Literature Collection

INTRODUCTION: The MELD-B project is a multidisciplinary research consortium with one of its aims focused on identifying childhood targets for the prevention of multiple long-term conditions (MLTCs). Drawing upon the expertise of policy and practice stakeholders can inform research questions, data analysis, and contribute to meaningful and practical outputs. In pursuit of this collaborative approach, a stakeholder workshop, co-designed with people with lived experience, was conducted to inform the next steps of the early prevention workstream of the MELD-B project. METHODS: The research team worked with four public contributors to co-design the workshop in terms of its aims and structure. This involved utilising a project-specific animation and developing an imaginary persona to illustrate the life-course concepts of MLTCs, with an emphasis on how early life factors can influence outcomes later in life. Stakeholders were divided into three groups, each with a mix of professions and facilitated by two team members. Jamboard (an online interactive whiteboard) was used to collate ideas, and overarching themes were identified. A poll was administered at the end of the workshop giving choices to prioritise time points for interventions. RESULTS: 25 stakeholders with policy and practice expertise of childhood attended the workshop. Stakeholders were from backgrounds including integrated care boards (n = 5), healthcare practitioners (n = 3), academics (n = 4), council employees (n = 9) and not-for-profit organisations (n = 4). The workshop aimed to identify critical time points and targets in the early life-course for feasible and practical interventions to prevent or delay MLTCs. Themes discussed included: mental health, educational attainment, early identification of health conditions and neurodiversity, nutritional choices, transitional periods, the virtual world, and intermediate outcomes on the pathway to future ill health. Stakeholders suggested that family-targeted interventions were important to prioritise in early childhood; however, at secondary school age individual-focused interventions may become more significant. A poll identified birth and ages 5-7 and 10-11 as the most important time points for interventions. CONCLUSIONS: People with lived experience should have central roles in shaping research questions, prioritising problems and engaging with stakeholders. Our workshop identified priority themes to inform prevention interventions using routinely collected and national cohort data. PATIENT OR PUBLIC CONTRIBUTION: The research team worked with four public contributors to co-design the workshop in terms of its aims and structure. Public contributions helped to identify stakeholders to invite to the workshop and co-produced PowerPoint slides to guide the workshop. In addition, the workshop utilised a co-produced project-specific animation and imaginary persona to help frame our research. Public contributors attended the workshop and helped to facilitate discussions by providing their own lived experience. Following the workshop, public contributors reviewed the themes identified by the research team from the discussions within the workshop. Finally, public contributors have also been involved in dissemination of the findings from this study, including this paper. Two of the public contributors are named co-authors on this paper, and two did not wish to be named as co-authors.

BACKGROUND: Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS: PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). RESULTS: There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. CONCLUSION: Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking.

BACKGROUND: Collaborative care (CC) could improve outcomes in primary care patients with common mental conditions. We assessed the effectiveness of a transdiagnostic model of telephone-based CC (tCC) delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking. METHODS: PARTNERS was a pragmatic trial in 502 primary care adults presenting with depressive symptoms, anxiety symptoms, or at-risk drinking randomized to (1) usual care by primary care providers (PCPs) enhanced with the results of computer-assisted telephone-based assessments (at baseline and 4, 8, and 12 months later) (enhanced usual care [eUC]) or (2) tCC consisting of eUC plus frequent telephone coaching and psychoeducation provided by mental health technicians who also communicated to the PCP recommendations from a psychiatrist for evidence-based pharmacotherapy, psychotherapy, or, when indicated, referrals to mental health services. The primary analysis compared the change on the 9-item Patient Health Questionnaire (PHQ-9) in participants presenting with depression (n = 366) randomized to tCC versus eUC. Secondary analyses compared changes on the Generalized Anxiety Disorder-7 scale (GAD-7) in those presenting with anxiety (n = 298); or change in the number of weekly drinks in those presenting with at-risk drinking (n = 176). RESULTS: There were no treatment or time×treatment effects between tCC and eUC on PHQ-9 scores for patients with depression during the 12-month follow-up. However, there was a treatment effect (tCC > eUC) on GAD-7 scores in those with anxiety and a time×treatment interaction effect on the number of weekly drinks (tCC > eUC) in those with at-risk drinking. CONCLUSION: Implementing transdiagnostic tCC for common mental disorders using lay providers appears feasible in Canadian primary care. While tCC was not better than eUC for depression, there were some benefits for those with anxiety or at-risk drinking. Future studies will need to confirm whether tCC differentially benefits patients with depression, anxiety, or at-risk drinking.

OBJECTIVE: American Indian and Alaskan Natives (AIAN) are regenerating cultural knowledge and practices to adapt westernized evidence-based interventions to address health concerns such as substance use. This study describes the process of selecting, adapting, and implementing motivational interviewing plus cognitive behavior therapy (motivational interviewing + Skills Training; MIST) for use in a combined substance use intervention with a rural, Northwest tribal community. METHODS: An established community and academic partnership worked together to make culturally mindful changes to MIST. The partnership incorporated community leaders/Elders (n = 7), providers (n = 9), and participants (n = 50) to implement an iterative process of adapting and implementing the adapted form of MIST. RESULTS: Key adaptations included presenting concepts grounded in tribal values, providing examples from the community perspective, and incorporating cultural customs and traditions. Overall, the MIST adaptation was favorably received by participants, and the adaptation appeared feasible. CONCLUSIONS: Adapted MIST appeared to be an acceptable intervention for this Native American community. Future research should evaluate the interventions efficacy in reducing substance use among this and other Native American communities. Future clinical research should consider strategies outlined in this adaptation as a potential process for working with Native American communities to implement culturally appropriate interventions.