A systematic review of online interventions for mental health in low and middle income countries: a neglected field The Contribution of Social Networks to the Health and Self-Management of Patients with Long-Term Conditions: A Longitudinal Study Online Respondent-Driven Sampling for Studying Contact Patterns Relevant for the Spread of Close-Contact Pathogens: A Pilot Study in Thailand Health information seeking on the Internet: a double divide? Results from a representative survey in the Paris metropolitan area, France, 2005–2006 The effect of Self-Help Groups on access to maternal health services: evidence from rural India Why We Need More Than Just Randomized Controlled Trials to Establish the Effectiveness of Online Social Networks for Health Behavior Change Social network as a predictor of hospital readmission and mortality among older patients with heart failure. Sudden cardiac death in low- and middle-income countries. Raising the Level of Analysis of Food-Borne Outbreaks: Food-Sharing Networks in Rural Coastal Ecuador Connecting the invisible dots: reaching lesbian, gay, and bisexual adolescents and young adults at risk for suicide through online social networks. Social networks and infant feeding in Oaxaca, Mexico. The Tanzania Connect Project: a cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study Relationships between social norms, social network characteristics, and HIV risk behaviors in Thailand and the United States. Adapting a natural (lay) helpers model of change for worksite health promotion for women. Improving mental health among people living with HIV: a review of intervention trials in low- and middle-income countries Use and Impact of eHealth System by Low-income Women With Breast Cancer
Background . Low and middle income countries ( LMICs ) are facing an increase of the impact of mental health problems while confronted with limited re sources and limited access to mental health care , known as the ‘ mental health gap ’ . One strategy to reduce the mental health gap would be to utilize the internet to provide more widely-distributed and low cost mental health care . We undertook this systematic review to investigate the effectiveness and efficacy of online interventions in LMICs . Methods . We systematic ally search ed the data -bases PubMed , PsycINFO , JMIR , and additional sources . MeSH terms , Thesaurus , and free text keywords were used . We included all r and omized controlled trials ( RCTs ) of online interventions in LMICs . Results . We found only three articles reported results of RCTs on  online interventions for mental health conditions in LMICs , but none of these interventions was compared with an active control condition . Also , the mental health conditions were diverse across the three studies . Conclusions . There is a dearth of studies examining the effect of online interventions  in LMICs , so we can not draw a firm conclusion on its effectiveness . However , given the effectiveness of  online interventions in high income countries and sharp increase of internet access in LMICs , online interventions may offer a potential to help reduce the ‘ mental health gap ’ . More studies are urgently needed in LMICs Evidence for the effectiveness of patient education programmes in changing individual self-management behaviour is equivocal . More distal elements of personal social relationships and the availability of social capital at the community level may be key to the mobilisation of re sources needed for long-term condition self-management to be effective . Aim To determine how the social networks of people with long-term conditions ( diabetes and heart disease ) are associated with health-related outcomes and changes in outcomes over time . Methods Patients with chronic heart disease ( CHD ) or diabetes ( n = 300 ) r and omly selected from the disease registers of 19 GP practice s in the North West of Engl and . Data on personal social networks collected using a postal question naire , alongside face-to-face interviewing . Follow-up at 12 months via postal question naire using a self-report grid for network members identified at baseline . Analysis Multiple regression analysis of relationships between health status , self-management and health-economics outcomes , and characteristics of patients ' social networks . Results Findings indicated that : ( 1 ) social involvement with a wider variety of people and groups supports personal self-management and physical and mental well-being ; ( 2 ) support work undertaken by personal networks exp and s in accordance with health needs helping people to cope with their condition ; ( 3 ) network support substitutes for formal care and can produce substantial saving in traditional health service utilisation costs . Health service costs were significantly ( p<0.01 ) reduced for patients receiving greater levels of illness work through their networks . Conclusions Support for self-management which achieves desirable policy outcomes should be construed less as an individualised set of actions and behaviour and more as a social network phenomenon . This study shows the need for a greater focus on harnessing and sustaining the capacity of networks and the importance of social involvement with community groups and re sources for producing a more desirable and cost-effective way of supporting long term illness management Background Information on social interactions is needed to underst and the spread of airborne infections through a population . Previous studies mostly collected egocentric information of independent respondents with self-reported information about contacts . Respondent-driven sampling ( RDS ) is a sampling technique allowing respondents to recruit contacts from their social network . We explored the feasibility of webRDS for study ing contact patterns relevant for the spread of respiratory pathogens . Material s and Methods We developed a webRDS system for facilitating and tracking recruitment by Facebook and email . One-day diary surveys were conducted by applying webRDS among a convenience sample of Thai students . Students were asked to record numbers of contacts at different setting s and self-reported influenza-like-illness symptoms , and to recruit four contacts whom they had met in the previous week . Contacts were asked to do the same to create a network tree of socially connected individuals . Correlations between linked individuals were analysed to investigate assortativity within networks . Results We reached up to 6 waves of contacts of initial respondents , using only non- material incentives . Forty-four ( 23.0 % ) of the initially approached students recruited one or more contacts  . In total 257 persons participated , of which 168 ( 65.4 % ) were recruited by others . Facebook was the most popular recruitment option ( 45.1 % ) . Strong assortative mixing was seen by age , gender and education , indicating a tendency of respondents to connect to contacts with similar characteristics . R and om mixing was seen by reported number of daily contacts . Conclusions Despite method ological challenges ( e.g. clustering among respondents and their contacts ) , applying RDS provides new insights in mixing patterns relevant for close-contact infections in real-world networks . Such information increases our knowledge of the transmission of respiratory infections within population s and can be used to improve existing modelling approaches . It is worthwhile to further develop and explore webRDS for the detection of clusters of respiratory symptoms in social networks Background The Internet is a major source of information for professionals and the general public , especially in the field of health . However , despite ever-increasing connection rates , a digital divide persists in the industrialised countries . The objective of this study was to assess the determinants involved in : 1 ) having or not having Internet access ;  and 2 ) using or not using the Internet to obtain health information . Methods A cross-sectional survey of a representative r and om sample was conducted in the Paris metropolitan area , France , in the fall of 2005 ( n = 3023 ) . Results Close to 70 % of the adult population had  Internet access  , and 49 % of Internet users had previously search ed for medical information . Economic and social disparities observed in online health information seeking are reinforced by the economic and social disparities in Internet access , hence a double divide . While individuals who reported having a recent health problem were less likely to have Internet access ( odds ratio ( OR ) : 0.72 , 95 % confidence interval ( CI ) : 0.53–0.98 ) , it is they who , when they have Internet access , are the most likely to search for health information ( OR = 1.44 , 95 % CI = 1.11–1.87 ) . Conclusion In the French context of universal health insurance , access to the Internet varies according to social and socioeconomic status and health status , and its use for health information seeking varies also with health beliefs , but not to health insurance coverage or health-care utilisation . Certain economic and social inequalities seem to impact cumulatively on Internet access and on the use of the Internet for health information seeking . It is not obvious that the Internet is a special information tool for primary prevention in people who are the furthest removed from health concerns . However , the Internet appears to be a useful complement for secondary prevention , especially for better underst and ing health problems or enhancing therapeutic compliance Introduction The main challenge for achieving universal health coverage in India is ensuring effective coverage of poor and vulnerable communities in the face of high levels of income and gender inequity in access to health care . Drawing on the social capital generated through women ’s participation in community organizations like SHGs can influence health outcomes . To date , evidence about the impact of SHGs on health outcomes has been derived from pilot-level interventions , some using r and omised controlled trials and other rigorous methods . While the evidence from these studies is convincing , our study is the first to analyse the impact of SHGs at national level . Methods We analyzed the entire data set from the third national District Level Household Survey from 601 districts in India to assess the impact of the presence of SHGs on maternal health service uptake . The primary predictor variable was presence of a SHG in the village . The outcome variables were : institutional delivery ; feeding new-borns colostrum ; knowledge about family planning methods ; and ever used family planning . We controlled for respondent education , wealth , heard or seen health messages , availability of health facilities and the existence of a village health and sanitation committee . Results Stepwise logistic regression shows respondents from villages with a SHG were 19 per cent ( OR : 1.19 , CI : 1.13 - 1.24 ) more likely to have delivered in an institution , 8 per cent ( OR : 1.08 , CI : 1.05 - 1.14 ) more likely to have fed newborns colostrum , have knowledge ( OR : 1.48 , CI 1.39 – 1.57 ) and utilized ( OR : 1.19 , CI 1.11 – 1.27 ) family planning products and services . These results are significant after controlling for individual and village-level heterogeneities and are consistent with existing literature that the social capital generated through women ’s participation in SHGs influences health outcome . Conclusion The study concludes that the presence of SHGs in a village is associated with higher knowledge of family planning and maternal health service uptake in rural India . To achieve the goal of improving public health nationally , there is a need to underst and more fully the benefits of systematic collaboration between the public health community and these grassroots organizations Despite their popularity and potential to promote health in large population s , the effectiveness of online social networks ( e.g. , Facebook ) to improve health behaviors has been somewhat disappointing . Most of the research examining the effectiveness of such interventions has used r and omized controlled trials ( RCTs ) . It is asserted that the modest outcomes may be due to characteristics specific to both online social networks and RCTs . The highly controlled nature of RCTs stifles the dynamic nature of online social networks . Alternative and ecologically valid research design s that evaluate online social networks in real-life conditions are needed to advance the science in this area BACKGROUND This study examines the relationship between social network and hospital readmission and mortality in older patients with heart failure . METHODS AND RESULTS Prospect i ve study conducted with 371 patients , age 65 and older , admitted for heart failure-related emergencies at 4 Spanish hospitals .  Social network was measured at baseline with a 4-item question naire that ascertained whether subjects were married  ,  lived with another person(s ) , saw or had telephone contact with family members daily or almost daily  , and were at home alone for less than 2 hours per day . Social network was deemed " high " where all 4 items were present , " moderate " where 3 were present , and " low " where 2 or fewer were present . Analyses were performed using Cox models , and adjusted for the main confounders . A total of 55 % of patients had high or moderate social networks . During a median follow-up of 6.5 months , 135 ( 36.4 % ) patients underwent a first emergency rehospitalization and 68 ( 18.3 % ) died . Compared with patients with high social network , hospital readmission was more frequent among those who had moderate ( hazard ratio [ HR ] 1.87 ; 95 % confidence interval [ CI ] 1.06 - 3.29 ; P < .05 ) and low social networks ( HR 1.98 ; 95 % CI 1.07 - 3.68 ; P < .05 ) . This relationship showed a positive dose-response ( p for linear trend 0.042 ) . The magnitude of this association was comparable to that of other important predictors of readmission , such as previous hospitalization . No relationship was observed between social network and death . CONCLUSION A very simple question naire measuring social network can identify patients with a higher short-term risk of hospital readmission Cardiovascular disease , and the incidence of sudden cardiac death ( SCD ) , will increase significantly in low- and middle-income countries ( LMIC ) . Thus , SCD threatens to become a global public health problem . We present a summary of the current research that has investigated the epidemiology of SCD in LMIC . Few studies of SCD in LMIC exist , and they are of variable method ological quality . Risk factors for SCD are described , taking into account recent global burden of disease and risk factor statistics . We describe 1 proposal for a community-based , prospect i ve , multiple- source methodology for SCD monitoring and surveillance that can be implemented in LMIC . Further research into the epidemiology of SCD in LMIC , using st and ardized methodology , would allow investigators and policy makers to determine the regions , communities , and individuals most at need for SCD prevention . Focusing on SCD and its prevention in LMIC should be a priority for the global health community Objectives : Consuming contaminated food is a well-documented individual-level risk factor for diarrheal disease . The sharing of food also influences the distribution of diarrheal disease risk through a community and region . Underst and ing this social process at a population level is therefore an important dimension of risk not captured by st and ard individual-level analyses . We examined social networks related to food-sharing in rural villages at 2 scales : within a village , examining whether connections within these networks clustered or were uniformly spread ; and among villages , looking at whether food-sharing networks differed according to the village 's remoteness from a population center . Methods : We surveyed 2129 individuals aged 13 years and older in 2003–2004 , within a representative ( block-r and omized ) sample of 21 rural villages in Esmeraldas province , northern coastal Ecuador . We calculated degree ( number of social contacts ) for a social network defined by sharing food . Results : Networks of households sharing food differ according to remoteness from a metropolitan center . On average , residents living in “ far villages ” had 2 more social contacts than those in “ close villages , ” and 12 more years of residence in their village . Estimates of transmissibility ( a measure of outbreak potential ) based on network structure varied as much as 2-fold across these villages . Conclusions : Food-sharing practice s link particular households in rural villages and have implication s for the spread of food-borne pathogens . The food-sharing  networks in remote rural villages are heterogeneous and clustered , consistent with contemporary theories about disease transmitters . Network-based measures may offer tools for predicting patterns of disease outbreaks , as well as guidance for interventions Young lesbian , gay , and bisexual ( young LGB ) individuals report higher rates of suicide ideation and attempts from their late teens through early twenties . Their high rate of Internet use suggests that online social networks offer a novel opportunity to reach them . This study explores online social networks as a venue for prevention research targeting young LGB . An automated data collection program was used to map the social connections between LGB self-identified individuals between 16 and 24 years old participating in an online social network .  We then completed a descriptive analysis of the structural characteristics known to affect diffusion within such networks . Finally , we conducted Monte Carlo simulations of peer-driven diffusion of a hypothetical preventive intervention within the observed network under varying starting conditions . We mapped a network of 100,014 young LGB . The mean age was 20.4 years . The mean nodal degree was 137.5 , representing an exponential degree distribution ranging from 1 through 4309 . Monte Carlo simulations revealed that a peer-driven preventive intervention ultimately reached final sample sizes of up to 18,409 individuals . The network 's structure is consistent with other social networks in terms of the underlying degree distribution . Such networks are typically formed dynamically through a process of preferential attachment . This implies that some individuals could be more important to target to facilitate the diffusion of interventions . However , in terms of determining the success of an intervention targeting this population , our simulation results suggest that varying the number of peers that can be recruited is more important than increasing the number of r and omly-selected starting individuals . This has implication s for intervention design . Given the potential to access this previously isolated population , this novel approach represents a promising new frontier in suicide prevention and other research areas The health benefits of delaying the introduction of complementary foods to infants ' diets are widely known . Many studies have shown that mothers with the support of close social network members are more compliant with medical recommendations for infant feeding . In our study , we examine the effects of a broader spectrum of network members ( 40 people ) on mothers ' infant feeding decisions . The survey was conducted in Oaxaca , Mexico as part of a follow-up to a nationwide Mexican Social Security Institute survey of infant health . Sixty mothers were interviewed from a stratified r and om sample of the original respondents .  Multivariate tests were used to compare the efficacy of network-level variables for predicting the introduction of 36 foods into infants ' diets , when compared with respondent-level variables . The study yields four findings . First , network-level variables were better predictors of the timing of food introduction than socio-demographic variables . Second , mothers with more indigenous networks delayed the introduction of some grains ( oatmeal , cereal , noodle soup , rice ) and processed pork products ( sausage and ham ) to the infant 's diet longer than mothers with less indigenous networks . Third , mothers who had stronger ties to their networks delayed the introduction of rice and processed pork products ( sausage and ham ) to the infant 's diet longer than mothers who had weaker ties to their networks . Fourth , mothers who heeded the advice of distant network members introduced some grains ( rice and cereal )  earlier than mothers who did not heed the advice of distant network members Background Tanzania has been a pioneer in establishing community-level services , yet challenges remain in sustaining these systems and ensuring adequate human re source strategies . In particular , the added value of a cadre of professional community health workers is under debate . While Tanzania has the highest density of primary health care facilities in Africa , equitable access and quality of care remain a challenge . Utilization for many services proven to reduce child and maternal mortality is unacceptably low . Tanzanian policy initiatives have sought to address these problems by proposing expansion of community-based providers , but the Ministry of Health and Social Welfare ( MoHSW ) lacks evidence that this merits national implementation . The Tanzania Connect Project is a r and omized cluster trial located in three rural districts with a population of roughly 360,000 ( Kilombero , Rufiji , and Ulanga).Description of interventionConnect aims to test whether introducing a community health worker into a general program of health systems strengthening and referral improvement will reduce child mortality , improve access to services , exp and utilization , and alter reproductive , maternal , newborn and child health seeking behavior ; thereby accelerating progress towards Millennium Development Goals 4 and 5 . Connect has introduced a new cadre — Community Health Agents ( CHA ) — who were recruited from and work in their communities . To support the CHA , Connect developed supervisory systems , launched information and monitoring operations , and implemented logistics support for integration with existing district and village operations . In addition , Connect ’s district-wide emergency referral strengthening intervention includes clinical and operational improvements . Evaluation design Design ed as a community-based cluster-r and omized trial , CHA were r and omly assigned to 50 of the 101 villages within the Health and Demographic Surveillance System ( HDSS ) in the three study districts . To garner detailed information on household characteristics , behaviors , and service exposure , a r and om sub- sample survey of 3,300 women of reproductive age will be conducted at the baseline and endline . The referral system intervention will use baseline , midline , and endline facility-based data to assess systemic changes . Implementation and impact research of Connect will assess whether and how the presence of the CHA at village level provides added life-saving value to the health system . Discussion Global commitment to launching community-based primary health care has accelerated in recent years , with much of the implementation focused on Africa . Despite extensive investment , no program has been guided by a truly experimental study . Connect will not only address Tanzania ’s need for policy and operational research , it will bridge a critical international knowledge gap concerning the added value of salaried professional community health workers  in the context of a high density of fixed facilities . Trial registration : IS RCT Objectives Assisting patients in lifestyle change using collaborative e-health tools can be an efficient treatment for non-communicable diseases like diabetes , cardiovascular disease and chronic obstructive lung disease that are caused or aggravated by unhealthy living in the form of unhealthy diet , physical inactivity or tobacco smoking . In a prospect i ve pilot study , we tested an online collaborative e-health tool in general practice . The aim of this study was to identify drivers of importance for long-term personal lifestyle changes from a patient perspective when using a collaborative e-health tool , including the support of peers and healthcare professionals . Setting General practice clinics in the Region of Southern Denmark . Participants 10 overweight patients who had previously successfully used a hybrid online collaborative e-health tool with both face-to-face and online consultations  to lose weight . Results The main themes identified were facilitators , barriers and support from family and peers . Establishment of a trustworthy relationship with the healthcare professionals was of paramount importance . It was important for the patients to monitor the measurable outcomes with realistic goals and feedback from a trusted person . Often , significant life events were identified as catalysts for successful long-term lifestyle changes . Dominant barriers to change were perception of insurmountable obstacles , experience of lack of self-efficacy and excess eating of high-calorie food . Finally , experiencing of trustworthy person-to-person forums , need for acknowledgement from referent others and support from family and peers were important drivers for long-term lifestyle change . Conclusion The most important driver in long-term weight loss was a strong relationship with a healthcare professional . Collaborative e-health tools can support the relationship and behavioural changes through monitoring and providing relevant feedback . The support from family and peers also matters , and long-term success depends on the ability to establish strong , positive support on a day-to-day basis OBJECTIVE Social norms have been associated with a wide range of health behaviors . In this study , the authors examined whether the social norms of HIV risk behaviors are clustered within social networks and whether the norms of network members are linked to the risk behaviors of their social network members . DESIGN Data were collected from the baseline assessment of 354 networks with 933 participants in a network-oriented HIV prevention intervention targeting injection drug users in Philadelphia , United States , and Chiang Mai , Thail and . MAIN OUTCOME MEASURES Four descriptive HIV risk norms of sharing needles , cookers , and cotton and front- or back-loading among friends who inject were assessed . RESULTS Three of 4 injection risk norms ( sharing needle , cookers , and cotton ) were found to be significantly clustered . In Philadelphia , 1 network member 's ( the index participant ) norms of sharing needles and front- or back-loading were found to be significantly associated with the network members ' risk behaviors , and the norm of sharing cotton was marginally associated . CONCLUSION The results of this study suggest that among injection drug users , social norms are clustered within networks ; social networks are a meaningful level of analyses for underst and ing how social norms lead to risk behaviors , providing important data for intervening to reduce injection-related HIV risks Social network interventions that utilize informal systems of helping can be an important strategy for health promotion change . This article describes the development , implementation and evaluation of a natural ( lay ) helping intervention for health promotion change , specifically design ed for women in small rural blue-collar worksites . One hundred and four women in four intervention worksites were recruited as natural helpers , and received health and skill-building education over an 18-month period . Qualitative evaluation showed : ( 1 ) two patterns of natural helping for women , i.e. participation due to a specific health concern with either themselves or others in their personal networks , and participation due to a larger sense of the importance of health and prevention ; ( 2 ) over time natural helpers exp and ed the diffusion of health promotion information from close network members to co-workers and were more likely to be approached by their co-workers for information ; ( 3 ) group activities at the worksite , particularly around physical activity , increased over time ; and ( 4 ) because of time constraints at the workplace , written material s were a major way of spreading information to co-workers . This study shows that women can be recruited and trained to diffuse health promotion information and provide support to co-workers for health behavior change People living with HIV ( PLWH ) experience greater psychological distress than the general population . Evidence from high-incomes countries suggests that psychological interventions for PLWH can improve mental health symptoms , quality of life , and HIV care engagement . However , little is known about the effectiveness of mental health interventions for PLWH in low- and middle-income countries ( LMICs ) , where the large majority of PLWH reside . This systematized review aims to synthesize findings from mental health intervention trials with PLWH in LMICs to inform the delivery of mental health services in these setting s. A systematic search strategy was undertaken to identify peer- review ed published papers of intervention trials addressing negative psychological states or disorders ( e.g. depression , anxiety ) among PLWH in LMIC setting s. Search results were assessed against pre-established inclusion and exclusion criteria . Data from papers meeting criteria were extracted for synthesis . Twenty-six papers , published between 2000 and 2014 , describing 22 unique interventions were identified . Trials were implemented in sub-Saharan Africa ( n = 13 ) , Asia ( n = 7 ) , and the Middle East ( n = 2 ) , and addressed mental health using a variety of approaches , including cognitive-behavioral ( n = 18 ) , family-level ( n = 2 ) , and pharmacological ( n = 2 ) treatments . Four r and omized controlled trials reported significant intervention effects in mental health outcomes , and 11 preliminary studies demonstrated promising findings . Among the limited mental health intervention trials with PLWH in LMICs , few demonstrated efficacy .  Mental health interventions for PLWH in LMICs must be further developed and adapted for re source -limited setting s to improve effectiveness ABSTRACT This article is the second of a two-part series reporting on a population -based study intended to use an eHealth system to examine the feasibility of reaching underserved women with breast cancer ( Gustafson , McTavish et al. , Reducing the digital divide for low-income women with breast cancer , 2004 ; Madison Center for Health Systems Research and Analysis , University of Wisconsin ; Comprehensive Health Enhancement Support System [ CHESS ] ) and determine how they use the system and what impact it had on them . Participants included women recently diagnosed with breast cancer whose income was at or below 250 % of poverty level and were living in rural Wisconsin ( n = 144 ; all Caucasian ) or Detroit ( n = 85 ; all African American ) . Because this was a population -based study all 229 participants received CHESS . A comparison group of patients ( n = 51 ) with similar demographics was drawn from a separate recently completed r and omized clinical trial . Use rates ( e.g. , frequency and length of use as well as type of use ) as well as impact on several dimensions of quality of life and participation in health care are reported . Low-income subjects in this study logged on and spent more time on CHESS than more affluent women in a previous study . Urban African Americans used information and analysis services more and communication services less than rural Caucasians . When all low-income women from this study are combined and compared with a low-income control group from another study , the CHESS group was superior to that control group in 4 of 8 outcome variables at both statistically and practically significant levels ( social support , negative emotions , participation in health care , and information competence ) . When African Americans and Caucasians are separated the control group 's sample size becomes 30 and 21 thus reducing power . Statistical significance is retained , however , in all four outcomes for Caucasians and in two of four for African Americans . Practical significance is retained for all four outcomes . We conclude that an eHealth system like CHESS will be used extensively and have a positive impact on low-income women with breast cancer
Second , we show that network composition , individual network central ity , and network structure are associated with important health behaviors and health and development outcomes in different context s across multiple levels of analysis and across distinct network types .
Lastly , we highlight the opportunities for health research ers and practitioners in LMICs to 1 ) design effective studies and interventions in LMICs that account for the sociocentric network positions of certain individuals and overall network structure , 2 ) measure the spread of outcomes or intervention externalities , and 3 ) enhance the effectiveness and efficiency of aid based on knowledge of social structure .
In low- and middle-income countries ( LMICs ) , naturally occurring social networks may be particularly vital to health outcomes as extended webs of social ties often are the principal source of various re sources .