ABSTRACT Background Mood symptoms vary seasonally, yet the underlying mechanisms remain unclear. We tested whether wearable-derived sleep, activity, circadian, and light exposure patterns mediate seasonal effects on mood in youth with emerging mood disorders. Methods We analysed 733 observation periods from 422 Australian youth (mean age 24.3±5.5 years; 63% female) attending early-intervention mental health services. Each observation comprised a clinical assessment paired with ≥5 valid days of GENEActiv wrist actigraphy. Season was modelled using sine-cosine functions of day-of-year. Sleep, activity, and circadian features were reduced using Joint and Individual Variation Explained, and light exposure features were reduced via principal components analysis. Linear mixed-effects models tested seasonal effects on depressive, psychiatric, manic, and functional outcomes. Mediation was examined using Sobel screening followed by cluster bootstrapping (1,000 iterations). Results Depressive (β=−0.67, p=0.023) and negative symptoms (β=−0.17, p=0.041) peaked in winter, whereas manic symptoms peaked in autumn (β=0.24, p=0.018). Reduced day-to-day variability in moderate-to-bright ambient light exposure (fewer transitions to brighter environments) mediated winter increases in depressive (indirect β=−0.06, p=0.006) and negative symptoms (indirect β=−0.05, p<0.001). Higher activity levels partially mediated season’s effect on depressive symptoms (indirect β=−0.010, p=0.032). Extended sleep with nocturnal activity mediated season’s effect on negative symptoms (indirect β=−0.02, p=0.001). No mediators emerged for manic symptoms. Conclusions Light exposure variability—reflecting constrained engagement with brighter environments during winter—emerged as the dominant mediator of seasonal mood worsening in Australian youth, with smaller contributions from sleep-activity-circadian patterns. These findings identify daily light variability as a promising, modifiable target for intervention.

Abstract Introduction Insomnia is common in older adults with mild cognitive impairment (MCI) and predicts future cognitive decline. Cognitive Behavioural Therapy for insomnia (CBT-I) is the first-line treatment for insomnia but is often unavailable. We tested the feasibility of a randomised controlled trial comparing 12-weeks of digital CBT-I vs wait-listed control in older adults with MCI and insomnia. Methods This was an investigator-initiated (NCT05568381), parallel open-label randomised-controlled feasibility trial. Participants were randomised to digital CBT-I (Sleepio, 6-weekly sessions) or a wait-listed control (3 fortnightly online modules of a sleep health education package) via a secure centralised platform which was also used to collect the outcome data. This study was undertaken remotely without in-person visits. Potential participants were recruited through online advertising and a memory clinic in Sydney, Australia. Those who met initial eligibility were invited to a screening and informed consent telehealth consultation. Inclusion criteria included adults aged ≥50 years, with an Insomnia Severity Index (ISI)>10, who met the clinical criteria of MCI on a neuropsychological battery (performed over telehealth for participants recruited online). The primary outcomes were the proportion of participants who met screening and randomisation criteria. A secondary outcome was the effect sizes and 95%CIs of the difference in ISI between the groups at week 12. Results Recruitment occurred March 23, 2023 to August 11, 2023 stopping when we reached our pre-defined sample size (digital CBT-I=19; control=21; 30 females; mean [SD] age=59.7 years [7.3]; ISI=17.0 [3.7]). 37% of participants issued a pre-screening number (n=246), were eligible to attend online screening. 47% of those issued a screening number (n=90) were eligible to be randomised (n=42). All randomised participants (n=40) were recruited through the online pathway. At 12-weeks there was a difference in ISI between the digital CBT-I (mean±SE 7.8±1.1 points) and control groups (13.7±1.05 points) (Cohen’s D [95%CI] -1.6 [-2.4 to 2.1]). 79% of participants completed ≥4 out of the CBT-I 6 sessions. All adverse events were minor and transient. Conclusion This population can be recruited through online pathways and follow the protocol as well as adhere to the intervention of this remotely conducted trial. Support (if any) CogSleep CRE Seed Funding Grant. BigHealth- intervention in-kind.

BackgroundThere is scant research examining evidence-based processes and practices that delineate how to include the voices of children in service design and delivery in school age care environments such as Outside of School Hours Care (OSHC). A possible structure to support children to share leadership in design of their OSHC program and have a meaningful voice in decision-making is co-production, whereby children and their OSHC communities have the opportunity to co-plan, co-design, co-deliver, and co-evaluate OSHC program activities. The Connect Promote and Protect Program (CP3), a social connection and wellbeing program that provides a structured method of co-producing with children, educators, and their OSHC communities, is examined.ObjectivesThis study aimed to explore the response to a co-production approach in OSHC settings as part of participation in the CP3.MethodsQualitative interviews and focus groups were conducted with 12 OSHC staff (educators, coordinators, managers, and volunteers) and 12 children attending OSHC as part of a wider mixed-methods implementation-effectiveness stepped-wedge trial of CP3 in 12 OSHC services located in urban and regional areas of New South Wales, Australia. Participants undertook semi-structured interviews/focus groups via multiple communication platforms (face-to-face, phone, and video-conferencing platforms). A representative research team (including researchers, OSHC educators/coordinators, OSHC administrators, clinicians, and parents of children in OSHC) used an inductive thematic analysis process. Two researchers undertook iterative coding using NVivo12 software, with themes developed and refined in ongoing team discussion.ResultsThe analysis identified nine sub-themes that related to child co-production and voice in CP3, which were organised into two super-ordinate themes: (1) processes that enable child agency and voice and (2) the impact of child agency and voice. Process related sub-themes included the following: co-production (ko-production) as a key driver; high-quality programming practice in a demanding environment; structure balanced with flexibility; the importance of being agile and having a willingness to adjust; and implementation factors supporting child voice. The impact related sub-themes included the following: empowerment of children through meaningful engagement; we all have a role in the team (a space for growing leadership skills); a spark through engagement and enjoyment; and being and belonging (the impact on children’s social and emotional wellbeing).ConclusionThis is the first known qualitative study to examine the use and impact of co-production processes in OSHC—where children not only co-design but also co-plan, co-deliver, and co-evaluate the activity programming alongside OSHC educators and their communities. The findings indicate that the co-production process provides a structured, yet flexible, way of supporting children’s voice and leadership even when delivered in diverse types of OSHC settings.

With mental health concerns on the rise among youth and young adults (age 12–24), increased mental health options include virtual care, apps and online tools, self-management and tracking tools, and digitally-enabled coordination of care. These tools may function as alternatives or adjuncts to face-to-face models of care. Innovative solutions in the form of digital mental health (dMH) services not only provide support, resources and care, but also decrease wait times and waitlists, increase access, and empower youth. However, organizational factors may impact the extent of dMH interventions are that accepted, used, and sustained in clinical settings. This qualitative study explores organizational barriers and facilitators surrounding the implementation of a digital platform (Innowell), which uses measurement-based care (MBC) to track youth progress and outcomes. Data was collected from 154 mental health care providers participating in 23 focus groups across Alberta, drawing on school and community settings, specialized mental health services, and primary care networks. A thematic analysis revealed the following: barriers included incompatibility with current systems and workflows, lack of inter-organizational collaboration, time commitment, perceived sustainability and lack of digital literacy. Facilitators included positive attitudes towards using dMH to optimize clinical practices by empowering youth and improving continuity of care, transitions in care, and quality of care, as well as workplace culture and leadership. The study highlights a critical need for decision makers and clinical leaders to address organizational factors by integrating training and support, establishing interoperability between digitized and in-person healthcare systems, and leveraging support for MBC and youth-centred care.

Background For youth and young adults (YYAs) with mental health concerns, digital mental health (dMH) can improve access to care and support collaboration with providers. Measurement-based care using a dMH platform may further optimize YYA outcomes by individualizing treatment approaches. Engaging service providers and YYA provides an opportunity to better understand how to mitigate implementation challenges. Aim Explore the experiences of mental health care providers and YYAs regarding the implementation of a dMH platform for YYAs accessing mental health care in multiple care settings. Methods Mental health care providers and YYA service users completed an electronic survey exploring their experiences and perceptions of implementing a dMH platform. Survey design, data analysis, and reporting were informed by the Consolidated Framework for Implementation Research (CFIR). Results A total of 195 individuals (100 providers, 95 YYAs) responded. Of those, 48 providers and 79 YYAs reported using the platform at least once. Both groups identified several important factors supporting implementation including collaborative relationships between providers and YYAs, the ability to monitor mental health outcomes, and increased YYA engagement in care. The need for increased provider training and automatic reminders for YYAs to use the platform were common barriers. Each group perceived the other to be uninterested in using the platform, highlighting the importance of using all stakeholder views to inform implementation planning. Conclusions Successful implementation of dMH for care of YYA requires ongoing, user-informed training, integration into existing workflows, and alignment with YYA priorities for care. Future work exploring provider and youth perceptions of the others’ “buy-in” is needed to inform future implementation strategies.

BACKGROUND:Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies.OBJECTIVE:The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults.METHODS:This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services.RESULTS:This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes.CONCLUSIONS:This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):PRR1-10.2196/51667.

The treatment needs of young people seeking mental health care are complex, challenging health services to identify and deliver a highly-personalized mix of interventions. Although many clinical decision-support tools exist for prognostication or assessing the risk of a specific outcome occurring, there is a necessity for tools to evaluate the multidimensional needs across domains relevant to treatment planning. We aimed to develop a service needs index that measures a young person’s needs across domains relevant to care provision and to examine the index’s construction under different assumptions. A cohort of young people (n=2193) aged 12-25-years who sought help at youth mental health services across Australia were invited to use a digital platform (Innowell) as part of their care and complete a multidimensional assessment. Using online assessment data from the eligible 1611 individuals (73.5%), a Service Needs Index comprised of three sub-indices (Clinical, Psychosocial, Comorbidity) was constructed and compared under two weighting approaches; an equal weighted scheme, and a weighting scheme constructed with expert input and correlation-optimization. These two approaches were compared with uncertainty and sensitivity analyses for three assumptions; normalization, aggregation, and weighting. The relationship between individual variables (questionnaire scores) and sub-indices were calculated using non-parametric correlation analysis. The Clinical, Psychosocial, and Comorbidity Indices were derived using standardized questionnaires to assess mental health symptoms and history, work and social functioning, and physical health and substance use, respectively. The Expert Input Index was preferred to the Equal weighting scheme due to its more stable output. For the expert input indices, the Clinical Index and Psychosocial Index were moderately related (correlation=0.45). The Clinical Index also had strong correlations with external variables that were not used in its construction, including both psychological distress (K10; r=0.60) and work and social functioning (WSAS; r=0.54). Among those with the top 25% of Clinical Index scores, almost half also belonged in the group with the top 25% of Psychosocial Index scores, while 11.5% of the total sample were in the bottom 25% percentiles for both Clinical and Psychosocial Index scores. A Service Needs Index for youth mental health should be assessed in real world settings before recommendations are made about its feasibility and acceptability, however, this tool could differentiate between needs to guide health-service level and individual-level decision making. The indexes could be delivered digitally and at scale to aid decision-making about the intensity, style, and duration of clinical, psychosocial, and allied services a young person requires, and increase the impact of investments for youth mental health.

BACKGROUND:Obstructive sleep apnea (OSA) is highly prevalent among older adults and has been associated with cognitive decline and dementia risk. The suitability of screening tools for detecting OSA in memory clinic settings is unclear. OBJECTIVE:To evaluate the utility and validity of the STOP-Bang questionnaire (SBQ) and pulse oximeter as a screening tool, compared to gold-standard polysomnography (PSG) in older adults attending a memory clinic. METHODS:Participants aged over 50 with new onset cognitive/mood concerns attended a memory clinic, then completed the SBQ, oximetry, and PSG. The SBQ and oximetry's accuracy in detecting moderate-severe and severe OSA was evaluated using receiver operating curves. Intraclass correlation and Bland-Altman plots compared the oximeter's adjusted oxygen desaturation index (ODI-Ox) and PSG's apnea-hypopnea index (AHI-PSG). RESULTS:Of 194 participants (mean age = 65.6, 64 males) who completed PSG, 184 completed the SBQ, and 138 completed oximetry. SBQ demonstrated limited performance for moderate-severe OSA (sensitivity = 52%, specificity = 62%, AUC = 0.600) and severe OSA (sensitivity = 18%, specificity = 87%, AUC = 0.577). Oximetry was satisfactory for moderate-severe OSA (sensitivity = 67%, specificity = 73%, AUC = 0.769) and severe OSA (sensitivity = 50%, specificity = 88%, AUC = 0.730). The diagnostic performance was improved with new cut-offs at ODI-Ox ≥ 11 for AHI-PSG ≥ 15 and ODI-Ox ≥ 20 for AHI-PSG ≥ 30. Bland-Altman plots and intraclass correlation indicated acceptable agreement for oximetry. CONCLUSIONS:The findings suggest that while the SBQ may be unsuitable to detect moderate or severe OSA for older adults with cognitive impairment, oximetry may be a viable screening tool. Given OSA treatment can optimize sleep and may slow cognitive decline, routine screening for OSA should be part of memory clinic assessments.

BackgroundLong wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality. ObjectiveThe primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors. MethodsYoung people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed. ResultsA total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness. ConclusionsThe digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people’s mental health.

Mobile health (mHealth) interventions in low-and middle-income countries (LMICs) have considerable potential to advance social and human development through the equitable delivery of health information and enabling self-care for disadvantaged populations. Involving stakeholders through co-design positively impacts the development of mHealth solutions and, in turn, their social, economic, and human development outcomes. The complex systems and multifaceted contexts confronted in co-design present barriers. This work focuses on barriers encountered in mHealth co-design in LMICs, related principally to culture, language, and technology. It presents a toolkit highlighting methods to best overcome such barriers, aiming to strengthen 'mobile phones for development' research and practice. Additionally, it provides an illustrative example of applying the toolkit. By presenting this toolkit to overcome barriers and create opportunities for realising health outcomes from information and communications technology (ICT) implementation, this article contributes to the fields of ICT for development, participatory design, and population and digital health.

Digital technologies can substantially improve mental health care by facilitating measurement-based care through routine outcome monitoring. However, their effectiveness is constrained by the extent to which these technologies are used by services, clinicians, and clients. This study aims to investigate engagement with the Innowell platform, a measurement-based digital mental health technology (DMHT), to gain insights into the individual and service-level factors influencing engagement. Participants were 2,682 help-seeking clients from 12 Australian mental health services (11 headspace centers and one private practice, Mind Plasticity) wherein the Innowell platform was implemented. Although the initial implementation was standardized, services varied in their practical and continued use of the platform, as well as in the resources allocated to foster engagement. All participants completed an initial assessment during onboarding. Engagement here was defined as their ensuing completion of the summary questionnaire, designed for routine outcome monitoring. Participants were classified as ‘Initial Assessment Only’, 'Single Use' (one completion of the summary questionnaire), or '2+ Uses' (two or more completions). We analyzed engagement differences across services and associations between engagement and initial assessment scores. Of the sample, 75.4% completed the initial assessment only, 11.5% had one completion of the summary questionnaire, and 13.0% had two or more completions. The service center was the strongest predictor of engagement, with Mind Plasticity participants showing over eight times higher engagement than other centers. At the individual level, higher scores in depression (P = .002), mania-like experiences (P = .047), suicide ideation (P = .004), hospitalization history for mental illness (P = .013), and physical activity (P < .001) were associated with increased engagement. Conversely, higher levels of anxiety symptoms (P = .011), substance misuse (P < .001), self-reported mental illness severity (P = .024), and social support (P = .047) predicted lower engagement. Age and several other clinical variables were not significant predictors when controlling for service-level factors. This study reveals that both individual and service-level factors significantly influence DMHT engagement, with the service center being the strongest predictor. This highlights the importance of service-level technology integration and support roles like Digital Navigators in fostering engagement. Significant variation in engagement among user groups indicates the need for a nuanced approach to measurement-based care. While mental illness generally did not impede engagement, self-perceived severity and anxiety symptoms were barriers. These findings underscore the critical importance of systemic factors and service-level integration strategies in driving DMHT engagement. User-centered designs remain important, but effective integration of DMHTs into existing mental health services is paramount for improving engagement across diverse user groups and clinical presentations. This multi-level approach – encompassing individual, service, and system-wide considerations – is essential for realizing DMHTs' full potential in delivering effective measurement-based care.

Objective The Thrive by Five app promotes positive interactions between children and parents, extended family, and trusted community members that support optimal socio-emotional and cognitive development in the early years. This article aims to describe the protocol for a prospective mixed-methods multi-site study evaluating Thrive by Five using surveys, interviews, workshops, audio diaries from citizen ethnographers and app usage data. Methods The study activities and timelines differ by site, with an extensive longitudinal evaluation being conducted at two sites and a basic evaluation being conducted at five sites. The learnings from the more comprehensive evaluations inform the iterative research and development processes while also ensuring ongoing evaluation of usability, acceptability and effectiveness of the app and its content across varying contexts. The study evaluates: (1) the impact of the Thrive by Five content on caregiver knowledge, behaviours, attitudes and confidence; (2) how the content changes relationships at the familial, community and system level; (3) how cultural and contextual factors influence content engagement and effectiveness and (4) the processes that facilitate or disrupt the success of the implementation and dissemination. Results All in-country partners have been identified and data collection has been completed in Indonesia, Malaysia, Afghanistan, Kyrgyzstan, Uzbekistan, Namibia and Cameroon. Conclusions Very few digital health solutions have been trialled for usability and effectiveness in diverse cultural contexts. By combining quantitative, qualitative, process and ethnographic methodologies, this innovative study informs the iterative and ongoing optimisation of the cultural and contextual sensitivity of the Thrive by Five content and the processes supporting implementation and dissemination.

BackgroundEmerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. ObjectiveThis narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. MethodsLiterature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. ResultsThe literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. ConclusionsOptimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation.

Measurement-based care (MBC) uptake is suboptimal in mental healthcare, limiting key opportunities to facilitate data-driven symptom monitoring and progress feedback. This misses critical opportunities for enhanced patient-clinician communication and early intervention. To understand young people’s changing perspectives, engagement, and value-add of the digitally-enabled MBC over time. As part of a randomised controlled trial, an added human support, the digital navigator (DN), provided technological and engagement assistance for young people to integrate an online platform (digitally-enabled MBC) as part of usual care. The DN conducted 118 semi-structured interviews with 73 young people (mean age 22.7 years, SD = 2.7) at baseline and 3-, 6- and 12-months follow-up visits. We found that the majority of the young people were enthusiastic about incorporating digitally-enabled MBC in care when they understood its potential to facilitate collaborative care with clinicians and enhance self-awareness about their mental health. Notably, the DN’s support was effective in fostering this understanding at the initial stage of implementation. However, it was evident that the lack of clinician involvement in MBC posed a risk of disillusionment to young people’s sustained engagement. As reported, clinician uptake of digitally-enabled MBC was poor, limiting its perceived value-add and sustainability. Digital technology shows significant potential for implementing MBC into mental health care. Young people want to use digitally-enabled MBC in their care and DNs can facilitate implementation through ongoing engagement and technical support. However, successful MBC implementation depends on broader systemic factors, particularly clinician and service engagement. Future research should examine how to address these contextual barriers and optimise DN support for implementation and sustained engagement.

BackgroundYouth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person’s life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. ObjectiveThe objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. MethodsGuided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. ResultsThemes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. ConclusionsOur findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase.

Kinship care and child fostering are a common practice in certain parts of Africa. This narrative review seeks to explore and thematically code the contextual circumstances in which children leave their natal homes and are fostered across Africa and the corresponding outcomes for these children. It draws on case studies from Cameroon, the Democratic Republic of the Congo, Ethiopia, Kenya, and Namibia and other countries across the region to illustrate the diversity and cultural importance of kinship care and child fostering. These countries were selected based on their inclusion in the Thrive by Five International Program, a child rearing program promoting social, emotional, and cognitive development of children from birth to age five. The importance of kinship care and child fostering is also reinforced by outcomes from codesign workshops conducted for the Thrive by Five International Program in which parents, caregivers, and subject matter experts discussed their perspectives on child rearing practices and the challenges faced by caregivers in their home countries. The paper highlights the need to support kinship and foster caregivers in Africa with culturally adapted and place‐based child rearing programs to help ensure fostered children reach their full developmental potential.

Objective Digital technology has the potential to support or infringe upon human rights. The ubiquity of mobile technology in low- and middle-income countries (LMICs) presents an opportunity to leverage mobile health (mHealth) interventions to reach remote populations and enable them to exercise human rights. Yet, simultaneously, the proliferation of mHealth results in expanding sensitive datasets and data processing, which risks endangering rights. The promotion of digital health often centers on its role in enhancing rights and health equity, particularly in LMICs. However, the interplay between mHealth in LMICs and digital rights is underexplored. The objective of this scoping review is to bridge this gap and identify digital rights topics in the 2022 literature on mHealth in Southeast Asian LMICs. Furthermore, it aims to highlight the importance of patient empowerment and data protection in mHealth and related policies in LMICs. Methods This review follows Arksey and O’Malley's framework for scoping reviews. Search results are reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Frequency and content analyses were applied to summarize and interpret the data. Results Three key findings emerge from this review. First, the digital rights topics covered in the literature are sparse, sporadic, and unsystematic. Second, despite significant concerns surrounding data privacy in Southeast Asian LMICs, no article in this review explores challenges to data privacy. Third, all included articles state or allude to the role of mHealth in advancing the right to health. Conclusions Engagement in digital rights topics in the literature on mHealth in Southeast Asian mHealth is limited and irregular. Researchers and practitioners lack guidance, collective understanding, and shared language to proactively examine and communicate digital rights topics in mHealth in LMIC research. A systematic method for engaging with digital rights in this context is required going forward.

Mental fitness is a construct that goes beyond a simple focus on subjective emotional wellbeing to encompass more broadly our ability to think, feel, and act to achieve what we want in our daily lives. The measurement and monitoring of multiple (often interacting) domains is crucial to gain a holistic and complete insight into an individual’s mental fitness. We aimed to demonstrate the capability of a new mobile app to characterise the mental fitness of a general population of Australians and to quantify the interrelationships among different domains of mental fitness. Cross-sectional data were collected from 4901 adults from the general population of Australians engaged in work or education who used a mobile app (Innowell) between September 2021 and November 2022. Individuals completed a baseline questionnaire comprised of 26 questions across seven domains of mental fitness (i.e., physical activity, sleep and circadian rhythms, nutrition, substance use, daily activities, social connection, psychological distress). Network analysis was applied at both a domain-level (e.g., 7 nodes representing each cluster of items) and an individual item-level (i.e., 26 nodes representing all questionnaire items). Only 612 people (12%) were functioning well across all domains. One quarter (n = 1204, 25%) had only one problem domain and most (n = 3085, 63%) had multiple problem domains. The two most problematic domains were physical activity (n = 2631, 54%) and social connection (n = 2151, 44%), followed closely by daily activity (n = 1914, 39%). At the domain-level, the strongest association emerged between psychological distress and daily activity (r = 0.301). Psychological distress was the most central node in the network (as measured by strength and expected influence), followed closely by daily activity, sleep and circadian rhythms and then social connection. The item-level network revealed that the nodes with the highest centrality in the network were: hopelessness, depression, functional impairment, effortfulness, subjective energy, worthlessness, and social connectedness. Social connection, sleep and circadian rhythms, and daily activities may be critical targets for intervention due to their widespread associations in the overall network. While psychological distress was not among the most common problems, its centrality may indicate its importance for indicated prevention and early intervention. We showcase the capability of a new mobile app to monitor mental fitness and identify the interrelationships among multiple domains, which may help people develop more personalised insights and approaches.

BACKGROUND:The global population is ageing rapidly and there is a need for strategies to promote health and wellbeing among older adults. Nutrition knowledge is a key predictor of dietary intake; therefore, effective educational programmes are urgently required to rectify poor dietary patterns. Digital health technologies provide a viable option for delivering nutrition education that is cost-effective and widely accessible. However, few technologies have been developed to meet the unique needs and preferences of older adults. OBJECTIVE:The aim of this study was to explore technology use among older adults and qualitatively determine the content needs and design preferences for an online nutrition education resource tailored to older adult consumers in Australia. METHODS:Twenty adult participants aged 55 years and older (95% female) participated in one of four 2-h participatory design workshops. In each workshop, prompted discussion questions were used to explore participants' technology use and preferences and to explore content needs and design preferences for an online nutrition education resource specific to older adults. RESULTS:All participants were regularly using a range of different devices (e.g., smartphones, tablets and computers) and reported being comfortable doing so. Participants wanted a website that provided general nutrition information, practical advice and recipes. To enhance engagement, they sought a personalised resource that could be adjusted to suit their needs, included up-to-date information and allowed for easy sharing with others by exporting information as a PDF. CONCLUSIONS:Participatory design methods generate new knowledge for designing and tailoring digital health technologies to be appropriate and useful for the target audience. Specifically, older adults seek an online resource that has large and simple fonts with clear categories, providing them with practical advice and general nutrition information that can be personalised to suit their own needs and health concerns, with the option to export and print information into a paper-based format. PATIENT OR PUBLIC CONTRIBUTION:Older adults actively participated in the development and evaluation process to generate ideas about potential features, functionalities, uses and practicalities of an online nutrition education resource.

Mediterranean diet interventions have demonstrated positive effects in the prevention and management of several chronic conditions in older adults. Understanding the effective components of behavioural interventions is essential for long-term health behaviour change and translating evidence-based interventions into practice. The aim of this scoping review is to provide an overview of the current Mediterranean diet interventions for older adults (≥55 years) and describe the behaviour change techniques used as part of the interventions. A scoping review systematically searched Medline, Embase, CINAHL, Web of Science, Scopus, and PsycINFO from inception until August 2022. Eligible studies were randomized and non-randomized experimental studies involving a Mediterranean or anti-inflammatory diet intervention in older adults (average age > 55 years). Screening was conducted independently by two authors, with discrepancies being resolved by the senior author. Behaviour change techniques were assessed using the Behaviour Change Technique Taxonomy (version 1), which details 93 hierarchical techniques grouped into 16 categories. From 2385 articles, 31 studies were included in the final synthesis. Ten behaviour change taxonomy groupings and 19 techniques were reported across the 31 interventions. The mean number of techniques used was 5, with a range from 2 to 9. Common techniques included instruction on how to perform the behaviour (n = 31), social support (n = 24), providing information from a credible source (n = 16), information about health consequences (n = 15), and adding objects to the environment (n = 12). Although behaviour change techniques are commonly reported across interventions, the use of the Behaviour Change Technique Taxonomy for intervention development is rare, and more than 80% of the available techniques are not being utilised. Integrating behaviour change techniques in the development and reporting of nutrition interventions for older adults is essential for effectively targeting behaviours in both research and practice.