Dr. Kevin Pottie

Global mental health explores cultural differences and context-specific conditions. It deals with the epidemiology of mental disorders, their treatment options, mental health education, the structure of mental healthcare systems and human rights issues. Specifically, this paper focuses on community-based mental health approaches that may be useful for marginalized and excluded populations, for example, frail elderly, francophone minorities and refugees. We explore the delivery of mental health support and care, psychoeducation, narrative therapies and trauma-informed approaches for these populations. We focus on lay persons, peer workers and community-based primary care practitioners and shared mental healthcare workers. We provide examples of these approaches and therapies and explore the central role of narrative approaches and proximity of care.

ObjectivesTo make informed decisions, the general population should have access to accessible and understandable health recommendations. To compare understanding, accessibility, usability, satisfaction, intention to implement, and preference of adults provided with a digital “Plain Language Recommendation” (PLR) format vs. the original “Standard Language Version” (SLV).Study Design and SettingAn allocation-concealed, blinded, controlled superiority trial and a qualitative study to understand participant preferences. An international on-line survey. 488 adults with some English proficiency. 67.8% of participants identified as female, 62.3% were from the Americas, 70.1% identified as white, 32.2% had a bachelor's degree as their highest completed education, and 42% said they were very comfortable reading health information. In collaboration with patient partners, advisors, and the Cochrane Consumer …

ObjectivesIncorporating health equity considerations into guideline development often requires information beyond that gathered through traditional evidence synthesis methodology. This article outlines an operationalization plan for the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-equity criterion to gather and assess evidence from primary studies within systematic reviews, enhancing guideline recommendations to promote equity. We demonstrate its use in a clinical guideline on medical cannabis for chronic pain.Study Design and SettingWe reviewed GRADE guidance and resources recommended by team members regarding the use of evidence for equity considerations, drafted an operationalization plan, and iteratively refined it through team discussion and feedback and piloted it on a medicinal cannabis guideline.ResultsWe propose a seven-step approach: 1) identify …

Background Among youth, symptoms of depression, anxiety, and alcohol use are associated with considerable illness and disability. Youth face many personal and health system barriers in accessing mental health care. Mobile applications (apps) offer youth potentially accessible, scalable, and anonymous therapy and other support. Recent systematic reviews on apps to reduce mental health symptoms among youth have reported uncertain effectiveness, but analyses based on the type of app‐delivered therapy are limited. Objectives We conducted this systematic review with youth co‐researchers to ensure that this review addressed the questions that were most important to them. The objective of this review is to synthesize the best available evidence on the effectiveness of mobile apps for the reduction of depressive symptoms (depression, generalized anxiety, psychological distress) and alcohol use among …

Background and objectives Newcomers (immigrants, refugees, and international students) face many personal, gender, cultural, environmental and health system barriers when integrating into a new society. These struggles can affect their health and social care, reducing access to mental health care. This study explores the lived experiences of African and Middle Eastern newcomers to Ontario, Canada. An understanding of newcomer integration challenges, successes and social justice issues is needed to improve health equity and social services. Methods In this qualitative study, we used a participatory research approach to collect stories reflecting participants’ integration perspectives and experiences. Beginning with our immigrant community network, we used snowball sampling to recruit newcomers, ages 18 to 30, originating from Africa or the Middle East. We used qualitative narrative analysis to interpret stories, identifying context themes, integrating related barriers and facilitators, and resolutions and learnings. We shared our findings and sought final feedback from our participants. Findings A total of 18 newcomers, 78% female and approximately half post-secondary students, participated in the study. Participants described an unknown and intimidating migration context, with periods of loneliness and isolation aggravated by cold winter conditions and unfamiliar language and culture. Amidst the struggles, the support of friends and family, along with engaging in schoolwork, exploring new learning opportunities, and participating in community services, all facilitated integration and forged new resilience. Conclusions Community …

BackgroundObservational studies can inform how we understand and address persisting health inequities through the collection, reporting and analysis of health equity factors. However, the extent to which the analysis and reporting of equity-relevant aspects in observational research are generally unknown. Thus, we aimed to systematically evaluate how equity-relevant observational studies reported equity considerations in the study design and analyses.MethodsWe searched MEDLINE for health equity-relevant observational studies from January 2020 to March 2022, resulting in 16 828 articles. We randomly selected 320 studies, ensuring a balance in focus on populations experiencing inequities, country income settings, and coronavirus disease 2019 (COVID-19) topic. We extracted information on study design and analysis methods.ResultsThe bulk of the studies were conducted in North America (n= 95, 30 …

Background: Uganda has one of the highest fertility rates globally, but only 30% of women report using an effective method of contraception. Community-based, multi-level interventions are needed to help couples in rural Uganda overcome barriers to contraceptive use.Methods: This study will pilot test the Family Health= Family Wealth intervention, a multi-level, community-based intervention employing transformative community dialogues, which use facilitated discussion to reshape community norms that influence family planning acceptance, to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4 sessions (two gender-segregated and two gender-mixed). Sessions simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. At the health system level, a refresher training will be conducted with health workers in the intervention community’s health center to address gaps in contraceptive knowledge and skills as identified from a needs assessment. The intervention will be evaluated through a pilot quasi-experimental trial paired with a mixed methods process evaluation. Participants include 70 couples (N= 140) randomized by community to the Family Health= Family Wealth intervention (n= 35 couples) or to an attention-matched water, sanitation, and hygiene (WASH) intervention (n= 35 couples). Participants include sexually active, married couples who are age 18 (or an emancipated minor) to 40 for women and age 18 (or an emancipated minor) to 50 for men, not …

Refugees are a growing and dynamic global population that require theories, programmes and policies to improve community-based integration and health care. Although many gender, cultural and system barriers persist, countries must innovate to support migration flow, universal care coverage, trauma-informed approaches and health equity for refugees.

BackgroundThere are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents.ObjectiveTo inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations …

An evidence-based approach is considered the gold standard for health decision-making. Sometimes, a guideline panel might judge the certainty that the desirable effects of an intervention clearly outweigh its undesirable effects as high, but the body of supportive evidence is indirect. In such cases, the application of the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach for grading the strength of recommendations is inappropriate. Instead, the GRADE Working Group has recommended developing ungraded best or good practice statement (GPS) and developed guidance under which circumsances they would be appropriate.Through an evaluation of COVID-1- related recommendations on the eCOVID Recommendation Map (COVID-19.recmap.org), we found that recommendations qualifying a GPS were widespread. However, guideline developers failed to label them …

BackgroundAddressing persistent and pervasive health inequities is a global moral imperative, which has been highlighted and magnified by the societal and health impacts of the COVID-19 pandemic. Observational studies can aid our understanding of the impact of health and structural oppression based on the intersection of gender, race, ethnicity, age and other factors, as they frequently collect this data. However, the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline, does not provide guidance related to reporting of health equity. The goal of this project is to develop a STROBE-Equity reporting guideline extension.MethodsWe assembled a diverse team across multiple domains, including gender, age, ethnicity, Indigenous background, disciplines, geographies, lived experience of health inequity and decision-making organizations. Using an inclusive, integrated …

Background and ObjectiveTo identify COVID-19 actionable statements (e.g., recommendations) focused on specific disadvantaged populations in the living map of COVID-19 recommendations (eCOVIDRecMap) and describe how health equity was assessed in the development of the formal recommendations.MethodsWe employed the place of residence, race or ethnicity or culture, occupation, gender or sex, religion, education, socio-economic status, and social capital-Plus framework to identify statements focused on specific disadvantaged populations. We assessed health equity considerations in the evidence to decision frameworks (EtD) of formal recommendations for certainty of evidence and impact on health equity criteria according to the Grading of Recommendations, Assessment, Development, and Evaluations criteria.ResultsWe identified 16% (124/758) formal recommendations and 24% (186/819) good …

Many clinicians or other health care providers may not know where to focus their initial efforts when encountering patients who face vulnerable housing. Early identification of patients with unstable housing, just like early identification of myocardial infarction, can play a critical role in preventing illness and poor long-term social and health outcomes. We suggest the evidence-informed ‘HOUSE approach’ that begins with understanding a patient’s lived experience but also integrates effective and evidence-based actions and interventions. Research now shows that the next generation of clinicians should learn an early focus on interventions that address housing, income, and comprehensive primary care to set the stage for addressing other underlying conditions and health issues. Providers should also learn to recognize mental health and substance use disorders early and support patients with these disorders using …

IntroductionThe COVID-19 pandemic underlined that guidelines and recommendations must be made more accessible and more understandable to the general public to improve health outcomes. The objective of this study is to evaluate, quantify, and compare the public’s understanding, usability, satisfaction, intention to implement, and preference for different ways of presenting COVID-19 health recommendations derived from the COVID-19 Living Map of Recommendations and Gateway to Contextualization (RecMap).Methods and analysisThis is a protocol for a multi-method study. Through an online survey, we will conduct pragmatic allocation-concealed, blinded superiority randomized controlled trials (RCTs) in three populations to test alternative formats of presenting health recommendations: adults, parents, and youth, with at least 240 participants in each population. Prior to initiating the RCT, our …

La situación de calle incrementa en gran medida la morbilidad y mortalidad, y agrava las desigualdades sanitarias y sociales que son evitables. Se presentan datos sobre una amplia gama de intervenciones focalizadas en cuanto a la situación de calle: vivienda de asistencia permanente (PSH, por su sigla en inglés); transferencias directas; gestión de casos estándar y el apoyo entre pares; intervenciones de salud mental como el tratamiento comunitario asertivo (ACT, por su sigla en inglés), la gestión intensiva de casos (ICM, por su sigla en inglés), la intervención de tiempo crítico (CTI, por su sigla en inglés) y los antipsicóticos inyectables; así como intervenciones por consumo de sustancias como los centros de consumo supervisado, los programas de alcoholismo controlado y las intervenciones farmacológicas para trastornos asociados al consumo de opioides.

Introduction Health equity is a moral and ethical imperative for clinicians, researchers, policymakers, and all who use health research. Both Cochrane and the Campbell Collaboration have focused on health equity for many years. Methods The new Equity Group will continue and expand this work by designing a program of projects aiming to (1) promote equity in the evidence base, (2) ensure equitable processes for stakeholder engagement, (3) produce high‐priority, equity‐focused evidence syntheses, (4) build capacity for equity design, analysis, and reporting, and (5) promote equity in implementation tools. Results We will build on our current network of collaborators and create a group structure striving to recruit across the PROGRESS‐Plus characteristics. Conclusion We invite readers to join our cause and contribute wherever they are able. Together, we can help Cochrane achieve its social responsibility …

Background People living with HIV (PLHIV) are at increased risk of COVID-19 acquisition, severe disease, and poor outcomes. Yet, little is known about COVID-19 vaccine hesitancy among PLHIV in high HIV burden countries, such as Nigeria. Objective This study aims to assess the acceptability of the COVID-19 vaccine and identify predictors and reasons for vaccine hesitancy among patients living with HIV and attending a tertiary hospital in Kano, northern Nigeria. Methods Using a mixed-methods design, structured questionnaires were administered to a clinic- based sample of patients living with HIV (n = 344), followed by 20 in-depth interviews with a sub-sample. Logistic regression and the framework approach were used to analyze the data. Results Less than half (46.2 %, n = 159) of the respondents were willing to take the COVID-19 vaccine. Vaccine acceptance was higher among non-Muslim PLHIV …

ImportanceTo ensure that youths can make informed decisions about their health, it is important that health recommendations be presented for understanding by youths.ObjectiveTo compare understanding, accessibility, usability, satisfaction, intention to implement, and preference of youths provided with a digital plain language recommendation (PLR) format vs the original standard language version (SLV) of a health recommendation.Design, Setting, and ParticipantsThis pragmatic, allocation-concealed, blinded, superiority randomized clinical trial included individuals from any country who were 15 to 24 years of age, had internet access, and could read and understand English. The trial was conducted from May 27 to July 6, 2022, and included a qualitative component.InterventionsAn online platform was used to randomize youths in a 1:1 ratio to an optimized digital PLR or SLV format of 1 of 2 health …

BackgroundRacialized, low-income, and migrant populations experience persistent barriers to vaccines against COVID-19. These communities in East and Northeast Calgary were disproportionately impacted by COVID-19, yet faced vaccine access barriers. Diverse multi-stakeholder coalitions and community partnerships can improve vaccine outreach strategies, but how stakeholders perceive these models is unknown.MethodsWe conducted a formative evaluation of a low-barrier, community-engaged vaccine outreach clinic in Calgary, Alberta, Canada, on June 5–6, 2021. We delivered an online post-clinic survey to clinic stakeholders, to assess whether the clinic achieved its collectively derived pre-specified goals (effective, efficient, patient-centered, and safe), to asses whether the clinic model was scalable, and to solicit improvement recommendations. Survey responses were analyzed using descriptive …

Established in 2015, the Multi-Stakeholder Engagement (MuSE) Consortium is an international network of over 120 individuals interested in stakeholder engagement in research and guidelines. The MuSE group is developing guidance for stakeholder engagement in the development of health and healthcare guideline development. The development of this guidance has included multiple meetings with stakeholders, including patients, payers/purchasers of health services, peer review editors, policymakers, program managers, providers, principal investigators, product makers, the public, and purchasers of health services and has identified a number of key issues. These include: (1) Definitions, roles, and settings (2) Stakeholder identification and selection (3) Levels of engagement, (4) Evaluation of engagement, (5) Documentation and transparency, and (6) Conflict of interest management. In this paper, we …