MENTAL HEALTH IN UNIVERSITY STUDENTS IN BANGLADESH: AN EXAMINATION OF CURRENT PRACTICES, SERVICE USE, AND AN EXPLORATION OF THE ACCEPTABILITY OF MHEALTH FOR MENTAL HEALTH AND MINDFULNESS

The prevalence of mental health problems, such as depression and suicide, is high in Bangladesh. The incidence of mental health problems in Bangladesh is highest in young adulthood and often occurs in university students. Mobile health apps are effective in Bangladesh for chronic health problems, though there is no current literature on the use of mHealth for mental health promotion in Bangladesh, nor in the university student population in Bangladesh. The study utilizes a multi-method design informed by Self-Determination Theory and the Technology Acceptance Model to explore motivational factors for mental health practices, such as coping techniques, and use of professional services, such as therapy. The quantitative component includes regression analysis of an online survey delivered to students currently enrolled in universities in Bangladesh to determine current attitudes and practices of mental health services (n=350) and the possibility of using mHealth for mental health (n=311). The qualitative component involves thematic analysis of semi-structured interviews with randomly selected students (n=12) who complete the quantitative portion of the study, regarding their opinion of mHealth for mental health app content. Results show that subjective perception of needing mental health support was the strongest predictor of clinical service utilization. Additionally, the perception of viewing mental health positively was associated with actual use of clinical services, but the association became insignificant after adjusting for the perceived need. One's social influences predicted perceived need for mental health support; and knowledge about mental health predicted positive views of clinical mental health care. Intent to use general mHealth is driven by social influence, ease of use, and perceived utility. According to this study, mobile health services are acceptable to this population and can be helpful for students with barriers to accessing traditional mental health services. The qualitative interviews revealed that students felt that guided mindfulness exercises relieved stress, and the potential of having easy access to such exercises on an app on their phone overcame barriers they had previously encountered. These findings suggest that an app with mindfulness exercises may be worth developing and testing in Bangladesh in order to promote student mental health

Reaching the Unheard: Overcoming Challenges in Health Research With Hard-To-Reach Populations

PURPOSE: Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research. METHODS: This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned. RESULTS: Creative strategies to engage hard-to-reach populations in research included considering the participants\u27 socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants\u27 preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live. CONCLUSIONS: Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective

Motivations and barriers for clinical mental health help-seeking in Bangladeshi university students: a cross-sectional study

Abstract Background University and college students are vulnerable to developing depressive symptoms. People in low-income countries are disproportionately impacted by mental health problems, yet few studies examine routes to accessing clinical services. Examining motivation and barriers toward seeking clinical mental health services in university students in Bangladesh is important. Method Using a cross-sectional survey (n = 350), we assess the relationship between the constructs of autonomy, relatedness, and competency toward using clinical mental health practices (i.e. using professional resources, taking medication) with (1) positive views, (2) perceived need, and (3) use of clinical mental health services among Bangladeshi university students. Results Results showed that the perceived need for mental health support was the predictor of the largest magnitude (aOR = 4.99, p = 0.005) for using clinical services. Having a positive view of clinical services was predictive of clinical service use (aOR = 2.87, p = 0.033); however, that association became insignificant (p = 0.054) when adjusting for the perceived need for mental health care. Of the SDT constructs, social influences were predictive of perceiving a need for mental health support, and mental health knowledge was predictive (aOR = 1.10, p = 0.001) of having a positive view of clinical mental health care. Conclusion Our findings show that knowledge of mental health is associated with positive views of mental health services, and that higher levels of stress and the presence of people with mental health problems are associated with the perception of a need for mental health care, which is ultimately responsible for using the services

Varenicline Combined With Oral Nicotine Replacement Therapy and Smartphone-Based Medication Reminders for Smoking Cessation: Feasibility Randomized Controlled Trial

BACKGROUND: Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. OBJECTIVE: This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. METHODS: A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. RESULTS: Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. CONCLUSIONS: Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966

Adverse Childhood Experiences as a Moderating Factor between Healthy Days and Amongst Adults with Obesity

BackgroundAdverse childhood experiences (ACEs) are known to be linked to a myriad of health consequences. There is also plentiful research finding that people with obesity experience poorer health. Much research has been done finding an association between ACEs and chronic diseases such as obesity; yet there have not been any studies to date examining if there is an interaction between ACEs and BMI that is significantly associated with the number of poor health days an individual experience. This study utilizes secondary analysis of cross sectional Behavioral Risk Factor Surveillance System (BRFSS) data to examine this relationship MethodsA total of 25,085 respondents of the BRFSS survey from years 2009-2015 in 4 different states (Alaska, Arkansas, New Mexico, and Washington) were used during analysis. Descriptive and linear regression analysis were used with weighted data to describe findings. ResultsAnalyses show that there is a significant interaction between BMI category and ACE experienced when looking at the outcome of poor health days both before controlling for demographic factors (p value= 0.0145), and after controlling (p value=0.0214). ConclusionFuture public health interventions must be centered upon holistic prevention of both mental health and chronic disease. Having a high BMI in conjunction with ACEs may result in higher unhealthy days due to an inability to manage the disease effectively. As such, preventative measures against ACEs must take place, and treatment for Obesity must encompass more than dietary and exercise regulations

Reaching the unheard: overcoming challenges in health research with hard-to-reach populations

Abstract Purpose Addressing obstacles such as logistical complexities, social stigma, and the impact of historical traumas is essential for the successful inclusion of underrepresented groups in health research. Methods This article reviews engagement and interview techniques used to ethically engage recently settled Afghan refugees in Oklahoma and rural Mexican-born women in Illinois in research. The paper concludes with a reflective discussion on the challenges and lessons learned. Results Creative strategies to engage hard-to-reach populations in research included considering the participants’ socioeconomic and cultural contexts in their interactions and developing community partnerships to establish trust and obtain reliable data. Other engagement strategies were communicating in the participants’ preferred language, providing assistance with reading and responding to study questions for those with low literacy, employing research staff from the population of interest, and recruiting in specific locations where the populations of interest live. Conclusions Community engagement is essential at all stages of research for building trust in hard-to-reach populations, achieving inclusivity in health research, and ensuring that interventions are culturally sensitive and effective

A qualitative exploration of university student perspectives on mindfulness-based stress reduction exercises via smartphone app in Bangladesh

Purpose Mental health problems are proliferating, and access to mental health care is difficult due to barriers imposed by the COVID-19 pandemic in low-income countries such as Bangladesh. University students are susceptible to mental health concerns, given their unique stressors (i.e., academic pressure, new social environment). Mindfulness techniques can promote mental health , yet their acceptability has not been examined among Bangladeshi university students. These techniques can be used on a digital app, to decrease barriers to use.Qualitative methods were used to examine the acceptability of mindfulness among university students in Bangladesh. In-depth interviews (n = 12) were conducted to examine student reactions to linguistically (Bangla) and culturally adapted mindfulness exercises. Thematic analysis generated three themes (1) previous experience with mindfulness (2) positive responses to and (3) improvements to mindfulness exercises. Results The results showed favourable attitudes towards the mindfulness content; students expressed positive psychological and physiological reactions. Students welcomed the concept of using these exercises on an app and felt it could overcomepast barriers to help-seeking. Conclusions This evidence suggests the value of exploring the acceptability of an app with mindfulness exercises for mental health promotion through a larger-scale pilot study in university students in Bangladesh

An Examination of Barriers to Accessing Mental Health Care, and Their Association with Depression, Stress, Suicidal Ideation, and Wellness in a Bangladeshi University Student Sample

Background: The mental health burden is high and rising among Bangladeshi university students. Understanding barriers to mental healthcare and how barriers impact mental health outcomes may inform the development of targeted interventions to decrease barriers and improve access to care. Aims: This study identifies barriers to mental healthcare and their association with mental health outcomes in a Bangladeshi university student sample. Methods: We conducted a cross-sectional survey (n = 350) on stigma-related, attitudinal, and instrumental barriers to accessing mental healthcare among Bangladeshi university students. We examined the association between stigma and non-stigma (i.e., attitudinal and instrumental) barriers with four mental health outcomes: suicidal ideation, depression, high perceived stress, and wellness. Results: Attitudinal barriers were the most reported barriers. Stigma-related barriers were significant for individuals who had experienced suicidal ideation (aOR = 2.97, p = 0.001), not for individuals with depression. Non-stigma-related barriers were significant for individuals who had experienced depression (aOR = 2.80, p = 0.011). Conclusions: The current work advances our understanding of how to improve access to mental healthcare among university students in Bangladesh. Stigma-related barriers were particularly salient for individuals who experienced suicidal ideation. Further study is needed on how stigma may impact access to care distinctly for different mental health problems among Bangladeshi university students

Engaging Children to Support Parental Weight Loss: A Randomized Trial

Background. Despite evidence that social network members influence the eating behaviors of adults, no study to date has had the primary aim of examining children as support partners for parents in a weight loss intervention. Aim. To evaluate parent adherence with eating/exercise goals and weight loss in a 6-month study engaging children as support partners. Method. Adults with obesity (body mass index ≥ 30 kg/m , n = 102) and at least one child ≥12 years were randomized to a child support or control group. In the child support group, children enrolled with their parent and engaged in a supportive behavior 2 days/week. In the control group, there was no enrolled child support. Parents in both groups selected a healthy eating strategy and daily step goal. Results. There was no difference in weight loss between the child support and control groups (−5.97 vs. −5.42 lbs, p =.81). In the child support group, 30% of children did not engage in the study. The majority of parents whose children did not engage withdrew from the study. In secondary analyses, parent adherence with eating/exercise goals increased with the days of child support (p \u3c.001). For all participants, low chaos in the home environment (p \u3c.04) and increased parent adherence with follow-ups (p \u3c.008) predicted weight loss. Conclusions. We found no treatment effect of child support on weight loss. Active child support of eating/exercise goals appeared to facilitate goal adherence, while anticipated but unrealized child support may have had iatrogenic consequences. Further investigation of family-focused weight loss interventions is warranted.