Literature Collection

BACKGROUND: The COVID-19 pandemic has accelerated the adoption of video consultations in mental health care, highlighting the importance of therapeutic alliances for successful treatment outcomes in both face-to-face and web-based settings. Telepresence, the sense of being present with the mental health specialist (MHS) rather than feeling remote, is a critical component of building a strong therapeutic alliance in video consultations. While patients often report high telepresence levels, MHSs express concerns about whether video consultations can replicate the quality of face-to-face interactions. Despite its importance, research on telepresence development in MHSs over time and the dyadic interplay between patients and MHSs remains limited. OBJECTIVE: This study aimed to evaluate the mutual influence within patient-MHS dyads on telepresence development during video consultations, using data from a randomized controlled trial assessing the feasibility of video consultations for depression and anxiety disorders in primary care. METHODS: The study included 22 patient-MHS dyads (22 patients, 4 MHSs). Telepresence was measured using the Telepresence in Videoconference Scale. Dyadic data were analyzed using the actor-partner interdependence model with a distinguishable dyad structural equation model. Actor effects refer to the impact of an individual's telepresence at time point 1 (T1) on their telepresence at time point 2 (T2), while partner effects represent the influence of one party's telepresence at T1 on the other's telepresence at T2. Sensitivity analyses excluded data from individual MHSs to account for their unique effects. RESULTS: A significant actor effect for MHSs (P<.001) indicated a high temporal stability of telepresence between T1 and T2. In contrast, the actor effect for patients was not statistically significant, suggesting a greater variability between T1 and T2. No significant partner effects for both patients and MHSs were observed, suggesting no mutual influence between dyad members. Age was a significant covariate for telepresence in both groups. CONCLUSIONS: Consistent with prior findings, MHSs experienced increased telepresence over time, whereas patients reported high telepresence levels from the start of therapy. The lack of dyadic influence highlights the need for further exploration into factors affecting telepresence development, such as age, technical proficiency, and prior treatment experience. Future studies with larger samples and more sessions are necessary to enhance the generalizability of these findings and to optimize the use of video consultations in mental health care.

OBJECTIVE: This paper outlines the design and implementation of iManage SCD, a self-management mobile health application for adolescents and young adults (AYA) with sickle cell disease (SCD) during transition from pediatric to adult health care. METHODS: The Integrate, Design, Assess, Share (IDEAS) framework, emphasizing user insights, iterative design, rigorous assessment, and knowledge sharing, guided the development process. The design team consisted of researchers, psychologists, physicians, social workers, AYA with SCD, and parents of AYA with SCD (n = 16) across three states. Qualitative focus groups and interviews were conducted and analyzed using thematic analysis across the integrate and design phases. Point of use feedback from AYA with SCD was used to assess feasibility and acceptability. RESULTS: The development process was centered around tenants of the Social-ecological Model of Adolescent and Young Adult Readiness to Transition. Development integrated multidisciplinary perspectives, fostering a person-centered approach. The iterative design process involved collaboration with a digital health firm, Agency39A. Health equity and implementation considerations were addressed at individual, community, and healthcare system levels. Themes that emerged from focus groups with AYA, clinicians, and researchers in the integrate and design phases of development included recommendations for content and user experience features. CONCLUSIONS: iManage SCD emerges as a comprehensive, user-friendly mobile health application, incorporating theoretical principles and direct user input. The development process demonstrated feasibility and acceptability, and the paper discusses dissemination strategies for the Community Health Workers and Mobile Health Programs to Help Young Adults with SCD Transition to Using Adult Healthcare Services (COMETS) study.

INTRODUCTION: People experiencing homelessness (PEH) face food insecurity, unstable housing and fragmented services that render conventional diabetes pathways unworkable and amplify complications. METHODS: Between January and April 2024, we conducted a nationwide, cross-sectional mixed-methods survey of front-line professionals via NHS, inclusion-health and voluntary-sector networks, analysing quantitative data (n = 104) with ANOVA, Kruskal-Wallis tests and ordinal logistic regression, and subjecting free-text responses to reflexive thematic analysis, before converging findings to develop the Integrated Holistic Diabetes Care Model for Homelessness (IHD-CMPH). RESULTS: Respondents comprised specialist diabetes clinicians (31%), homelessness/inclusion-health staff (38%) and VCSE providers (32%); median perceived Type 1 prevalence among PEH was 20% versus 8% nationally (p < 0.001). Fifty-seven per cent rated diabetes outcomes for PEH as poor or very poor, and 66% reported more frequent amputations and vision loss. Clear organisational policies (OR 1.62, 95% CI 1.06-2.48), cross-sector collaboration (OR 2.76, 1.20-6.36) and outreach-specific training (OR 2.50, 1.50-4.17) were independently associated with better outcomes. Thematic analysis highlighted service fragmentation, inflexible appointments and insufficient homelessness-specific education. DISCUSSION: Diabetes inequities among PEH stem chiefly from modifiable structural failures rather than patient non-adherence. The novel IHD-CMPH, anchored in outreach and mobile screening, provides a scalable framework to operationalise inclusion-health policy, improve glycaemic surveillance and avert avoidable admissions; this first national study translating multi-sector front-line evidence into a coherent policy model offers concrete levers for health-system reform and equity advancement.

BACKGROUND: Type 2 diabetes (T2D) disproportionately affects individuals of South Asian descent. Additionally, diabetes distress (DD) may lead to complications with diabetes management. This study examines the prevalence of DD among foreign-born individuals of South Asian descent in New York City (NYC) and its association with sociodemographic and clinical factors. METHODS: Baseline data was collected from the Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, an intervention designed to reduce hemoglobin A1c (HbA1c) among South Asian individuals with uncontrolled T2D at primary care practices in NYC. The Diabetes Distress Scale (DDS) measured DD, and Core Healthy Days Measures assessed physical and mental healthy days. Sociodemographic variables were analyzed using descriptive statistics, Chi-square tests assessed categorical variables, and Wilcoxon Rank Sum tests evaluated continuous variables (Type I error rate = 0.05). Logistic regression models examined associations between HbA1c, mental health, and other covariates with dichotomized DD subscales. RESULTS: Overall, 414 participants completed the DDS at baseline (median age = 55.2 years; SD = 9.8). All were born outside of the US; the majority were born in Bangladesh (69.8%) followed by India, Pakistan, and Nepal (24.7%) and Guyana and Trinidad and Tobago (5.5%). High emotional burden, regimen-related distress and physician-related distress were reported by 25.9%, 21.9%, and 6.2% of participants, respectively. In adjusted analyses, individuals with ≥ 1 day of poor mental health had higher odds of overall distress (OR:3.8, p = 0.013), emotional burden (OR:4.5, p < 0.001), and physician-related distress (OR:4.6, p = 0.007) compared to individuals with no days of poor mental health. Higher HbA1c (OR:1.45, p = < 0.001) was associated with regimen-related distress; and lower emotional support was associated with overall distress (OR:0.92, p < 0.001) and regimen-related distress (OR:0.95, p = 0.012). Individuals born in Bangladesh had significantly lower odds of overall distress, emotional burden, and regimen-related distress compared to individuals born in Guyana and Trinidad and Tobago. CONCLUSIONS: Findings highlight the rate and risk factors of DD among individuals of South Asian descent living in NYC. Screening for DD in patients with prediabetes or diabetes should be integrated to address mental and physical health needs. Future research can benefit from a longitudinal analysis of the impact of DD on diabetes self-management and health outcomes. TRIAL REGISTRATION: This study uses baseline data from "Diabetes Management Intervention for South Asians" (NCT03333044), which was registered with clinicaltrials.gov on 6/11/2017.