Stakeholders' views and opinions on existing guidelines on “How to Choose Mental Health Apps”

BackgroundMental health Applications (Mhealth Apps) can change how healthcare is delivered. However, very little is known about the efficacy of Mhealth Apps. Currently, only minimum guidance is available in Assessment and Evaluation Tools (AETs). Therefore, this project aims to understand AET developers' perspectives and end users' experiences and opinions on “how to choose a Mhealth App”.ObjectiveThe primary objectives were: (1) obtaining stakeholder's opinions and experiences of development and use of AETs for Mhealth Apps, their weaknesses and strengths, and barriers in their implementation of Mhealth Apps; (2) the experiences of App users, their analyzation and, obstacles in the use of apps; and (3) to quantify themes related to choosing a Mhealth App.MethodsThis qualitative study, used a sampling method to recruit six stakeholders (one App developer, two AET developers, an individual with lived experience of mental health illness, and two physicians) who were interviewed using a topic guide. These were examined by researchers (CT, WK, & FN) using thematic content analysis. Additionally, an anonymous online survey of 107 individuals was conducted.FindingsOur analyses revealed six main themes: (a) needs and opportunities; (b) views on Mhealth apps; (c) views & opinions on AETs; (d) implementation barriers; (e) system of evaluation and; (f) future directions. The first key concept was, all stakeholders agreed that Apps could significantly impact mental health and that end-users were unaware of mental health AETs and Apps. Secondly, due to commercial interests, end-users reliability of App evaluations requires clear conflict-free guidelines. Thirdly, AETs should be evaluated and developed through a rigorous methodology. Finally, stakeholders shared insights into future developments for AETs and Mhealth Apps. Additionally, online survey respondents chose a “health professional” as their preferred source of guidance in selecting a Mhealth app (84%) and best suited to develop guidelines (70%).ConclusionThe interviews and survey highlight the need for Mhealth Apps to be regulated and the importance of health professionals' engagement in the implementation process. Similarly, without well-defined roles for App evaluations within the health care system, it is unlikely that AETs will have wider spread use and impact without risk

Alcohol Use and Risk Drinking in Ontario Ethnic Groups

This thesis examines the prevalence and patterns of alcohol consumption among Ontario ethnic groups, as well as socio-demographic and cultural factors that increase or reduce their vulnerability to risk drinking. A mixed methods approach was applied. Qualitative data were obtained through focus group discussions with the key informants and community members from seven Ontario communities: the Polish, Portuguese, Russian, Tamil, Punjabi, Serbian and Somali. Quantitative data were derived from the CAMH Monitor, a cross-sectional survey of Ontario adults, collected between January 2005 and December 2010 (N=13,557). The results show higher prevalence of self-reported lifetime, current and risk drinking among the Canadian and the European-origin groups compared with other ethnic groups. Within-group gender differences were evident for all ethnic groups, with the narrowest gender gap being observed within the North European group and the widest in the South Asian group. First generation immigrants have generally lower prevalence of alcohol consumption and risk drinking than Canadian-born respondents, with foreign born individuals from the European groups reporting higher rates of alcohol use and risk drinking than other groups. While previous studies generally found an increase in immigrants' alcohol consumption with years in Canada, our data suggest that longer duration of residence may have either positive or negative effects on immigrants' alcohol use, depending on the country of origin/traditional drinking pattern. Although the non-European ethnic groups have higher rates of abstinence and lower alcohol consumption rates, a considerable proportion of people from these ethnic groups may be at risk of alcohol-related harm due to risky and harmful alcohol consumption patterns. Drinking levels that are considered `normal' or 'excessive', the type and size of alcoholic beverages, and the perception of the risks and problems related to alcohol use are largely shaped by cultural norms and beliefs. Socio-economic disadvantages and barriers to service utilization heighten the minority ethnic groups' vulnerability to alcohol-related problems. This theses contributes new and important evidence on the prevalence and patterns of alcohol consumption in Canada's ethnic groups, and factors that contribute to risk drinking. The findings have significant implications for prevention and service provision, particularly for minority ethnic groups that are already marginalized and unlikely to access mainstream services.Ph.D

Nature-Based Equity: An Assessment of the Public Health Impacts of Green Infrastructure in Ontario Canada

The built environment is a physical determinant of health essential to the planning and development of a more equitable society. Communities face growing challenges due to environmental stressors such as climate change, with vulnerable communities experiencing a disproportionate burden of adverse health outcomes. The interdependencies between urban planning and public health outcomes are inextricable, with respect to improving access to healthier built environments for vulnerable and marginalized groups. Widespread implementation of nature-based solutions, such as green infrastructure, provides a multi-functional strategy to support sustainable development, increase climate resilience, enhance ecological connectivity, and create healthier communities. A Health Equity Impact Assessment presents the findings of a participatory research study utilizing key informant interviews of public health unit professionals (eight) and a survey of green infrastructure volunteers and workers (36) on the impact of green infrastructure on individual and community mental and physical well-being, service use, and perceived unmet needs, using Ontario, Canada as a case study. Study findings indicate that where green infrastructure is both productive and publicly accessible, the benefits were significant for vulnerable populations. These benefits include increased social connectivity, skills development, and food security. Green infrastructure could be a viable strategy to address environmental stressors, improve health equity, and support localization of the UN Sustainable Development Goals (SDGs)

Online personalized feedback intervention to reduce risky cannabis use. Randomized controlled trial

Given the widespread use of cannabis, and the concomitant risks associated with the drug, there is a need to increase the availability of interventions designed to reduce risky cannabis use. One promising intervention in the addictions employs personalized normative feedback to motivate change. A two-arm randomized controlled trial (RCT) was conducted in which participants who used cannabis in a risky fashion were randomly assigned to one of two groups - those who received an online personalized feedback report in addition to educational materials about risky cannabis use and those who just received the online educational materials. Follow-up assessment occurred at three- and six-months post-randomization. Outcome variables included: number of days cannabis was used in the past 30, risky cannabis use (ASSIST score of four or more), and participant estimates of the proportion of cannabis users among those of the same age and gender. A total of 744 participants with risky cannabis use were recruited for the trial using online advertisements. There were no significant differences between intervention and educational materials only groups at three- and six-month follow-ups for the outcome variables, number of days used cannabis in the last 30 (p = 0.927) and proportion of participants engaging in risky cannabis use (p = 0.557). At three and six month follow-ups, participants who received the feedback intervention were more likely than those in the educational materials group to estimate that a larger proportion of people their age and gender did not use cannabis in the last year (p = 0.028). While there was some evidence that the personalized feedback intervention modified normative perceptions about cannabis use, there did not appear to be support for the prediction that the intervention reduced cannabis consumption

Examining Trends of Cigarette Smoking Amongst Syrian Refugees During Their First Two Years in Canada

This brief report explored trends of cigarette smoking among Syrian newcomers in the first two years of resettlement in Canada. 1794 adult Syrian refugees were surveyed about their physical and mental health, and smoking behaviours. Results were analyzed using descriptive statistics, Wilcoxon signed-rank tests, and logistic regressions. Almost 27% of the sample reported cigarette smoking (50% light smokers and 50% moderate/heavy smokers). Light smokers increased and moderate/heavy smokers decreased in the number of cigarettes smoked from year 1 to year 2. Moderate/heavy smokers were more likely to be male and reported higher post-traumatic stress scores, while light smokers reported higher depression scores. Only 14.3% of smokers recalled receiving advice from health care providers in Canada regarding their smoking habits. Healthcare providers should provide tailored advice to everyone who is an active smoker with a specific emphasis on those who have concurrent health issues