Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Background: In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals’ development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub‐Saharan Africa region, which faces a large burden of mental disorders.Methods: The study population for this cross‐sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL.Results: Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge‐related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health‐related disorders. Those who had experience in the use of mental health‐related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS.Conclusion: The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Background: The lack of public knowledge and the burden caused by mental-health issues’ effect on developing and implementing adequate mental-health care for young and adolescent in low- and middle-income countries (LMIC). Primary health care could be the key in facing the challenge, but it suffers from insufficient resources and poor mental health literacy. This study’s aim was to adapt the content validity of the Mental Health Literacy Scale (MHLS) developed by O’Connor & Casey (2015) with researchers and primary health-care workers in low- and middle-income contexts in South Africa (SA) and in Zambia. Objectives: The study population comprised two expert panels (N = 21); Clinical Experts (CE) (n = 10) from Lusaka, Zambia and Professional Research Experts (PE) (n = 11) from the MEGA project management team were recruited to the study. Methods: MHLS was validated in a South African and a Zambian context using a heterogeneous expert-panel method. Participants were asked to rate the 35 MHLS items on a 4-point scale with 1 as not relevant and 4 as very relevant After the rating, all 35 MHLS items were carefully discussed by the expert panel and evaluated according their relevance. The data were analyzed using an item-level content validity index (I-CVI) and narrative and thematic analyses. Results: All 35 items ranked by the PREs met the cutoff criteria (≥0.8), and ten (n = 10) items were seen as relevant by CE when calculating I-CVIs. Based on the results of ratings and discussion, a group of sixteen (n = 16) of all items (n = 35) were retained as original without reviewing. A total of nineteen (n = 19) items were reviewed. Conclusion: This study found the MHLS to have sufficient validity in LMICs’ context but also recognized a gap between professional researchers’ and clinical workers’ knowledge and attitudes related to mental health.

Engaging with children and adolescents in mental health settings who are exhibiting behaviours that challenge can often result in the use of seclusion, restraint and coercive practices. It is recognised that more therapeutic ways to engage this population are needed, adopting trauma informed interventions may provide a solution. The aim of this systematic review is to synthesize the evidence in relation to the effect of trauma-informed interventions on coercive practices in child and adolescent residential settings. The review is guided by elements of the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. Results were synthesized and reported narratively. Nine studies met the eligibility criteria for this review. There was a lack of homogeneity amongst the studies. The trauma-informed interventions used were typically multi-faceted, underpinned by a variety of approaches and sought to bring about changes to clinical practice. Most studies (n = 8) reported significant reductions in the use of restrictive practices following the implementation of a trauma informed approach. The use of a trauma-informed approach, underpinned by an organisational change or implementation strategy, have the potential to reduce coercive practices with children and adolescents. However, the included interventions were insufficiently described to draw strong conclusions.

Mental health disorders among primary school children remain a crucial issue. Early health promotion interventions can positively affect and prevent the onset of mental disorders. Promising digital mental health methods have been implemented for adolescents and youths with scarce evidence among younger ages. Therefore, the aim of the current systematic review was to identify health promotion interventions on mental health and wellbeing, with the use of digital methods, delivered in primary school settings. Six digital interventions have been identified, three of which were targeting teachers and the others students. Regardless of the limited number of studies, the effectiveness of the web-based interventions upon teachers’ knowledge and attitudes and the positive impact on children’s behavioral improvements has been documented. The lack of adequate evidence highlights the need for further research in the field. The current review provides information for professionals working in primary schools useful for the design and implementation of effective mental health and wellbeing interventions.

Background: Trauma-informed care (TIC) is a framework that embeds safety, trust, choice, collaboration, and empowerment into practice. Although training improves TIC attitudes, implementation in European residential child and adolescent settings remains inconsistent, and immersive technologies such as virtual reality (VR) are underevaluated for this purpose. Objective: This study aims to evaluate whether a VR-enhanced training program improves TIC attitudes among staff and trainees in residential child and adolescent care across European sites and to examine site-level heterogeneity. Methods: We conducted a multisite pre-post evaluation within the European Union–co-funded Safe4Child project. Participants completed a standardized online TIC module followed by a mentor-facilitated VR simulation. Attitudes were measured using the ARTIC-10 (10-item version of the Attitudes Related to Trauma-Informed Care; 7-point) scale immediately before the online module and immediately after the VR simulation; the design, therefore, evaluates the combined program rather than VR in isolation. Analyses included Wilcoxon signed-rank tests, multivariable regression, and Bayesian models with skeptical priors. Results: Among 79 matched participants from Bulgaria, Finland, and Germany, mean (SD) ARTIC-10 scores increased from 5.33 (1.05) to 5.57 (1.20; P <.001; Cohen d =0.22). Effects varied by site. Germany showed significant improvement (Cohen d =0.56), whereas Bulgaria and Finland did not reach significance. Bayesian estimation yielded a mean change of 0.24 points (95% CI 0.11‐0.37) with P ( Δ >0) ≈ 1.00. Prior trauma-related training showed a probable but uncertain additional benefit. Conclusions: The VR-enhanced TIC program produced a small overall improvement in attitudes, with a moderate effect in Germany, suggesting that immersive training can strengthen TIC learning when aligned with local contexts. The absence of a control group precludes attributing effects specifically to VR. Larger comparative trials are needed to determine whether VR confers advantages over conventional training approaches.