Sisira Edirippulige

The pandemic showed the potential of existing telehealth to increase healthcare access but also the need for healthcare workers to be competent and skilled in delivering care through this modality. We undertook a systematic literature review to identify telehealth-related courses developed since the start of the COVID-19 pandemic and summarised study characteristics, learning objectives, and course content. Articles describing telehealth-related training and education programs implemented between 2020 and 2024 were included. Papers were required to list specific program content or learning objectives for any educational level or type of health professional. Two authors independently extracted data. Quality of articles was assessed against the SQUIRE 2.0 guidelines. Quantitative data was summarised and reported using frequencies and percentages, learning objectives were mapped across the six Association of American Medical Colleges (AAMC) telehealth competency domains, and qualitative categories were thematically synthesised. Of 7547 articles identified, 51 were included. Most courses were implemented in the USA (82%), mostly targeted to undergraduate students (51%), and the number of articles per year increased over time. Most courses were developed by universities (53%), sometimes in collaboration with health services, and content was primarily applicable across multiple specialties. Participants nearly always evaluated the courses (90%). Content included basic knowledge and skills in telehealth, patient safety, and ethics, with learning objectives often on technology and communication. Only four programs included all AAMC telehealth competencies. This review highlights that telehealth education and training has expanded since the onset of the COVID-19 pandemic, however, current curricula are lacking experiential learning. Courses generally covered telehealth communication competencies in detail, but more content on the ethical and legal requirements, billing, physical examination, patient education, and eligibility for telehealth is required. For efficient resource use, standardised training can be applied across disciplines with addition of site or speciality-specific modules.

Interest in telehealth has led to an increase in the availability of online telehealth courses. Understanding student perspectives of the learning experience and how the courses equip students with the skills for their future professions is warranted. To this end, five health, education, and social science electronic databases and a search engine (i.e., Pubmed, EBSCO, Proquest, Elsevier, and Google Scholar) were searched as part of a systematic review for peer-reviewed research published in English over 10 years (2013-2023). Ten studies were selected for the final review, resulting in the perspectives of 2,305 healthcare students and professionals. The curriculum content and student feedback were synthesised using thematic analyses and presented using a combination of flowcharts and tables. Each study was also assessed for bias using critical appraisal tools for qualitative, quantitative and mixed-method research designs. Key pedagogical themes emerged, including simulations, interprofessional collaboration, resources, self-directed learning, peer learning, feedback, and technology. The use of simulations and interprofessional collaboration emerged as the two most regularly cited aspects of teaching that students found useful. Recommendations described potential inclusion of pedagogical techniques when conducting online training, and teaching methodology requiring further investigation.

Introduction: Universal digital mental health interventions (DMHIs) are emerging as a viable approach to promoting mental health among children and adolescents in general population. However, there is a scarcity of meta-analyses that examined their short- and long-term effects or potential moderators in individuals aged 19 or younger. Methods: A systematic search was conducted to identify randomised controlled trials that delivered universal DMHIs for promoting mental health, targeting children and adolescents aged 19 or younger in general population. Meta-analysis was performed to identify studies using Comprehensive Meta-Analysis. Results: The meta-analysis of 29 included studies identified significant overall effects ( g = 0.16) as well as significant effects for anxiety ( g = 0.09), depression ( g = 0.06), psychological distress ( g = 0.28), externalising problem ( g = 0.21), psychological well-being ( g = 0.19), interpersonal functioning ( g = 0.21) and social-emotional skills ( g = 0.19) at post-intervention. The analysis of 7 studies that followed up 6 months or longer revealed a significant overall effect ( g = 0.09) as well as significant effects for anxiety ( g = 0.11) and depression ( g = 0.05) at follow-up. Age and intervention duration moderated the overall effects. Gamification moderated the effect on depression. Attrition rate moderated the effect on social-emotional skills. Conclusions: Providing universal DMHIs with longer durations to younger children may be critical for effectively improving a range of mental health outcomes among children and adolescents. To promote engagement and effectiveness, future studies may explore how gamification and other features for reducing attrition could be effectively incorporated into DMHIs.

Background: Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. Objective: Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. Methods: Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. Results: We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and “other” (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. Conclusions: Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-048964

BACKGROUND Population studies show that musculoskeletal conditions are a leading contributor to the total burden of healthy life lost, second only to cancer and with a similar burden to cardiovascular disease. Prioritizing the delivery of effective treatments is necessary, and with the ubiquity of consumer smart devices, the use of digital health interventions is increasing. Messaging is popular and easy to use and has been studied for a range of health-related uses, including health promotion, encouragement of behavior change, and monitoring of disease progression. It may have a useful role to play in the management and self-management of musculoskeletal conditions. OBJECTIVE Previous reviews on the use of messaging for people with musculoskeletal conditions have focused on synthesizing evidence of effectiveness from randomized controlled trials. In this review, our objective was to map the musculoskeletal messaging literature more broadly to identify information that may inform the design of future messaging interventions and summarize the current evidence of efficacy, effectiveness, and economics. METHODS Following a prepublished protocol developed using the Joanna Briggs Institute Manual for Evidence Synthesis, we conducted a comprehensive scoping review of the literature (2010-2022; sources: PubMed, CINAHL, Embase, and PsycINFO) related to SMS text messaging and app-based messaging for people with musculoskeletal conditions. We described our findings using tables, plots, and a narrative summary. RESULTS We identified a total of 8328 papers for screening, of which 50 (0.6%) were included in this review (3/50, 6% previous reviews and 47/50, 94% papers describing 40 primary studies). Rheumatic diseases accounted for the largest proportion of the included primary studies (19/40, 48%), followed by studies on multiple musculoskeletal conditions or pain sites (10/40, 25%), back pain (9/40, 23%), neck pain (1/40, 3%), and “other” (1/40, 3%). Most studies (33/40, 83%) described interventions intended to promote positive behavior change, typically by encouraging increased physical activity and exercise. The studies evaluated a range of outcomes, including pain, function, quality of life, and medication adherence. Overall, the results either favored messaging interventions or had equivocal outcomes. While the theoretical underpinnings of the interventions were generally well described, only 4% (2/47) of the papers provided comprehensive descriptions of the messaging intervention design and development process. We found no relevant economic evaluations. CONCLUSIONS Messaging has been used for the care and self-management of a range of musculoskeletal conditions with generally favorable outcomes reported. However, with few exceptions, design considerations are poorly described in the literature. Further work is needed to understand and disseminate information about messaging content and message delivery characteristics, such as timing and frequency specifically for people with musculoskeletal conditions. Similarly, further work is needed to understand the economic effects of messaging and practical considerations related to implementation and sustainability. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2021-048964

Telemedicine is viewed as a crucial tool for addressing the challenges of limited medical resources at healthcare facilities. However, its adoption in healthcare is not entirely realised due to perceived barriers. This systematic review outlines the critical facilitators and barriers that influence the implementation of telemedicine in the Indian healthcare system, observed at the infrastructural, socio-cultural, regulatory and financial levels, from the perspectives of healthcare providers, patients, patient caregivers, society, health organisations and the government. This review complies with the current PRISMA-P protocol. 1200 peer-reviewed studies published from December 2016 to December 2021 in the PubMed, Cochrane, Scopus, Web of Science, CINAHL, MEDLINE and PsycInfo databases were considered for the title and abstract screening, after which 157 articles were chosen for the full-text review. In the end, 26 studies were selected for data synthesis. Data privacy and security concerns, doctor and patient resistance to information and communications technology (ICT), poor infrastructure, and lack of ICT training were considered significant barriers to implementing telemedicine. However, reduced healthcare delivery costs, improved patient access to healthcare in remote areas, and reduced patient waiting times all helped promote telemedicine implementation. The review outcomes also revealed that the barriers and facilitators at the regulatory and financial level largely influenced the adoption of telemedicine systems in India, with 59% (n=20) articles citing a reduction in healthcare delivery costs as the critical facilitator and 59% citing fear of violation of patient privacy and security as the significant barrier.

Background: Stress in adolescence is associated with adverse mental health outcomes. Coping resources have been proved by literature to have buffering effects on the impact of stress on mental health. It is imperative to understand the stress and coping strategies of adolescents. However, to date, there has been a scarce of qualitative examination of stress and coping strategies in adolescents in a Chinese population.Objectives: This study aimed to understand the stress experience and coping strategies of high school students in China.Methods: This study adopted a qualitative design involving three focus group interviews. A purposive sampling method was used to recruit high school students who were enrolled in grades 10 to 11, and their teachers, at a Chinese high school which resulted in 20 students and 9 teacher participants. Data were analysed using inductive thematic analysis.Results: A total of 4 themes were identified: (i) sources of stress; (ii) impacts of stress (iii) coping strategies used by students; and (iv) recommendations for stress management programs. Students experienced excessive stress in their daily lives. The primary source of stress came from high expectations for academic achievement. Other sources of stress were peer relationships and family issues. The stress had negative impacts on students’ emotions, sleep, study, and mental wellbeing. The students demonstrated various coping strategies, with the most common being avoidant coping. Students and teachers agreed that the coping strategies were not effective in reducing stress in the long run and that more coping skills training was needed.Conclusions: This study is the first to assess the perceptions of Chinese high school students and their teachers regarding adolescent stress experiences and coping strategies. Chinese high school students experienced significant stress in their daily lives and demonstrated unhelpful coping strategies. Participants demonstrated consensus that they did not have the skills to cope. There is a demonstrated need for interventions that focus on increasing coping skills in this population.

The practice of neuroscience-informed psychotherapy (NIP) that aims to refine the existing practice of psychotherapy is a recent topic in psychotherapy research. The researcher interviewed 25 Japanese psychotherapists and investigated the presence, benefits and needs of NIP and the potential barriers that may hinder the learning of NIP. A thematic analysis identified that the practice of NIP is currently limited in Japan due to limited learning opportunities. However, a minor proportion of Japanese psychotherapists practice NIP and experienced benefits, such as developing confidence in performing psychotherapy and effectively guiding clients to normalize problems. NIP may benefit psychotherapists in Japan and other Asian countries as psychotherapy in Japan and other Asian countries share many characteristics influenced by Confucianism, Buddhism and Westernization.