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Thursday 31 December 2020
Monday 28 December 2020
Lupine Publishers | Applying Innovation Diffusion Theory to Determine Motivating Attributes for Successful Implementation of Internet-Based Interventions for Evidence Based Medicine: a Developing Country Context
Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
Current
healthcare outcomes depend on the adoption of valid and latest research
evidence and practicing evidence-based medicine (EBM). EBM is the process of
adaptation of the finest available scientific research evidence into routine
clinical practice. However, literature reports gap between actual and required
clinical practice. This gap will not be bridged by just updating physicians
about EBM. Therefore, it is required to study the motivational factors in a
context to use technology in routine clinical practice as things behave
differently under varying constraints. This study aimed to address this gap by
investigating motivating factors to promote EBM, focusing mainly on developing
country context. Innovation diffusion theory will be used to provide the basic
or theoretical support for the research as this theory states that the adoption
of any innovation is itself facilitated by its certain characteristics.
Cross-sectional quantitative methodology will be used for this research. SPSS
and SEM will be used to analyze data and validation of the tested research
model. The innovation diffusion theory may provide constructive and practical
insights into the factors for the successful implementation of EBM, as well as
it will provide a guideline for those who try to adopt the bestevidences into
their clinical practice.
Keywords: Innovation diffusion theory; Evidence based
medicine; EBM; DOI Diffusion of innovation
Introduction
The
innovation is a new idea that is observed by the individual. Evidence-based medicine
is an innovation in the clinical decisionmaking process, which promises to
improve health care delivery [1]. But at the same time, practicing EBM is a
paradigm shift that is changing the conventional way of the clinical
decision-making process [2]. Acceptance of any change or innovation in
conventional clinical practices is always very hard, and multiple factors play
their part in the adoption procedure [3]. The characteristics of innovation
play a significant role in defining its rate of adoption [4]. For an innovation
to be adopted, it must be perceived as offering relative advantage, i.e.,
simple, compatible, observable and testable. Roger proposes one of the
theoretical approaches addressing the diffusion of innovation (DOI). DOI model
is supportive at describing the acceptance of explicit clinical events, mostly
when determining which components will need additional effort if diffusion is
to ensure [4]. Literature showed applications of DOI in health departments as
well [5-7]. Becker and Mohr worked to identify organizational characteristics
linked with the diffusion process among the health department [6]. One study
found that demographic features age, gender, education level, urban and rural
areas had a great impact on the time for adoption of innovation. It was noted
that the initial adopters of innovations different by age, education and used
information-seeking approaches as compared to their jurisdictions who are
varied by rurality [7,8]. Graduated younger people who had a higher standing in
their graduating class and belonged to urban areas were ready to adopt less
risky interventions. In comparison, older people in countryside areas who had a
normal standing in their graduating class, and they established their
leadership roles were ready to take more risks, but they adopt less
conventional innovations. It is also evident in literature that large health
departments easily adopt innovations than small health departments. The
accessibility of funds and human resources are the reasons which are supporting
this finding [8,9].
The
effective implementation of EBM in the healthcare sector, a better
understanding of the motivating factors is required in detail. Relation and
association of factors with each other are also very important as the context is
very special, and physicians have autonomous authority in the clinical
decision-making process. Context and users of technology matter a lot because
things behave differently under varying constraints. It is evident from
literature that the primary characteristics of the innovations have been
conflicting as these are inherent in the innovation. These primary
characteristics are not dependent on the perceived characteristics of the
intended users. Augury of the potential user’s behavior depends on their perception
about the primary traits as different users may perceive the primary
characteristics of the innovation in a different way, which can cause different
behavior of the users. This is the origin of the problem of using the primary
characteristics of innovation.
Innovation Diffusion Theory (IDT) is used for this research work because IDT is
considered relevant and useful to researchers conducting studies of information
systems innovations in healthcare organizations. The IDT theory tries to
explain the diffusion of new ideas, attitudes, opinions, and behaviors all over
a community. The IDT is an important constituent of the upgrading health
services worldwide, yet the literature illustrates that it is not always an
easy theory to relate empirically [10]. IDT identifies five factors that
influence the diffusion and adoption of an innovative idea or strategy. The IDT
offers a theoretical framework globally to accept information technology. The
role of ethnical background plays an important part in the adoption of new
ideas/technology as it addresses that how, why, and what adoption rate of new
technology can relate with different social backgrounds and settings [11]. IDT
not only addresses the adoption of information technology only, but it also
addresses other diffusion processes through the society, such as the acceptance
of new technology products such as services, style of music, fashion, food,
ideas, or political candidates [11-13].
This study builds upon what is known from past research on the diffusion and
research conducted by Jenine K. Harris [8], which described the significance to
comprehend how health personnel perceives the relative advantage, simplicity,
compatibility, and testability of evidence-based decision making. Specifically,
this research examined the effect of IDT factors, which can play a great
motivational role for the physicians to adopt the new way of the clinical
decision-making process. Results are based on their perceptions and experience
of practicing EBM. Rogers identified five (05) elements of a new or substitute
clinical behavior that can help in determining the adoption of a new activity
such as EBM. These are relative advantage, compatibility, complexity,
trialability, and observability [14]. Definitions of all these four elements
are given in Table 1 along with the hypothesized relations. All these variables
are discussed below.
Independent variables
Relative
advantage: The social prestige, satisfaction and convenience, clinicians are
some important factors for measuring the degree of relative advantage. Relative
advantage can also be measured in economic terms for a new clinical activity
[3]. Objective advantage of innovation is less important as compared to
clinician’s perception of the advantages of innovation. Clinicians, patients,
and the healthcare system together decide the best-evidence practice
implementation. For instance, if a new clinical activity changes the power
distribution balance in professional groups in a negative way, then the
innovation cannot be successfully applied. On the other hand, if the proposed
activity generates more revenue and benefits the clinicians without disturbing
the balance of power distribution, then innovation will be readily accepted and
adopted.
Therefore, it is hypothesized that
H1: Relative advantage of EBM has a noteworthy positive effect on the usage
intention for EBM adoption.
Compatibility: It is necessary
for successful adoption of an innovation that it must tackle an issue that is
perceived as problematic by the clinicians. For instance, a new clinical
activity or procedure will be adopted fast if it helps clinicians to detect
cancer or other life-threatening illness at very early stages [15]. It is a
strong medical belief that early detection of a disease is beneficial for the
patients. Accordingly, clinical activity or procedure offering this capacity
will be adopted quickly. The rapid adoption of mammography screening [16,17]
and testing for prostate cancer are a few real-life examples. Though literature
also has some controversial debates about the therapy mentioned above
effectiveness.
Therefore,
it is hypothesized that
H2: Compatibility of EBM has a significant positive effect on the usage
intention for EBM adoption.
Complexity/Simplicity: Literature proves
that the probability of adoption for a clinical procedure increases when the
procedure is simple, easy, and well defined. For example, the rate of change in
drug regimen for patients by clinicians is high and the reason behind this
phenomenon is that it is easy to adopt. While some precautionary activities as
detecting and handling patients with harmful alcohol consumption [18] have not
been adopted quickly, though reported potential health gain in literature. This
may be due to the complexity of these activities. All preventions at the
primary level are vulnerable due to the patient’s resistance and their lack of
accuracy in self-reporting risk behaviors. Additionally, inadequate expertise
in the consulting skills of clinicians necessary to achieve change may be the
other reason.
Therefore,
it is hypothesized that
H3: Complexity/simplicity of EBM has a significant positive effect usage intention
for EBM adoption.
Trialability: According to
Rogers, “trialability” is the degree of modification of an innovation. In other
words, the capability to test an intervention in medicine on a limited basis
allows clinicians to explore the implementation of the procedure, its
acceptability, and the possible outcomes. Rogers claims that the ability to
undertake limited cost-benefit experiments of an intervention endorses trust
and confidence that the evidence is not only, but its implementation is
logistically promising as well.
Therefore, it is hypothesized that
H4: Trialability of EBM has a significant positive effect on the usage
intention for EBM adoption.
Observability: Observability
means the idea of innovation is visible to others. The visibility of
innovation’s results motivates colleagues to discuss that particular
innovation. Discussions on the method or innovation by the influential
physician will further enhance the adoption rate. More clinicians will tend to
adopt the change in their clinical behavior if the role model practitioner is
more influential and charismatic. New techniques are often adopted very quickly
in the surgery department because of a common belief that there are
disadvantages in being “left behind” by not adopting new technology.
Therefore, it is hypothesized that
H5: Observability of EBM has a significant positive effect on the usage
intention for EBM adoption.
Dependent variable
UI:
In IS research, the system usage intention is a vital construct. Self-reported
usage is the only aspect of UI addressed by most of the researchers in
quantitative studies. These studies adapted self-reported usage to
operationalize the actual system usage, in the absence of usage metrics. In
technology acceptance studies intentions leads towards behavior [19]. The
reason behind this is high values of correlation reported in the literature for
the relation of intention and behavior. This research framework focused on the
use of UI as a dependent variable because the use of UI as a dependent variable
has literature support relative advantage and compatibility equivalent to PEOU
and PU constructs. Under conditions of incomplete volitional control, the
intention cannot act as a sufficient predictor of the behavior [20].
Diagrammatic representation of the research framework along with dependent and
independent variables is given as Figure 1.
Methodology
Sampling
A
simple random sampling method was used to collect data. Random numbers were
generated through the computer after having access to the staff records of the
physicians in the selected hospitals. The self-administered questionnaire used
as a data collection tool. A description of the questionnaire is provided in
the next section (Figure 2). A total of 350 questionnaires were distributed,
and 290 responses were returned. Thus, the response rate was 82.85%. Total of
twenty responses was discarded due to the same reply, missing responses or left
blank and thus the usable response rate was 77.1% of the 270 respondents, 61.1%
were female doctors (Mean age= 38.3 years, SD= 10.7) and 38.9% were male
doctors (Mean age= 40.1 years, SD= 9.83).
Data collection tool
A
structured close-ended questionnaire was used. At the beginning of the
questionnaire definition of evidence-based medicine was provided to have a
better understanding of the concept. Demographic questions (were age, gender,
organization, and working experience) were included at the beginning of the
questionnaire. It was requested to the participants to give feedback by
thinking that practice evidence-based medicine will be a requirement in the
future for their routine clinical practice. The standard variable for
innovation diffusion theory (technical compatibility, simplicity, relative
advantage, and intentions) was used in the current research model. The variables
derived from other related studies on the extension of the IDT (Trialability
and Observability) were also included to have a deeper understanding of the
phenomenon. Seven (07) points Likert scale (1=strongly disagree, 7=strongly
agree) was used to code the responses. English was the language of the
questionnaire. All the constructs were measured through the validated items
confirmed by the literature.
Results and Discussion
Data
screening was performed to identify missing data. The expectation-maximization
technique was applied by using little’s MCAR test, and it was found that the
missing data was less than 10 percent, and it is missing completely at random.
Missing data were handled by using the mean substitution imputation method.
Skewness and kurtosis were checked to detect data normality at a univariate
level while Kolmogorov Smirnov and Shapiro Wilks tests were performed to check
multivariate normality. Results suggested that the data was normally
distributed both at univariate and multivariate level. The linear regression
method by using the Mahalanobis distance test was performed to detect the
presence of outliers. Results revealed that the presence of the few outliers;
it was, decided to retain all the cases, as there was insufficient evidence to
suggest that these outliers were not part of the entire population (Hair et al.
2006). Construct reliability for each construct is calculated with alpha value
and tabulated in Table 2 all values are within an acceptable range. After basic
data screening process factor analysis is performed.
Factor analysis (FA)
FA
is a multivariate regression analysis statistical method used to analyze the
correlation structure between different variables/constructs. In FA, after
identifying latent dimensions of the constructs, data reduction was performed.
Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) are
two steps in FA. The data is explored in EFA, while hypothesis is tested in CFA
[21]. For the current analysis, the researcher performed both steps of factor
analysis. EFA: There are two main steps in EFA, which are extraction and
rotation processes. The extraction process identifies the underlying factors or
constructs, while the rotation process yields an easy presentation of a factor
loading pattern. In the current analysis, the researcher used the orthogonal
rotation method for factor loading. Before performing factor analysis, we must
check the suitability of current research data for sample adequacy. For this
purpose, we performed KMO and Bartlett’s Test.
Kaiser-Meyer Olkin (KMO) and Bartlett’s Test
For
the current research study, the value of the KMO test is 0.853, which shows the
confidence about sample size adequacy to proceed for further steps of factor
analysis. The result for Bartlett’s test can be interpreted on the value of
significance. The value of significance is .000 confirmed that the analysis
could continue by using factor analysis as tabulated in Table 3. Furthermore,
for exploratory factor analysis (EFA), the principal components analysis (PCA)
and orthogonal model with varimax rotation method were applied. The result of
principal component analysis also confirms the presence of 6 factors explaining
the total variance of the components as shown in Table 4. The results
recommended the deletion of the item SP4 of Complexity/ Simplicity construct,
as it was highly cross loaded on another latent factor, OB (observability). The
graphical presentation of latent constructs based on eigenvalues in EFA is
shown in the scree plot (Figure 3). Scree plot plots all the eigenvalues in
their decreasing order, where eigenvalues on the vertical axis and factors on
the horizontal axis. The scree plot confirms the choice of 6 components.
Confirmatory factor analysis (CFA)
CFA
consists of the measurement and structural model. The measurement model used to
evaluate the model validity and reliability. The reliability includes
Cronbach’s alpha, while validity includes discriminant validity. Whereas
structural model is used to test the relationship between constructs. The
result for discriminant validity is shown in Table 5. The off-diagonal values
represents correlation squared while diagonal values represent AVE In order to
meet the criteria for discriminant validity, it is required that the AVE square
root for each construct should be greater than the interconstruct correlation
as tabulated in Table 6. It is also found that the inter-construct correlation
value was not above the square-root of the AVE, so the model satisfies the
discriminant validity criterion. In Table 7, the fit indexes for both
measurement and structural model are given. Hypothesis testing is done by using
the structural model. It is noted that four out of five hypotheses are
supported either at .001 (***) or .05 level of p-value; only one hypothesis BIßOB is rejected. Path diagram showing all
the hypothesis is presented in Figure 4. The most probable reason for the
insignificant hypothesis between observability and usage intention was that the
software and information system had less observability by physicians, hence
less rate of adoption as compare to hardware innovation [22]. Consequently, the
more potential user can see the innovation, the more likely he will adopt it.
This
study has following limitations:
a) Cross-sectional self-reported data limit this study.
b) Only one healthcare system, which might not reflect the factors for the
successful diffusion of EBM in other health care settings.
c) Using an anonymous survey for data collection.
d) The small sample sizes.
Conclusion
Evidence-based
medicine holds promise in improving health care quality and efficacy by
improving the clinical decision-making process. So far, health care is decades
behind other industries to adoption and use of information technology (IT).
Though, stakeholders in the health care sector have highlighted the urgent need
to adopt IT systems. This research work advocates that the resources presently
accessible to practice EBM are unlikely to attain full diffusion in the
preferred time frames. Regardless of the existing resources, the factors
influencing adoption patterns are also unlikely to change absent significant
incentives that have a positive impact on the new paradigm of clinical
practice. Already a lot of time elapsed between the introduction of sustainable
EBM technologies and today. There is growing recognition that the EBM diffusion
process is multidimensional and that no single dimension will effectively
address all the barriers and challenges to EBM adoption by physicians. Future
research that draws on cross-national comparisons of government programs and
their effect on diffusion factors could help shape policy maker’s attempts to
accelerate EBM adoption among health providers. It would be informative to have
in-depth information on how physicians and other providers react to the
government-introduced standards.
https://lupinepublishers.com/psychology-behavioral-science-journal/fulltext/applying-innovation-diffusion-theory-to-determine-motivating-attributes-for-successful.ID.000187.php
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Wednesday 23 December 2020
Wishing you a Magical and Blissful Holiday.
May this Christmas end the year on a cheerful note and make way for a fresh and bright New year. Wishing you a magical and blissful holiday.
Tuesday 22 December 2020
Lupine Publishers | Juvenile Delinquency and It’s Psychological Implication-a Case Study of Pakistan
Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
According to common law-the legal
dispensation system used in most countries across the world, including
Pakistan-two fundamental components are required to prove the commission of a
crime: firstly, actus reus and secondly mens rea. In general, the first of
these two-the actus reus-is the physical act (or omission) of committing the
crime. The second-mens rea-is the necessary intent to prove that the alleged
perpetrator wanted to commit the crime. Besides, these demonstrate potential
psychological impacts over the societies across the world, which is focused on
this study. The study adopts qualitative means to examine the psychological
implications of Juvenile delinquency in Pakistan and provide insightful
understanding for the readers.
Keywords:Juvenile; Psychological implication; Pakistan; Legal
developments
Introduction
Human nature a complex topic since the
earlier ages. Factors, conditions, circumstances, helping in the evolution of
human nature. The different persons are acting differently in the same
situation, making us wonder. The DNA composition of every man making us all
perplexed. The same number of chromosomes millions of genes and genetic codes
all contributing to the evolution and development of human psychology. Youngs,
children, minors have always been the apple of the eye of the legislature. From
the base of fundamental rights having a special place in principles of the
policy of the supreme law of the land. “Doli incapax” the Latin term referring
to the limelight fact inability of young to do the crime [1]. However, the
question arises in societies like Pakistan, where we see young offenders
involved in all sorts of crimes. Dealing with them, the legislature in Pakistan
had to provide an act Juvenile Justice System Act, 2018 [2]. So now the
hypothesis we can give is that the adolescent delinquency is mainly depending
on the psychology of the offender. Factors contributing to it are Age, Social
Status, Abusive Culture, Inequality and Partiality, Social Circle, Poor
Education System, Social Factors, Economic Factors. The present study examines
the juvenile delinquency and its psychological implication as a general and
taking Pakistan as a case study. It presents the background and introduction of
the subject matter in section one, provides an in-depth discussion in section
two and concludes the discussion in section three with proactive findings with
some appropriate suggestions.
Discussion
Keeping in focus the psychology is the
heart of every juvenile case, so, following special procedure is introduced by
the legislature in Juvenile Justice System Act, 2018:
a) Report about juvenile psychology/
economic and social status by the probation officer.
b) Trial to be concluded in four months to prevent them from the agony.
c) No trial with adults.
d) No arrest or detention in jail.
e) Special committee to formulate a reformative judgement in a case where
needed.
f) No fetters or capital punishment.
g) The expense of litigation with medical treatment by the state.
h) Immunity of publication of name and facts of juvenile.
Furthermore, the height of delight is
that the punishment awarded under this act will never act as conviction in case
of jobs and future life of juvenile. It means an act done in the rage of
hormones will not become repent/regret in future. Legislature wanted to secure
the future of juveniles, but to the contrary, it is giving dirty minds of
societies to get their work done without getting their hands dirty. The hands
of the juvenile are tainted with the filth of crime; their minds are tortured
with the agony of offences and trials; however, they are getting away easily.
The upcoming decades will lead us to see the fact that all crimes will be done
by juveniles making it impossible to track the real offenders as juveniles are
never to be tortured for retraction of confession. Latest amendment sections 82
and 83 in Pakistan Penal Code, 1860, giving immunity to juvenile again the very
nature was to safeguard the psychology of juveniles [3]. However, the honey of
immunity and the general exception is attracting the thugs of society to attack
the delicate minds and incorporate them with microchips of crimes, infecting
their minds and softness.
According to a Society for the Protection
of the Rights of the Child (SPARC) report [4], published in 2012, in Pakistan
1500 to 2000, juveniles were imprisoned. This figure, however, excludes
thousands of under trial juveniles whose numbers are unknown. Figure 1 presents
an overview of the Juvenile detention facilities as provided by the governments
of various provinces of Pakistan-it provides that Sindh province tops in the
provision of such facilities, i.e. four centres; Punjab provinces adhere two
centres; Khaybar Pakhtunkhwa (KPK) demonstrates one facilitation centre which
is not functional; while Baluchistan province does not have any such facility
[5].
Conclusion
Greater care is to be taken while dealing
in such cases; penalties/ punishments/ reformations are to be awarded, keeping
in view psychology of juvenile along with other factors of the case. Every case
is to be dealt with individually keeping the facts in mind the future of
juvenile can help us to determine the future of Pakistan.
https://lupinepublishers.com/psychology-behavioral-science-journal/pdf/SJPBS.MS.ID.000186.pdf
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Friday 18 December 2020
Lupine Publishers | A Review of Telepsychology and Mental Health Mobile Apps in Advanced Countries: Opportunities for Ghana’s Mental Health Care
Lupine Publishers | Scholarly Journal Of Psychology And Behavioral Sciences
Abstract
Sustainable development denotes the
development of nations in ways that are not restrictive for future generations
in their efforts to meet their own needs. Without healthy human beings,
sustainable development cannot be successfully carried out or assessed as a
goal. For this reason, health, which forms the third arm of sustainable
development goals have received much attention across nations. In Ghana,
however, the aspect of health which has not received as much attention lies in
the area of mental health. This paper addresses how mental health care and
access in Ghana can be improved through the use of applied science and
technology. Specifically, recommendations are made about the prospects that
telepsychology and mental health mobile apps hold for applications in Ghana.
This concept is introduced in the paper by reviewing telemental health
practices and the use of mobile mental health apps in more advanced countries
like the United States and Britain. The paper addresses how these two concepts
can be introduced in Ghana, and guided by the experiences of other African
countries, the potential associated challenges of implementation are also
discussed. The paper ends with recommendations on how to overcome these
challenges and makes note of the impossibility of fully achieving sustainable
development goals for health when Ghana’s mental health care system remains in
such dire states.
Keywords:Sustainable development; Ghana; Mental health;
Telepsychology; Mental health mobile apps
Introduction
In September 2015, 194 countries adopted
the sustainable development goals spearheaded by the United Nations. These 17
goals officially came into effect in January 2016 with the ultimate aim of a
higher quality of life for all (“The Sustainable Development Agenda,” n.d.).
Sustainable development can be defined as development that meets the needs of
the present without compromising the ability of future generations to meet
their own needs. Sustainable development implies development and growth in
conscious ways that do not cause havoc for future generations. Human beings are
the central reason for the need for sustainable development and at the same
time, without humans, the agenda for sustainable development cannot be
realized. Health and wellbeing comprise the third arm of the United Nations’
sustainable development goals.
The goals of sustainable development cannot be achieved when there is a high
prevalence of encumbering illnesses (Von Schirnding & Mulholland [1]).
Health is a significant contributor to, and an indicator of, sustainable
development and its wide-reaching impact on people, societies, countries,
economies and such goals as the sustainable development goals have corralled
attention to this integral area. In doing so, there is an aspect of health that
has not gained as much attention as the physical health related issues in Ghana
and this lies in the area of mental health. Mental health can be defined as a
state of well-being in which every individual realizes his or her own
potential, can cope with the normal stresses of life, can work productively and
fruitfully, and is able to make a contribution to his or her community (“WHO |
Mental health: a state of well-being”, 2017). It comprises an individual’s
psychological, emotional, and social being with impacts on the way one thinks,
feels and acts. The state of an individual’s mental health affects how stress
is handled, how relationships are managed, and the decisions that one makes.
Just like physical health, mental health is important in every phase of life,
from childhood to adulthood. In childhood for example, mental health plays a
role in the bond between parents and their children. It helps set a solid
foundation for life. During adolescence, mental health plays an integral role
in the way the adolescent develops a sense of morality, and in adulthood,
mental health plays a significant role in the way work, family and intimate
relationships develop and evolve. In a pandemic such is currently being
experienced with the coronavirus, its associated distresses of grief, social
isolation, fear, panic and pre-existing mental health conditions mandate the
pursuit of mental health can be ameliorative.
Problems with mental health can come in mild, moderate or severe forms. They
can impact how one deals with mandatory social isolation or social distancing
during a pandemic. They can impact a child’s understanding of social cues, for
example, as can be the case with Autism Spectrum Disorders. Issues with mental
health can influence the way the student is able to take in, process and
understand information as can be the case with learning disorders. In the case
of the new mother, problems with mental health can impact the way she is able
take care of her child as can be the case with post-partum depression. Early detection
and intervention tend to yield better outcomes for individuals with mental
health disorders. In Ghana, however, access to mental health care and mental
health professionals are severely lacking. According to the World Health
Organization’s situational analysis report on Ghana, there is a mental health
treatment gap of 98% in Ghana, meaning that only 2 out of every 100 Ghanaians
with mental health issues will get the care they need. Advancements in
technology have played a crucial role in the evolution of health care treatment
and prevention. From electronic medical record keeping systems to portable
diagnostic devices, health care systems are making use of technological
advancements that bring about more efficiency. Diagnostic devices are being
produced to be more sensitive in ways that can lead to early diagnosis and now,
because of technology, healthcare devices are being made in sophisticated ways
that allow for transfer and use in countries and areas that do not have easy
access to such mechanisms. The impact that technology has had on medical
science has been enormous and continues to evolve daily. In the field of
psychology, technology has had impacts although not as great as that of the
field of medicine. During a pandemic such as the world is currently facing with
the coronavirus, many occupational fields, not just medical or psychological
are turning to technology to provide care and services. Ghana can explore ways
that technology can positively influence mental health care and access. This paper
explores a few of these ways.
Methodology
The methodology for this research paper
involved a review of the telepsychology practices and mobile mental health app
use in advanced countries, particularly the United States and the United
Kingdom. The APA and BPS telepsychology guidelines were reviewed in addition to
the United Kingdom’s National Health Service digital library for mobile mental
health apps and the APA’s mobile mental health app evaluation model. These
countries were selected based on the major advances they have made with regard
to regulating the use of telepsychology practice and mobile mental health apps.
A literature review was also conducted on the application of telepsychology and
mental health mobile apps in other African countries. This review was conducted
mainly to balance the opportunities of telepsychology and mobile mental health
apps observed in the advanced countries like the United States and United
Kingdom with the potential real-life implementation challenges that have been
discovered in similar cultural contexts.
Review of Telepsychology
and Mental Health Mobile Apps
The trends of telepsychology and mental
health mobile apps in more advanced countries can serve as learning
opportunities for Ghana’s mental health system. The following sub-sections
discusses some of these opportunities and makes suggestions for implementation
[2-4].
Telepsychology and mental
health care access
Telepsychology can be defined as the
provision of psychological services using telecommunication technologies.
Psychological services provided with such a modality can be in lieu of or in
addition to traditional therapy or treatment. With telecommunication mechanisms
like e-mail, texting, mobile apps and videoconferencing, mental health services
can be provided without the need for inperson interactions. Telepsychology
presents as a unique option for patients who are not ambulatory or for people
and families who are unable to travel to the psychologist’s office to access
services. For individuals whose diagnoses (such as agoraphobia or the fear of
social situations) prevent them from leaving the house to get to the
psychologist, telepsychology presents as an opportunity to begin the process of
treatment that would eventually help them overcome their fear and potentially
transfer to in-person treatment. The practice of some form of telepsychology or
online counseling is not a novel concept in Ghana or abroad. Telepsychology has
been around since the launch of the internet in 1972 (Alleman [2]). Currently,
psychologists worldwide perform or have performed some sort of online
counseling or telepsychology. In 2008, a survey conducted by the American
Psychological Association revealed that 87 percent of psychologists provide
mental health care services via telepsychology (American Psychological
Association, 2009). The prevalence of this practice has led to the formulation
of practice guidelines in some developed countries like the United States,
Britain, and Canada. Mental health care access is an area in Ghana’s mental
health care system that requires major development. With the exception of the
popular, major psychiatric hospitals in the country, it can be difficult for
the average Ghanaian to know where to go to in order to seek mental health care
especially one that is not located in a psychiatric hospital. In recent years,
the Ministry of Health has made provisions to allow for the placement of
clinical psychologists in its hospitals. However, mental health care access
continues to be a problem because of location, insufficient numbers of clinical
psychologists and stigma among other reasons. Today, one is more likely to gain
access to a clinical psychologist in the nation’s capital of Greater Accra than
in any of the other regions of Ghana. This problem is worsened by reported
estimates from Osei [3], the former Chief Psychiatrist of the Accra Psychiatric
Hospital of a doctor-patient ratio of 1:1.7 million in the mental health sector
(Awaf [4]). Stigma can be a deterrent when it comes to seeking mental health
care even among people who have relatively easy access to these services. With
clinical psychology facilities sometimes being housed in places like the Accra
Psychiatric Hospital, individuals may be afraid to seek out these services for
fear of being perceived as ‘mad’. In cases like these, the practice of
telepsychology holds the potential for ameliorating such problems by
abbreviating the distance between the prospective patient and psychologist, for
allowing easy access to psychologists and for reducing the potential stigma of
accessing the psychologist in a setting that could potentially be stigmatizing.
Development of telepsychology
guidelines and opportunities for ghana
In 2013, the American Psychological
Association (APA) released their guidelines for the practice of telepsychology.
Prior to that in September 2009, the British Psychological Society (BPS)
released its second edition of regulations concerning the provision of
psychological services via the internet and other nondirect means (Professional
Practice Board [5]). The formation of these guidelines was a response to the
increasing rate of the use of telecommunication strategies among its
psychologists. While the APA and BPS recognized the potential for
telepsychology to increase access to psychological services, it also recognized
the need for the formal regulation of tele psychological practices because of
the potential challenges it presented. It is possible for Ghana to take a cue
from these guidelines in order to pre-empt any potential challenges, and to
keep itself from being reactive when tele psychological services rise to the
capacities experienced in more developed countries. The formulation of such a
guideline for Ghana’s psychologists will also serve as a mechanism to permit
the use of such a service delivery mechanism as a solution to Ghana’s mental
health care access problems [6]. For the APA (and BPS), core issues identified
in their guidelines for telepsychology include the competence of the
psychologist in providing tele psychological services and the importance of the
need for the psychologist to be well-versed in the use of the telecommunication
technologies as well as the awareness of the potential impact of such a
modality on clients/patients, supervisees and other relevant stakeholders
(“Guidelines for the Practice of Telepsychology”, 2013). There is a vast array
of choices when it comes to telecommunication technologies today and it is
important for the psychologist using such modalities to be knowledgeable about
their chosen systems of communication especially where issues of privacy and
confidentiality are concerned. Given the sensitivity of information that is
shared in the client-psychologist relationship, the potential fears of stigma
as well as the consequences of client-psychologist privileged information
becoming public knowledge, it is important for the psychologist to be
thoroughly knowledgeable about their telecommunication mechanisms and its
privacy/confidentiality limitations in order to select systems that provide the
most privacy/ confidentiality possible and to communicate any such limitations
to the patient/client as sanctioned by psychological practice.
The upholding of the standards of care in
the delivery of telepsychology services was also an important issue in the
development of the APA and BPS telepsychology guidelines. By these, the
guidelines reinforced the importance of translating the same ethical and
professional practices of in-person services to telepsychology. While
telecommunication technologies have the potential of connecting the patient to
the psychologist, it also has the potential of creating a disconnect in the
patient-psychologist therapeutic relationship. The patient/client who ‘sees’
the psychologist via a telecommunication device may not feel as close to the
psychologist as the patient/client who does so face-to-face or in-person. In
the patient- psychologist relationship, trust and the feeling of safety are
important, and these tend to be more easily developed through in-person
interactions.
For this reason, the APA and BPS
telepsychology guidelines advise that psychologists choose telecommunication
systems that do not negatively impact the development of a good
patientpsychologist therapeutic relationship. In the spirit of upholding the
ethical and professional standards of practice, it is also important that the
psychologist assesses the effectiveness of telepsychology modalities to meet
the needs of the client. While mental health care access can be a problem,
telepsychology should be an option which not only connects the patient to the
psychologist but which also does so in a way that ensures the patient is
receiving optimal ethical and professional standards of care. Ethical and
professional standards of care cannot be sacrificed on the altar of mental
health care access. Sometimes, the severity of a mental health issue is such
that an in-person service is required, and treatment cannot ethically be
provided via the practice of telepsychology.
An area of focus that the APA guidelines
concentrated on and which might potentially require some significant adaptation
for Ghana as compared to the other identified core areas lies in the area of
psychological testing. Psychological testing is equivalent to the laboratory
testing that is performed in the medical sciences in that it is also needed for
aiding in diagnoses formation and the assessment of the current functioning of
the patient. While there are online psychological testing options, most tests
are designed for in- person interactions allowing for the observed behaviors of
patients/clients during the testing process to serve as important information
in the testing process. For example, if a cognitive test is being conducted on
a child who ends up scoring above average, it is also important to note if the
child was attentive during the testing process or if the child had difficulty
staying seated. It is important to note if the child was able to follow social
cues or the child answered questions while staring out a window without making
eye contact with the psychologist. While testing via videoconferencing can
provide such information, it can be difficult to ascertain what part the
videoconferencing in itself contributes to the behaviors witnessed in the
patient/client during the testing process. Psychological testing in Ghana
already possesses issues given the fact that the available testing tools are
designed for a foreign population. This can create issues regarding validity
and reliability of tests results for the Ghanaian cultural context without the
additional variable of a telecommunication system of testing. Still, with the
goal of the maintenance of ethical and professional standards of practice,
guidelines can be formulated that ensures integrity of practice and the
provision of appropriate care while trying to solve the problem of mental
health care access.
Mobile apps and mental health
care access
Mobile applications serve as mechanisms
through which the problem of mental health care access can also be solved or
improved upon. A mobile application or mobile app is an application software
that is designed to run on mobile devices such as smart phones or tablets. With
advances in technology, it is more common now to find individuals using smart
phones which come with the capability of having apps such as those for emails,
social media, messaging, shopping, gaming, and other areas of interest. Today,
some smart phones have already built-in mobile apps that are geared towards
health. Some apps for example allow people to track their food and water
intake, physical activity and even stress levels. There are mental health apps
(also known as mHealth apps) too that, for example, provide support for
teenagers struggling with depression like the Code Blue app and apps that guide
people through breathing exercises for stress management like the Breathe2Relax
app. Some of these mental health apps are also interactive, combining
therapeutic techniques with real life experts like the Lantern app. Other apps
that can be used in addition to real life treatment include mobile applications
such as the PTSD Coach, Self-Help for Anxiety Management (SAM) and Optimism
apps which allow people to track their symptoms over time while providing
psychological tools (“Top 10 Mental Health Apps”).
As already discussed, the problem of mental health care access in Ghana is
impacted by the lack of clinical psychologists in the country, the physical
distance between the patient and psychologist as well as the inability of
people to know where and how to contact a psychologist, especially one that is
not located in a psychiatric hospital setting. While accessing mental health
services in a psychiatric hospital setting is not a problem in itself, there
can be a hesitancy to access services in such locations because of the potential
stigma of being perceived as ‘mad.’ Mobile applications have been used as a
bridge to mental health care access problems in countries like the United
States and Britain. mHealth apps can be designed where people in Ghana have a
way of accessing available clinical psychologists and facilities by location
and specialty. These apps can have built in the ability of also getting in
touch with or communicating with a psychologist to begin treatment. Such an app
also has the potential of regulating professional psychology practice in the
country if the app only includes psychologists and facilities in the country
which are actively licensed. When a psychologist or facility ceases to maintain
active licensure, measures can be put in place to withdraw inclusion in the app
or deactivate visibility and access to such psychologists and facilities. With
such an app approved by the Ghana Psychological Council, psychologists will
want to ensure active licensure of themselves and their facilities while
potential patients are assured of getting access to qualified and approved
professionals and facilities. Such an app which provides information on the
psychologist, location and specialty will also serve as important data for
developing the profession in the country. For example, if the app indicates the
need for more psychologists who work with geriatric populations, geriatric
training programs can be developed to cater for the mental health needs of such
a population in the country. In mental health treatment, clinicians sometimes
make use of group therapy to help support individuals who struggle through the
same symptoms or problems. For example, group therapy can be used with
individuals struggling with substance use, individuals who have gone through
grief and loss, and individuals who struggle with depression and anxiety. This
group treatment modality allows individuals to receive support from others who
experience the same problems they go through and whom can empathize with their
struggle. It also presents with opportunities for these individuals to hold
each other accountable to treatment goals and to have a sense of purpose
through their ability to contribute to the lives of others like themselves who
are hurting thus raising self-esteem. There are apps that Ghana can adapt or
develop that provide the platform to offer group therapy with a trained
therapist. Such an app can be helpful for communal support through mental
health struggles without some of the potential reservation and risks to
confidentiality that the typical face-to-face group therapy presents.
In the traditional face-to-face group
therapy setting, there are times when an individual or groups of individuals
may not be as open or as vocal in ways that allow them to contribute to and
benefit from group treatment. When the option of such an app is available, this
can allow those who would likely be more hesitant and withdrawn to be more
vocal and open. In addition to the group therapy module, mental health mobile
apps present as a good opportunity for complementing in-person treatment or the
practice of telepsychology. mHealth apps can provide supportive services to
patients and clients between sessions that help facilitate treatment. The
individual who is seeing a psychologist for anxiety related problems, for
example, can have an app that provides resources for coping such as breathing
exercises.
According to Henderson et al. [7] , one
factor that affects the seeking out of mental health services includes lack of
knowledge to identify features of mental illnesses. It is possible for people
with mental health problems to experience difficulties that they either do not
understand or which they brush aside. Sometimes the responsibilities of daily
life can prevent one from attending to mental health problems until symptoms
reach a point where they become severe enough to require psychiatric
hospitalization or attempts are made to commit suicide. There is a great need
for Ghanaians to be educated on mental health and through psychoeducation,
convey the importance of seeking help while normalizing mental health help
seeking behaviours to that of physical health seeking behaviors. When people
are made to conceptualize seeking mental health help the same way they would
seek medical help, fears associated with mental health stigma can be reduced
and we could possibly see a decline in suicide behaviors. Mental health apps
that are geared towards psychoeducation can be useful in Ghana’s fight for
mental health education, access, and care. Such mental health apps can include
screening for mental health issues which would have the potential for making on
the spot referral recommendation when applicable. For example, an individual
experiencing symptom of depression can take a questionnaire on the mHealth app
that indicates their level of depression (whether mild, moderate, or severe)
and makes recommendations to see a psychologist.
Development of mhealth apps and
opportunities for ghana
The American Psychological Association
has developed an app evaluation model in response to the increasing use of
mHealth technologies. This decision to develop the evaluation model was also a
response to questions received from mental health care professionals concerning
the efficacy and risks of these mobile mental health apps. It appears the expanding
use of mobile mental health apps was such that the development of the
evaluation model was a better alternative to running every available app
through an approval process and advertising those as APA-approved. In contrast
to the stance taken by the American Psychological Association, the United
Kingdom’s National Health Service has included in its digital library, a list
of mhealth apps with indications of which apps have been approved and which
apps are in the process of being tested by NHS. There are legitimate concerns
regarding the increasing number of mHealth apps and the associated tendency for
people to self-diagnose or use such mechanisms in lieu of the necessary
professional care. The increased access to the internet in general has come with
the tendency for people to look up the symptoms they experience -whether
physical or behavioral- in order to figure out what is wrong with them. The
enormous and varied number of mHealth apps only provides more avenues for
potential selfdiagnoses and misuse.
It is for this reason that Ghana’s Psychological Council could combine the
strategies used by both the APA and UK’s NHS to formulate an evaluation model
that is used to recommend apps for the public. With such a mechanism in place,
mHealth apps can be reviewed and regulated by the appropriate professional
national body from the very onset. Also, mHealth app developers can begin the
app development process keeping in mind that the final product would have to go
through an approval process before being used by the public. The Ghana
Psychological Council or Association bodies can themselves develop approved
apps for its professionals and countrymen and women as well. The apps that are
locally developed would have to be suited to the Ghanaian context and take into
consideration some of the cultural and unique expressions of mental health
problems among Ghanaians, for example, the commonality of somatization of some
mental health problems.
Finding and
Recommendation
Telepsychology and mental health mobile
apps hold unique opportunities for improving mental health care and access in
Ghana when adopted. Like most opportunities, these two concepts present with
challenges that will be discussed in the sections to follow with
recommendations on how to overcome these obstacles in order to improve mental
health care and access. When mental health care and access is improved upon,
the nation’s sustainable development goals for health can make gains towards a
more complete picture of fulfillment. Ghana’s sustainable development goals for
health cannot be entirely met if its mental health care problems persist.
Human health resources
Telepsychology and mobile apps provide
potential solutions to mental health care problems in Ghana, but certain issues
currently impede its implementation. These issues are not unlike the issues
discovered in an analysis of tele mental health in South Africa (Jefee-Bahloul
et al., [8] ). Just like in South Africa, Ghana does not have sufficient human health
resources. As already discussed, there aren’t enough mental health
professionals to meet the current demand in the nation. For this reason, there
is the need for mental health or psychology training up to the highest level
possible in the country. There is also the need for the profession to be
properly supported by the government in order to keep from deterring other
professional aspirants from the field of mental health care or psychology.
Infrastructure
An obvious potential limitation also lies
in the requirements of technical and administrative support that the proposed
technology mechanisms require. The use of telepsychology mandates adequate
bandwidths that might not be available or which may be too expensive to
acquire. Also, while messaging apps like WhatsApp and Skype can be used for
telepsychology, these also require adequate amounts of data which could be
relatively expensive when used at the levels that would be required for
appropriate treatment. Again, should the problem of expense be addressed,
another potential problem arises in the requirement of stable network
connectivity which is not always the case in Ghana.
Political will
Until the year 2012 when Ghana’s mental
health bill was passed, the country operated under a mental health law that was
put into effect in 1972. Although Ghana made tremendous strides with the
passing of the 2012 mental health act, five years later, the Legislative
Instruments which will serve to assist the implementation of the bill is yet to
be passed (Boateng [5]). Improvement in mental health care and access through
recommendations of modalities like telepsychology and the use of mental health
mobile apps would also only be more successful with government or political
backing. Without support from Ghana’s government to improve upon mental health
care, Ghana will likely continue to lag behind when it comes to attaining the
advances that have been seen in the more developed countries with mental health
care practice [9-11].
Conclusion
Sustainable development is development
that meets the needs of the present without compromising the ability of future
generations to meet their own needs. The health of human beings plays a central
role in the fulfillment of sustainable development goals both as enactors and
indicators of sustainable development. Health forms the third arm of the United
Nation’s sustainable development goals and has received great attention given
its implications not just on sustainable development goals but to the lives of
families, societies and economies. In meeting sustainable development goals for
health, mental health has not received as much attention although it holds just
as much significance in attaining sustainable development goals for health.
Mental health can have just as significant an impact on families, societies and
economies. An individual with a healthy body but an unhealthy mind can be just
as incapable of functioning as an individual with a healthy mind but an
unhealthy body. Telepsychology and mobile mental health apps present as great
opportunities for mitigating mental health care access problems in Ghana.
During and outside of pandemic realities, these technologies can serve as means
of connecting the potential patient to the psychologist, discovering options
for mental health care, regulating the practice of psychotherapy in the
country, and providing psychoeducation and complementary resources to
treatment. With continuing growth in Ghana’s telecommunication technologies and
support for the work of mental health professionals, the discussed challenges
can be overcome and Ghana can make its way toward greater mental health care
access, and ultimately, the achievement of its sustainable development goals
for health.
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