effectiveness of the programme in improving diabetes management of T1D by young people.Malaysian governmen

The Outcome of a Multidimensional Intervention Strategy for the Management of Generalized Anxiety Disorder in an Internal Medicine Setting

Anxiety disorders are very prevalent in the United States. The most common type, Generalized Anxiety Disorder (GAD), affects 6.8 million adults every year. GAD can cause significant deficits in a person’s ability to function, decrease their quality of life and increases a person’s risk of attempting suicide. The purpose of this evidence-based practice (EBP) project was to improve the outcomes of adults diagnosed with GAD in an internal medicine setting by implementing a protocol composed of a combination of interventions. A thorough literature search was conducted to find the best available evidence to support the project. A total of 11 pieces of evidence were used and the Johns Hopkins Appraisal Tool was used to grade the evidence. After a thorough review of the literature, it was concluded that best practice for the treatment of GAD was a combination of interventions that included verbal and written education, cognitive behavioral therapy (CBT), using an online application, and medication therapy. This protocol was implemented in an internal medicine office in Indianapolis, IN. A total of 12 participants completed the project. Their anxiety was measured using the Generalized Anxiety Disorder-7 (GAD-7) questionnaire at baseline, then at two, four and eight weeks after implementation. To analyze the data, a one-way ANOVA will be used to measure the effectiveness of the protocol. Further recommendations should focus on the treatment of generalized anxiety disorder in non-psychiatric care settings

A Mobile-based drugs and alcohol addiction self-assessment and management scheme

Thesis submitted in partial fulfillment of the requirements for the Degree of Master of Science in Mobile Telecommunication and Innovation at (MSc.MTI) at Strathmore UniversityThe number of people dying of drugs and alcohol induced causes is alarmingly high and is gradually rising. One reason for the high numbers is that most drugs and alcohol users are not aware when they transition into addicts. However, some users believe that they are in control of their drugs and alcohol usage. Other users might be aware of their addiction but may not get help due to: the high cost of getting help, the absence of help, or the fear of stigmatisation. Some of those aware might have accepted the addiction as part of their life, or might have other personal reasons for not seeking help. To reduce the deaths, drugs and alcohol users need to know if they are addicted, the severity of the addiction and how to manage the addiction. To identify and manage an addiction, a drugs and alcohol assessment is done by a trained clinician who then recommends ways to help manage the addiction. This could be costly to most drugs and alcohol users, and family or friends might get involved which can lead to stigmatisation. A review on drugs and alcohol assessment tools and existing applications was done to get an understanding of how the tools work and how they can be improved. Existing drugs and alcohol assessment and management mobile applications where analysed to identify their strengths and areas of improvements. The review of the tools and analysis of the assessment applications provided the requirements needed for the research. The identified requirements helped in designing a scheme that was implemented to help the users and addict. The solution was verified and validated to make sure that it meets the users’ requirements through accurate assessment results on drugs and alcohol use, and enabling addicts manage their addictions. The methodology used was applied research through prototyping. This was done by using a quantitative and qualitative research approach using: interviews, observation, questionnaires and documentary analysis. Interviews with drugs and alcohol users, addicts and clinicians was done to find out the need of the application and their expectations and suggestions. Observation was used to see how drugs and alcohol assessment is done, and questionnaires was given to addicts and users to identify their needs and the need of the application, existing gaps and their expectations. Documentary analysis was used to gather information on the assessment and diagnosis tools, and information on existing applications to identify their strengths and areas of improvement

Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study

This is the accepted version of the article, which has been published in final form at doi: 10.1111/hex.12011.Background: Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa. Aim: We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice. Methods: We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction. Results: The young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators. Conclusions: Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities.NIH