Publications by authors named "Lisa A Marsch"

144 Publications

Comparing the feasibility of four web-based recruitment strategies to evaluate the treatment preferences of rural and urban adults who misuse non-prescribed opioids.

Prev Med 2021 Sep 7:106783. Epub 2021 Sep 7.

Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA. Electronic address:

This cross-sectional study examined the feasibility of using four different web-based strategies to recruit rural and urban adults who use opioids non-medically for a survey on opioid use disorder (OUD) treatment preferences, and compared the treatment preferences of rural versus urban participants. Preferences for medication for opioid use disorder (MOUD) formulation and OUD treatment models were assessed through an online survey. Recruitment advertisements were shown on Facebook, Google AdWords, Reddit, and Amazon Mechanical Turk (MTurk). Participants were categorized by zip code into urban versus rural residence using the Centers for Medicaid and Medicaid Health Resources and Services Administration definitions. OUD treatment preferences were compared using chi-square and t-tests. Among the 851 participants recruited, 815 provided zip codes and were classified as residing in rural (n = 200, 24.5%) or urban (n = 615, 75.4%) regions. A crowdsourcing service (MTurk) recruited the most rural participants, while posts on a social news website (Reddit) recruited the most urban participants (χ = 17.0, p < 0.01). While preferred MOUD formulation and OUD treatment model did not differ by rurality, rural participants were more likely to report a willingness to receive OUD treatment integrated with general medical care (χ = 18.9, p < 0.0001). This study demonstrated that web-based strategies are feasible for recruiting rural adults who misuse opioids. Results suggest OUD treatment preferences largely did not differ by rural residence, and highlight the importance of enhancing the availability and increasing education about MOUD formulations in rural regions.
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http://dx.doi.org/10.1016/j.ypmed.2021.106783DOI Listing
September 2021

Insomnia predicts treatment engagement and symptom change: a secondary analysis of a web-based CBT intervention for veterans with PTSD symptoms and hazardous alcohol use.

Transl Behav Med 2021 Aug 31. Epub 2021 Aug 31.

Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH 03766, USA.

Posttraumatic Stress Disorder (PTSD) and hazardous drinking are highly comorbid, and often more severe than PTSD or hazardous drinking alone. Integrated, web-based interventions for PTSD/hazardous drinking may increase access to care, but have demonstrated equivocal results in reducing PTSD and hazardous drinking. One factor that may explain treatment engagement and symptom change is the presence of insomnia symptoms. The current study conducted secondary data analysis of a randomized controlled trial of an integrated web-based intervention for PTSD symptoms and hazardous drinking to examine insomnia symptoms as predictors of PTSD symptoms, alcohol use, and treatment engagement. In the parent study, 162 veterans in primary care reporting PTSD symptoms and hazardous drinking were randomized to receive either the intervention or treatment as usual. The current study examined insomnia among veterans who received the intervention (n = 81). Regression models tested baseline insomnia symptoms as predictors of treatment engagement, follow-up PTSD symptoms, and alcohol use. Hierarchical regression models tested change in insomnia during treatment as a predictor of follow-up PTSD symptoms and alcohol use. Results showed baseline insomnia predicted treatment engagement and follow-up drinking days, but not PTSD symptoms or heavy drinking days. Although overall change in insomnia was small, it predicted follow-up PTSD and heavy drinking days, but not drinking days. Results are consistent with previous research highlighting the importance of identifying and treating insomnia in the course of integrated treatment for PTSD/hazardous drinking. Future research should investigate how to best integrate insomnia, PTSD, and/or hazardous drinking interventions to maximize treatment engagement.
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http://dx.doi.org/10.1093/tbm/ibab118DOI Listing
August 2021

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 8;50 Suppl 1:52-63. Epub 2021 Aug 8.

Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, United States.

Introduction: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study.

Objectives: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process.

Methods: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors.

Results: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions.

Conclusions: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.008DOI Listing
July 2021

Scaling Up Science-Based Care for Depression and Unhealthy Alcohol Use in Colombia: An Implementation Science Project.

Psychiatr Serv 2021 Aug 4:appips202000041. Epub 2021 Aug 4.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (Marsch, Bartels, Bell, Martinez Camblor, Cubillos, John, Lemley, Torrey); Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia (Gómez-Restrepo, Castro, Cárdenas Charry, Cepeda, Jassir, Suárez-Obando, Uribe); Hospital Universitario San Ignacio, Bogotá, Colombia (Gómez-Restrepo, Suárez-Obando); Department of Psychiatry, Dartmouth-Hitchcock, Lebanon, New Hampshire (Cubillos, Torrey); National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland (Williams).

Background: Mental disorders are a major cause of the global burden of disease and significantly contribute to disability and death. This challenge is particularly evident in low- and middle-income countries (LMICs), where >85% of the world's population live. Latin America is one region comprising LMICs where the burden of mental disorders is high and the availability of mental health services is low. This is particularly evident in Colombia, a country with a long-standing history of violence and associated mental health problems.

Methods: This article describes the design of a multisite implementation science project, "Scaling Up Science-Based Mental Health Interventions in Latin America" (also known as the DIADA project), that is being conducted in six primary care systems in Colombia. This project, funded via a cooperative agreement from the National Institute of Mental Health, seeks to implement and assess the impact of a new model for promoting widespread access to mental health care for depression and unhealthy alcohol use within primary care settings and building an infrastructure to support research capacity and sustainability of the new service delivery model in Colombia. This care model centrally harnesses mobile health technology to increase the reach of science-based mental health care for depression and unhealthy alcohol use.

Results: This initiative offers great promise to increase capacity for providing and sustaining evidence-based treatment for depression and unhealthy alcohol use in Colombia.

Next Steps: This project may inform models of care that can extend to other regions of Latin America or other LMICs.
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http://dx.doi.org/10.1176/appi.ps.202000041DOI Listing
August 2021

Mobile Augmented Screening to Increase HIV Testing Among Emergency Department Patients as Young as 13 Years.

Cureus 2021 Jun 22;13(6):e15829. Epub 2021 Jun 22.

Epidemiology, New York University School of Global Public Health, New York, USA.

Because adolescents and emerging adults are frequently not offered HIV testing, and often decline tests when offered, we developed and tested a tablet-based intervention to increase HIV test rates among emergency department (ED) patients aged 13-24 years. Pediatric and adult ED patients in a high volume New York City hospital (N = 295) were randomized to receive a face-to-face HIV test offer, or to complete a tablet-based intervention that contained an HIV test offer delivered via computer. Test rates in both conditions were then compared to historic test rates in the same ED during the previous six months. Among participants aged 19 years and younger who were offered HIV testing and declined before enrollment in the study, participants in the tablet-based condition were 1.7 times more likely to test for HIV compared to participants in the face-to-face condition. Participants aged 19 years and younger were three times as likely to test for HIV compared to patients the same age who were treated in the previous six months (26.39%, n = 71 study participants vs. 10.29%, n = 189 prior patients, OR = 3.13, [Formula: see text] = 54.76, p < 0.001). Protocols designed to offer HIV testing to all eligible patients can significantly increase adolescent test rates compared to standard practice. Because tablets are equally effective compared to face-to-face offers, and in some cases more so, EDs may consider tablet-based interventions that require fewer staff resources and may integrate more easily into high-volume workflows.
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http://dx.doi.org/10.7759/cureus.15829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8301293PMC
June 2021

Relationship between the sociodemographic characteristics of participants in the DIADA project and the rate of compliance with follow-up assessments in the initial stage of the intervention.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 21;50 Suppl 1:102-109. Epub 2021 Jul 21.

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.

Objective: Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care.

Methods: A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of 3 months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at 3 months after study initiation.

Results: At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than 3 months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (95 % [CI] 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment.

Conclusions: The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.006DOI Listing
July 2021

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 17;50 Suppl 1:64-72. Epub 2021 Jul 17.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.

Introduction: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

Methods: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data.

Results: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
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http://dx.doi.org/10.1016/j.rcpeng.2021.01.001DOI Listing
July 2021

Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 16;50 Suppl 1:73-82. Epub 2021 Jul 16.

Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth College.

Harmful alcohol use is a public health problem worldwide, contributing to an estimated 5.1% of the global burden of illness. Screening and addressing at-risk drinking in primary care settings is an empirically supported health care intervention strategy to help reduce the burden of alcohol-use problems. In preparation for introducing screening and treatment for at-risk drinking in primary care clinics in Colombia, we conducted interviews with clinicians, clinic administrators, patients, and participants in Alcoholics Anonymous. Interviews were conducted within the framework of the Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (DIADA, [Detection and Integrated Care for Depression and Alcohol Use in Primary Care] www.project-diada.org) research project, and its qualitative phase that consisted of the collection of data from 15 focus groups, 6 interviews and field observations in 5 regional settings. All participants provided informed consent to participate in this research. Findings revealed the association of harmful alcohol use with a culture of consumption, within which it is learned and socially accepted practice. Recognition of harmful alcohol consumption includes a social context that influences its screening, diagnosis and prevention. The discussion highlights how, despite the existence of institutional strategies in healthcare settings and the awareness of the importance of at-risk drinking among health personnel, the recognition of the harmful use of alcohol as a pathology should be embedded in an understanding of historical, social and cultural dimensions that may affect different identification and care scenarios.
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http://dx.doi.org/10.1016/j.rcpeng.2020.11.004DOI Listing
July 2021

Patterns of digital information and communication technology use among patients at primary health care centres in Colombia: Phase I of the DIADA project.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 10;50 Suppl 1:116-132. Epub 2021 Jul 10.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, USA.

Objective: Assess the prevalence and types of digital technology use, as well as the extent to which patients use the internet and mobile devises. Evaluate the socioeconomic characteristics of patients and the possible relation to patterns of technology use in Colombia. Understand the nature of patient technology use in primary care for finding medical information.

Methods: A survey was applied to adult patients who attended primary health care centers systems in 6 Colombian cities. The survey inquired about demographic characteristics, insurance, access to services, cell phone use, internet access, and the use of such technology to access health-related services and information. Data was collected and managed using REDCap. Summary statistics on each survey item were calculated and the differences between discrete variables were analyzed using chi-square. Multivariate analyses were performed using logistic regression analysis for binary dependent variables.

Results: A total of 1580 patients were surveyed across the six study sites. 93% of the patients reported they have a cell phone. Patients from urban healthcare centers showed a higher use of the Internet on their phone than less urban settings. Around half of the surveyed patients reported Internet use (49.7%). Among Internet users, 65% of participants use the Internet looking for health care information. Around one-third of patients use cellphones to arrange clinic visits. Around 24% of participants answered positively for both Whooley's questions. Of those who screened positive on the Whooley questions, 43% reported being moderately anxious, 47% reported being very anxious. 51% reported having moderate pain; 52% reported having severe pain.

Conclusions: The patterns of technology use identified in this study are essential for developing future health interventions based on ICT. The design of ICT clinical interventions must take into account the cellphone payment plans, availability of internet connection, advantages, and disadvantages of messenger services, including SMS as a possible alternative to people who do not have smartphones.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.003DOI Listing
July 2021

Characterizing the perceived stigma towards mental health in the early implementation of an integrated services model in primary care in Colombia. A qualitative analysis.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 10;50 Suppl 1:91-101. Epub 2021 Jul 10.

Pontificia Universidad Javeriana, Bogotá, Colombia.

Background: Stigma is a sociocultural barrier to accessing mental health services and prevents individuals with mental health disorders from receiving mental health care. The Ministry of Health and Social Protection of Colombia acknowledges that a great number of people with mental disorders do not seek medical aid due to stigma.

Objectives: Characterise the perceived stigma towards mental health among the stakeholders involved in the early implementation of the DIADA project [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)]. Explore whether the implementation of this model can decrease stigma. Describe the impact of the implementation on the lives of patients and medical practice.

Materials And Methods: Eighteen stakeholders (7 patients, 5 physicians and 6 administrative staff) were interviewed and a secondary data analysis of 24 interview transcripts was conducted using a rapid analysis technique.

Results: The main effects of stigma towards mental health disorders included refusing medical attention, ignoring illness, shame and labelling. Half of the stakeholders reported that the implementation of mental health care in primary care could decrease stigma. All of the stakeholders said that the implementation had a positive impact.

Conclusions: The perceived stigma was characterised as social and aesthetic in nature. Communication and awareness about mental health is improving, which could facilitate access to mental health treatment and strengthen the doctor-patient relationship. Culture is important for understanding stigma towards mental health in the population studied.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.009DOI Listing
July 2021

Health-related quality of life and health literacy among adult primary care patients with subsidized or contributive health insurance in Colombia.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 9;50 Suppl 1:22-29. Epub 2021 Jul 9.

Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.

Context: Colombia passed Law 100 in 1993 with the goal of providing universal health care coverage, and by 2013, over 96% of the Colombian population had health insurance coverage. However, little is known about how health-related quality of life (HRQoL) and health literacy are related among those with the two most common types of health insurance coverage: subsidized (those with lower incomes) and contributory (those with higher incomes) coverage.

Objectives And Methods: In the current exploratory investigation, data from adults visiting six primary care clinics in Colombia were analysed to examine the relationship between HRQoL (assessed as problems with mobility, self-care, completing usual activities, pain/discomfort, and anxiety/depression), demographics, the two health insurance types, and health literacy. Analyses also assessed whether, within insurance types, health literacy was related to HRQoL.

Results: Results showed that those with contributory health insurance coverage had greater health literacy than those with subsidized coverage, and this was accounted for by differences in education and socioeconomic status. HRQoL did not differ by insurance type. Although lower health literacy was related to worse HRQoL in the overall sample, in subgroup analyses lower health literacy significantly related to worse HRQoL only among those with subsidized health insurance coverage.

Conclusion: Targeting skills which contribute to health literacy, such as interpreting medical information or filling out forms, may improve HRQoL, particularly in those with subsidized insurance coverage.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.005DOI Listing
July 2021

Scaling up mental health interventions for depression and unhealthy alcohol use in Colombia.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 10;50 Suppl 1:1-3. Epub 2021 Jul 10.

Investigadora Principal, Director Center for Technology and Behavioral Health, Andrew G. Wallace Professor, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States.

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http://dx.doi.org/10.1016/j.rcpeng.2021.06.001DOI Listing
July 2021

An Examination of the Feasibility of Detecting Cocaine Use Using Smartwatches.

Front Psychiatry 2021 24;12:674691. Epub 2021 Jun 24.

Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States.

As digital technology increasingly informs clinical trials, novel ways to collect study data in the natural field setting have the potential to enhance the richness of research data. Cocaine use in clinical trials is usually collected self-report and/or urine drug screen results, both of which have limitations. This article examines the feasibility of developing a wrist-worn device that can detect sufficient physiological data (i.e., heart rate and heart rate variability) to detect cocaine use. This study aimed to develop a wrist-worn device that can be used in the natural field setting among people who use cocaine to collect reliable data (determined by data yield, device wearability, and data quality) that is less obtrusive than chest-based devices used in prior research. The study also aimed to further develop a cocaine use detection algorithm used in previous research with an electrocardiogram on a chestband by adapting it to a photoplethysmography sensor on the wrist-worn device which is more prone to motion artifacts. Results indicate that wrist-based heart rate data collection is feasible and can provide higher data yield than chest-based sensors, as wrist-based devices were also more comfortable and affected participants' daily lives less often than chest-based sensors. When properly worn, wrist-based sensors produced similar quality of heart rate and heart rate variability features to chest-based sensors and matched their performance in automated detection of cocaine use events. www.ClinicalTrials.gov, identifier: NCT02915341.
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http://dx.doi.org/10.3389/fpsyt.2021.674691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8264124PMC
June 2021

The DIADA project: A technology-based model of care for depression and risky alcohol use in primary care centres in Colombia.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 7;50 Suppl 1:4-12. Epub 2021 Jul 7.

Department of Psychiatry, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, United States.

Introduction: People with mental health conditions frequently attend primary care centers, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centers in Colombia.

Methods: Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in six urban and rural primary care centers in Colombia. The model included a series of steps aimed at screening patients attending medical appointments with general practitioners and supporting the diagnosis and treatment given by the general practitioner. We describe the model, its implementation and the characteristics of the screened and assessed patients.

Results: During the implementation period, we conducted 22,354 screenings among 16,188 patients. The observed rate of general practitioner (GP)-confirmed depression diagnosis was 10.1% and of GP-confirmed diagnosis of unhealthy alcohol use was 1.3%. Patients with a depression diagnosis were primarily middle-aged women, while patients with unhealthy alcohol use were mainly young adult men.

Discussion: The provision of training and technology-based strategies to screen patients and support the decision-making of GPs during the medical appointment enhanced the diagnosis and care provision of patients with depression and unhealthy alcohol use. However, time constraints, as well as structural and cultural barriers, were challenges for the implementation of the model, and the model should take into account local values, policies and resources to guarantee its long-term sustainability. As such, the long-term sustainability of the model will depend on the alignment of different stakeholders, including decision-makers, institutions, insurers, GPs, patients and communities, to reduce the amount of patients seeking medical care whose mental health conditions remain undetected, and therefore untreated, and to ensure an appropriate response to the demand for mental healthcare that was revealed by the implementation of our model.
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http://dx.doi.org/10.1016/j.rcpeng.2020.11.005DOI Listing
July 2021

A characterisation of social media users within the primary care system in Colombia and predictors of their social media use to understand their health.

Rev Colomb Psiquiatr (Engl Ed) 2021 Jul 7;50 Suppl 1:42-51. Epub 2021 Jul 7.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, United States.

Introduction: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).

Methods: As part of a larger scale-up study, we surveyed 1580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour.

Results: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%).

Conclusions: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
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http://dx.doi.org/10.1016/j.rcpeng.2021.06.002DOI Listing
July 2021

Technology-Delivered Intervention Strategies to Bolster HIV Testing.

Curr HIV/AIDS Rep 2021 08 9;18(4):391-405. Epub 2021 Jun 9.

Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA.

Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations. PURPOSE OF REVIEW: This non-systematic review provides an overview of the scientific research between 2015 and 2020 focused on the use of digital technology to bolster HIV testing and suggests novel technologies for exploration. RECENT FINDINGS: A total of 40 studies were included in the review that span a wide range of available technology. Studies effectively increased HIV testing among study participants. Generally, participants in the intervention/exposure groups had significantly higher rates of HIV test uptake compared to participants in the comparison groups at study follow-up. For a variety of reasons (e.g., differences in ways the technologies were used and study design), no digital tool clearly performed better than others, but each have the capacity to increase outreach and self-testing. An exploration of the potential use of nascent technologies is also discussed, as well as the authors' experiences using a number of these technologies in our research.
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http://dx.doi.org/10.1007/s11904-021-00565-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8188945PMC
August 2021

Feasibility of mHealth interventions for depressive symptoms in Latin America: a systematic review.

Int Rev Psychiatry 2021 May 9;33(3):300-311. Epub 2021 Jun 9.

Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.

Depression is a prevalent disorder and leading cause of disability in Latin America, where the mental health treatment gap is still above 50%. We sought to synthesise and assess the quality of the evidence on the feasibility of mHealth-based interventions for depression in Latin America. We conducted a literature search of studies published in 2007 and after using four electronic databases. We included peer-reviewed articles, in English, Spanish or Portuguese, that evaluated interventions for depressive symptoms. Two authors independently extracted data using forms developed a priori. We assessed appropriateness of reporting utilising the CONSORT checklist for feasibility trials. Eight manuscripts were included for full data extraction. Appropriate reporting varied greatly. Most ( = 6, 75%) of studies were conducted in primary care settings and sought to deliver psychoeducation or behaviour change interventions for depressive symptoms. We found great heterogeneity in the assessment of feasibility. Two studies used comparator conditions. mHealth research for depression in Latin America is scarce. Included studies showed some feasibility despite methodological inconsistencies. Given the dire need for evidence-based mental health interventions in this region, governments and stakeholders must continue promoting and funding research tailored to cultural and population characteristics with subsequent pragmatic clinical trials.
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http://dx.doi.org/10.1080/09540261.2021.1887822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8318676PMC
May 2021

The DIADA Project: A technology-based model of care for depression and risky alcohol use in Primary Care Centres in Colombia.

Rev Colomb Psiquiatr 2021 Jun 15;50 Suppl 1:4-13. Epub 2021 May 15.

Department of Psychiatry, Dartmouth's Geisel School of Medicine, Dartmouth College, Hanover (New Hampshire), Estados Unidos.

Introduction: People with mental health conditions frequently attend primary care centres, but these conditions are underdiagnosed and undertreated. The objective of this paper is to describe the model and the findings of the implementation of a technology-based model of care for depression and unhealthy alcohol use in primary care centres in Colombia.

Methods: Between February 2018 and March 2020, we implemented a technology-based model of care for depression and unhealthy alcohol use, following a modified stepped wedge methodology, in 6urban and rural primary care centres in Colombia. The model included a series of steps aimed at screening patients attending medical appointments with general practitioners and supporting the diagnosis and treatment given by the general practitioner. We describe the model, its implementation and the characteristics of the screened and assessed patients.

Results: During the implementation period, we conducted 22,354 screenings among 16,188 patients. The observed rate of general practitioner-confirmed depression diagnosis was 10.1% and of confirmed diagnosis of unhealthy alcohol use was 1.3%. Patients with a depression diagnosis were primarily middle-aged women, while patients with unhealthy alcohol use were mainly young adult men.

Discussion: The provision of training and technology-based strategies to screen patients and support the decision-making of general practitioners during the medical appointment enhanced the diagnosis and care provision of patients with depression and unhealthy alcohol use. However, time constraints, as well as structural and cultural barriers, were challenges for the implementation of the model, and the model should take into account local values, policies and resources to guarantee its long-term sustainability. As such, the long-term sustainability of the model will depend on the alignment of different stakeholders, including decision-makers, institutions, insurers, general practitioners, patients and communities, to reduce the amount of patients seeking medical care whose mental health conditions remain undetected, and therefore untreated, and to ensure an appropriate response to the demand for mental healthcare that was revealed by the implementation of our model.
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http://dx.doi.org/10.1016/j.rcp.2020.11.022DOI Listing
June 2021

Access barriers, self-recognition, and recognition of depression and unhealthy alcohol use: A qualitative study.

Rev Colomb Psiquiatr 2021 Jun 13;50 Suppl 1:55-66. Epub 2021 May 13.

Departmento de Psiquiatría, Geisel School of Medicine, Dartmouth College, Hanover, Estados Unidos.

Introduction: Access to healthcare services involves a complex dynamic, where mental health conditions are especially disadvantaged, due to multiple factors related to the context and the involved stakeholders. However, a characterisation of this phenomenon has not been carried out in Colombia, and this motivates the present study.

Objectives: The objective of this study was to explore the causes that affect access to health services for depression and unhealthy alcohol use in Colombia, according to various stakeholders involved in the care process.

Methods: In-depth interviews and focus groups were conducted with health professionals, administrative professionals, users, and representatives of community health organisations in five primary and secondary-level institutions in three regions of Colombia. Subsequently, to describe access to healthcare for depression and unhealthy alcohol use, excerpts from the interviews and focus groups were coded through content analysis, expert consensus, and grounded theory. Five categories of analysis were created: education and knowledge of the health condition, stigma, lack of training of health professionals, culture, and structure or organisational factors.

Results: We characterised the barriers to a lack of illness recognition that affected access to care for depression or unhealthy alcohol use according to users, healthcare professionals and administrative staff from five primary and secondary care centres in Colombia. The groups identified that lack of recognition of depression was related to low education and knowledge about this condition within the population, stigma, and lack of training of health professionals, as well as to culture. For unhealthy alcohol use, the participants identified that low education and knowledge about this condition, lack of training of healthcare professionals, and culture affected its recognition, and therefore, healthcare access. Neither structural nor organisational factors seemed to play a role in the recognition or self-recognition of these conditions.

Conclusions: This study provides essential information for the search for factors that undermine access to mental health in the Colombian context. Likewise, it promotes the generation of hypotheses that can lead to the development and implementation of tools to improve care in the field of mental illness.
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June 2021

Implementation of a New Hampshire community-initiated response to the opioid crisis: A mixed-methods process evaluation of Safe Station.

Int J Drug Policy 2021 Apr 29;95:103259. Epub 2021 Apr 29.

Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Lebanon, NH 03766, USA.

Background: New Hampshire (NH) ranked first for fentanyl- and all opioid-related overdose deaths per capita from 2014 to 2016 and third in 2017 with no rate reduction from the previous year relative to all other states in the US. In response to the opioid crisis in NH, Manchester Fire Department (MFD), the state's largest city fire department, launched the Safe Station program in 2016 in partnership with other community organizations. This community-based response to the crisis-described as a connection to recovery-focuses on reducing barriers to accessing resources for people with substance use and related problems. The study aim is to characterize the multi-organizational partnerships and workflow of the Safe Station model and identify key components that are engaging, effective, replicable, and sustainable.

Methods: A mixed-methods design included: semi-structured qualitative interviews conducted with 110 stakeholders from six groups of community partners (Safe Station clients, MFD staff and leadership, and local emergency department, ambulance, and treatment partner staff); implementation and sustainability surveys (completed by MFD stakeholders); and ethnographic observations conducted at MFD. Qualitative data were content analyzed and coded using the Consolidated Framework for Implementation Research. Survey subscales were scored and evaluated to corroborate the qualitative findings.

Results: Community partners identified key program characteristics including firefighter compassion, low-threshold access, and immediacy of service linkage. Implementation and sustainability survey data corroborate the qualitative interview and observation data in these areas. All participants agreed that community partnerships are key to the program's success. There were mixed evaluations of the quality of communication among the organizations.

Conclusion: Safe Station is a novel response to the opioid crisis in New Hampshire that offers immediate, non-judgmental access to services for persons with opioid use disorders requiring community-wide engagement and communication. Data convergence provides guidance to the sustainability and replicability of the program.
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http://dx.doi.org/10.1016/j.drugpo.2021.103259DOI Listing
April 2021

Is telemedicine the answer to rural expansion of medication treatment for opioid use disorder? Early experiences in the feasibility study phase of a National Drug Abuse Treatment Clinical Trials Network Trial.

Addict Sci Clin Pract 2021 04 20;16(1):24. Epub 2021 Apr 20.

Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.

Telemedicine (TM) enabled by digital health technologies to provide medical services has been considered a key solution to increasing health care access in rural communities. With the immediate need for remote care due to the COVID-19 pandemic, many health care systems have rapidly incorporated digital technologies to support the delivery of remote care options, including medication treatment for individuals with opioid use disorder (OUD). In responding to the opioid crisis and the COVID-19 pandemic, public health officials and scientific communities strongly support and advocate for greater use of TM-based medication treatment for opioid use disorder (MOUD) to improve access to care and have suggested that broad use of TM during the pandemic should be sustained. Nevertheless, research on the implementation and effectiveness of TM-based MOUD has been limited. To address this knowledge gap, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded (via the NIH HEAL Initiative) a study on Rural Expansion of Medication Treatment for Opioid Use Disorder (Rural MOUD; CTN-0102) to investigate the implementation and effectiveness of adding TM-based MOUD to rural primary care for expanding access to MOUD. In preparation for this large-scale, randomized controlled trial incorporating TM in rural primary care, a feasibility study is being conducted to develop and pilot test implementation procedures. In this commentary, we share some of our experiences, which include several challenges, during the initial two-month period of the feasibility study phase. While these challenges could be due, at least in part, to adjusting to the COVID-19 pandemic and new workflows to accommodate the study, they are notable and could have a substantial impact on the larger, planned pragmatic trial and on TM-based MOUD more broadly. Challenges include low rates of identification of risk for OUD from screening, low rates of referral to TM, digital device and internet access issues, workflow and capacity barriers, and insurance coverage. These challenges also highlight the lack of empirical guidance for best TM practice and quality remote care models. With TM expanding rapidly, understanding implementation and demonstrating what TM approaches are effective are critical for ensuring the best care for persons with OUD.
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http://dx.doi.org/10.1186/s13722-021-00233-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056373PMC
April 2021

Long-acting buprenorphine vs. naltrexone opioid treatments in CJS-involved adults (EXIT-CJS).

J Subst Abuse Treat 2021 09 8;128:108389. Epub 2021 Apr 8.

NYU Grossman SOM, United States of America. Electronic address:

The EXIT-CJS (N = 1005) multisite open-label randomized controlled trial will compare retention and effectiveness of extended-release buprenorphine (XR-B) vs. extended-release naltrexone (XR-NTX) to treat opioid use disorder (OUD) among criminal justice system (CJS)-involved adults in six U.S. locales (New Jersey, New York City, Delaware, Oregon, Connecticut, and New Hampshire). With a pragmatic, noninferiority design, this study hypothesizes that XR-B (n = 335) will be noninferior to XR-NTX (n = 335) in retention-in-study-medication treatment (the primary outcome), self-reported opioid use, opioid-positive urine samples, opioid overdose events, and CJS recidivism. In addition, persons with OUD not eligible or interested in the RCT will be recruited into an enhanced treatment as usual arm (n = 335) to examine usual care outcomes in a quasi-experimental observational cohort.
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http://dx.doi.org/10.1016/j.jsat.2021.108389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384640PMC
September 2021

Web-based cognitive behavior therapy for chronic pain patients with aberrant drug-related behavior: How did it work and for whom?

J Behav Med 2021 Apr 12. Epub 2021 Apr 12.

Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.

This study explored mediating pathways, moderating factors, and moderated mediation effects of a web-based, cognitive behavioral therapy (CBT) intervention for chronic pain patients with aberrant drug-related behavior (ADRB). In a 2-arm RCT, patients with chronic pain who screened positive for ADRB received treatment-as-usual (TAU, n = 55) or TAU plus a 12-week, web-based CBT intervention (n = 55). Assessments were conducted at weeks 4, 8, and 12, and at 1- and 3-months post intervention. Web-CBT significantly reduced pain catastrophizing, which, in turn, reduced pain interference and pain severity via a pathway of pain catastrophizing. Web-CBT also significantly reduced ADRB both directly and indirectly by reducing pain catastrophizing. For pain interference and pain severity, web-CBT was more effective than TAU for younger patients (≤ age 50). For pain severity, web-CBT was more effective for both younger patients (≤ age 50), and those with a lifetime substance use disorder. Findings suggest that web-CBT's positive impact on pain outcomes and ADRB are mediated by its effect on pain catastrophizing, and its treatment effects may be most robust for younger patients and those with histories of substance dependence.
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http://dx.doi.org/10.1007/s10865-021-00219-9DOI Listing
April 2021

Barriers and facilitators to the diagnosis and treatment of depression in Primary Care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

Rev Colomb Psiquiatr 2021 Jun 23;50 Suppl 1:67-76. Epub 2021 Mar 23.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, Estados Unidos.

Introduction: Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

Methods: The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at 5 primary care clinics in Colombia, and used thematic analysis to study the data.

Results: Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritisation at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

Discussion: This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.
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http://dx.doi.org/10.1016/j.rcp.2021.01.001DOI Listing
June 2021

Scaling up mental health interventions for depression and unhealthy alcohol use in Colombia.

Rev Colomb Psiquiatr 2021 Jun 19;50 Suppl 1:1-3. Epub 2021 Mar 19.

Investigadora Principal, Director Center for Technology and Behavioral Health, Andrew G. Wallace Professor, Geisel School of Medicine, Dartmouth College, Hanover, Nuevo Hampshire, EE. UU.

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http://dx.doi.org/10.1016/j.rcp.2020.12.001DOI Listing
June 2021

Implementation facilitation to introduce and support emergency department-initiated buprenorphine for opioid use disorder in high need, low resource settings: protocol for multi-site implementation-feasibility study.

Addict Sci Clin Pract 2021 03 9;16(1):16. Epub 2021 Mar 9.

Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.

Background: For many reasons, the emergency department (ED) is a critical venue to initiate OUD interventions. The prevailing culture of the ED has been that substance use disorders are non-emergent conditions better addressed outside the ED where resources are less constrained. This study, its rapid funding mechanism, and accelerated timeline originated out of the urgent need to learn whether ED-initiated buprenorphine (BUP) with referral for treatment of OUD is generalizable, as well as to develop strategies to facilitate its adoption across a variety of ED settings and under real-world conditions. It both complements and uses methods adapted from Project ED Health (CTN-0069), a Hybrid Type 3 implementation-effectiveness study of using Implementation Facilitation (IF) to integrate ED-initiated BUP and referral programs.

Methods: ED-CONNECT (CTN 0079) was a three-site implementation study exploring the feasibility, acceptability, and impact of introducing ED-initiated BUP in rural and urban settings with high-need, limited resources, and different staffing structures. We used a multi-faceted approach to develop, introduce and iteratively refine site-specific ED clinical protocols and implementation plans for opioid use disorder (OUD) screening, ED-initiated BUP, and referral for treatment. We employed a participatory action research approach and use mixed methods incorporating data derived from abstraction of medical records and administrative data, assessments of recruited ED patient-participants, and both qualitative and quantitative inquiry involving staff from the ED and community, patients, and other stakeholders.

Discussion: This study was designed to provide the necessary, time-sensitive understanding of how to identify OUD and initiate treatment with BUP in the EDs previously not providing ED-initiated BUP, in communities in which this intervention is most needed: high need, low resource settings.

Trial Registration: The study was prospectively registered on ClinicalTrials.gov (NCT03544112) on June 01, 2018: https://clinicaltrials.gov/ct2/show/NCT03544112 .
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http://dx.doi.org/10.1186/s13722-021-00224-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941881PMC
March 2021

A characterisation of social media users within the Primary Care System in Colombia and predictors of their social media use to understand their health.

Rev Colomb Psiquiatr 2021 Jun 19;50 Suppl 1:44-54. Epub 2021 Mar 19.

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, Estados Unidos.

Introduction: Social media use is growing in Latin America and is increasingly being used in innovative ways. This study sought to characterise the profile of social media users, among primary care patients in Colombia, and to assess predictors of their use of social media to search for health and mental health information (searching behaviour).

Methods: As part of a larger scale-up study, we surveyed 1,580 patients across six primary care sites in Colombia about their social media use. We used chi-square and Student's t-tests to assess associations between demographic variables, social media use and searching behaviour, and a Chi-square Automatic Interaction Detector (CHAID) analysis to determine predictors of searching behaviour.

Results: In total, 44.4% of respondents reported that they were social media users. Of these, 35.7% used social media to search for health-related information and 6.6% used it to search for mental health-related information. While the profile of individuals who used social media to search for health-related information was similar to that of general social media users (the highest use was among women living in urban areas), the presence of mental health symptoms was a more important predictor of using social media to search for mental health-related information than demographic variables. Individuals with moderate-severe symptoms of anxiety reported a significantly higher percentage of searching than individuals without symptoms (12.5% vs. 5.2%).

Conclusions: Given that some individuals with mental health disorders turn to social media to understand their illness, social media could be a successful medium for delivering mental health interventions in Colombia.
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http://dx.doi.org/10.1016/j.rcp.2020.12.010DOI Listing
June 2021

Relationship between the sociodemographic characteristics of participants in the DIADA Project and the rate of compliance with follow-up assessments in the initial stage of the intervention.

Rev Colomb Psiquiatr 2021 Jun 15;50 Suppl 1:106-113. Epub 2021 Mar 15.

Departamento de Epidemiología Clínica y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.

Objective: Analyse the relationship between the sociodemographic profile of the DIADA study participants and the rate of compliance with the follow-up assessments in the early stage of this project's intervention for depression and unhealthy alcohol use offered within primary care.

Methods: A non-experimental quantitative analysis was conducted. The sociodemographic data of DIADA [Detección y Atención Integral de Depresión y Abuso de Alcohol en Atención Primaria (Detection and Integrated Care for Depression and Alcohol Use in Primary Care)] study participants had been previously collected. At the time of the evaluation (September 12, 2019), only the participants who had been in the project for a minimum of three months were included. By using univariate (Chi-squared) analyses, we studied the association between participants' sociodemographic profile and their rate of compliance with the first follow-up assessment at three months after study initiation.

Results: At the date of the evaluation, 584 adult participants were identified, of which 389 had been involved in the project for more than three months. From the participants included, 320 performed the first follow-up, while 69 did not. The compliance rate to the first follow-up was 82.3% (CI 95% 78.1%-86%) and was not affected by: site location, age, sex, civil status, level of education, use of smartphone, PHQ9 score (measuring depression symptomatology) or AUDIT score (measuring harmful alcohol use). Participants who do not use a smartphone, from rural areas and with a lower socioeconomic status, tended to show higher compliance rates. Statistically significant associations were found; participants with lower job stability and a lack of access to the Internet showed higher compliance rates to the early initial follow-up assessment.

Conclusions: The compliance rate was high and generally constant in spite of the variability of the sociodemographic profiles of the participants, although several sub-groups of participants showed particularly high rates of compliance. These findings may suggest that integrating mental health into primary care allows the structural and financial barriers that hinder access to health in Colombia to be broken down by raising awareness about mental illnesses, their high prevalence and the importance of timely and accessible medical management.
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http://dx.doi.org/10.1016/j.rcp.2020.11.019DOI Listing
June 2021

Health-related quality of life and health literacy among adult primary care patients with subsidized or contributive health insurance in Colombia.

Rev Colomb Psiquiatr 2021 Jun 23;50 Suppl 1:23-31. Epub 2021 Feb 23.

Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia; Departamento de Psiquiatría y Salud Mental, Pontificia Universidad Javeriana, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Colombia.

Context: Colombia passed Law 100 in 1993 with the goal of providing universal health care coverage, and by 2013, over 96% of the Colombian population had health insurance coverage. However, little is known about how health-related quality of life (HRQoL) and health literacy are related among those with the two most common types of health insurance coverage: subsidised (those with lower incomes) and contributory (those with higher incomes) coverage.

Objectives And Methods: In the current exploratory investigation, data from adults visiting six primary care clinics in Colombia were analysed to examine the relationship between HRQoL (assessed as problems with mobility, self-care, completing usual activities, pain/discomfort, and anxiety/depression), demographics, the two health insurance types, and health literacy. Analyses also assessed whether, within insurance types, health literacy was related to HRQoL.

Results: Results showed that those with contributory health insurance coverage had greater health literacy than those with subsidised coverage, and this was accounted for by differences in education and socioeconomic status. HRQoL did not differ by insurance type. Although lower health literacy was related to worse HRQoL in the overall sample, in subgroup analyses lower health literacy significantly related to worse HRQoL only among those with subsidised health insurance coverage.

Conclusion: Targeting skills which contribute to health literacy, such as interpreting medical information or filling out forms, may improve HRQoL, particularly in those with subsidised insurance coverage.
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http://dx.doi.org/10.1016/j.rcp.2020.11.018DOI Listing
June 2021

Evaluating the Effectiveness of a Web-Based Program (POP4Teens) to Prevent Prescription Opioid Misuse Among Adolescents: Randomized Controlled Trial.

JMIR Public Health Surveill 2021 02 25;7(2):e18487. Epub 2021 Feb 25.

Department of Biomedical Data Science, Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, Lebanon, NH, United States.

Background: Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences emphasize the importance of prevention efforts targeting PO misuse. To our knowledge, we have developed the first interactive web-based program (POP4Teens [P4T]) focused specifically on the prevention of PO misuse among adolescents.

Objective: This study aimed to evaluate the effectiveness of P4T, a web-based program designed to prevent adolescent PO misuse, in comparison with JustThinkTwice (JTT), an active control website, on PO-related attitudes, knowledge, risk perception, and intentions to use.

Methods: We conducted a web-based randomized controlled trial in 2018. A total of 406 adolescents (aged 12-17 years) were randomly assigned to either P4T or JTT. The outcome variables were attitudes, knowledge, and risk perceptions associated with PO misuse, intentions to use POs, and program feedback. Data were collected at baseline and at 1, 3, and 6 months.

Results: Both programs resulted in significant and sustained improvements in intention to use POs, increased perceived risk, impacted expectancies consistent with prevention, and improved PO refusal skills. P4T produced significantly greater increases in PO-related knowledge than JTT did, and it was reportedly easier to use and more liked. Baseline scores for youth reporting past-year medical use of POs, friends who engage in nonmedical use of POs, and/or poor mental health underscored their at-risk status compared with youth from the other groups.

Conclusions: P4T positively impacted all study variables that are known to prevent PO misuse among teens. Moreover, its web-based nature simplifies the dissemination and implementation of this novel tool designed to help meet the challenges of the evolving national opioid crisis.

Trial Registration: ClinicalTrials.gov NCT02737696; https://clinicaltrials.gov/ct2/show/NCT02737696.
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http://dx.doi.org/10.2196/18487DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128362PMC
February 2021
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