Martel Rhiannon Mary, Darragh Margot Louise, Lawrence Aniva Joanne, Shepherd Matthew John, Wihongi Tracey, Goodyear-Smith Felicity Anne
Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, The University of Auckland, Auckland, New Zealand.
Manaia Health Primary Health Organisation, Whangarei, New Zealand.
JMIR Res Protoc. 2019 Jan 9;8(1):e12108. doi: 10.2196/12108.
In New Zealand (NZ), 1 in 4 adolescents is affected by mental health issues (eg, depression and anxiety) and engages in risk behaviors (eg, harmful drinking and substance abuse), with rates among Māori youth being significantly higher. The majority of NZ secondary school students visit their local primary health care providers (PHPs) at least annually, yet most do not seek help for mental health and risk behavior (MHB) concerns. While youth think it acceptable to discuss sensitive issues during a consultation with their PHPs, unless problems are severe, such conversations are not initiated by PHPs. Early intervention for MHB concerns can prevent long-term health and well-being issues. However, this relies on the early identification of developing problems and youth being offered and accepting help. YouthCHAT is an electronic, multi-item screening tool developed in 2016 to assess MHB concerns among youth. YouthCHAT is completed before a consultation with the PHP, who can access a summary report straight away. A help question allows young people to identify issues that need addressing. A resource pack uses stepped care pathways to guide providers to use appropriate brief interventions.
This study aimed to explore the utility, feasibility, and acceptability of YouthCHAT when tailored for use with youth in primary care settings with large Māori populations. Objectives of the study are to evaluate the implementation of YouthCHAT in nurse-led youth clinics, school-based clinics, and general practice in Te Tai Tokerau (Northland, NZ); to develop a framework for the scaling up of YouthCHAT across further settings; to assess health provider and youth acceptability of the tool; to improve screening rates for mental health and help-seeking behavior; to enable early identification of emerging problems; and to improve brief intervention delivery.
Using a bicultural mixed-methods co-design approach, 3 phases over a 3-year period will provide an iterative evaluation of the utility, feasibility, and acceptability of YouthCHAT, aiming to create a framework for wider-scale rollout and implementation.
Recruitment for the first phase began in September 2018. YouthCHAT was implemented at the first site in October 2018 and is expected to be at a further two sites in late January to early February 2019. The study is due for completion at the end of 2021.
YouthCHAT has potential as a user-friendly, time efficient, and culturally safe screening tool for early detection of MHB issues in NZ youth. The resource pack assists the clinician to provide appropriate interventions for emerging and developed youth mental health and lifestyle issues. Involving input from community providers, users, and stakeholders will ensure that modifiable elements of YouthCHAT are tailored to meet the health needs specific to each context and will have a positive influence on future mental, physical, and social outcomes for NZ youth.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/12108.
在新西兰（NZ），四分之一的青少年受到心理健康问题（如抑郁和焦虑）的影响，并存在危险行为（如有害饮酒和药物滥用），其中毛利族青年的比例显著更高。大多数新西兰中学生每年至少会去当地的初级医疗服务提供者（PHPs）处就诊，但大多数人不会就心理健康和危险行为（MHB）问题寻求帮助。虽然青少年认为在与初级医疗服务提供者的咨询过程中讨论敏感问题是可以接受的，但除非问题严重，否则初级医疗服务提供者不会主动开启此类对话。对MHB问题进行早期干预可以预防长期的健康和幸福问题。然而，这依赖于对正在出现的问题进行早期识别，以及青少年能够获得并接受帮助。YouthCHAT是2016年开发的一种电子多项筛查工具，用于评估青少年中的MHB问题。YouthCHAT在与初级医疗服务提供者进行咨询之前完成，提供者可以立即获取总结报告。一个帮助问题使年轻人能够识别需要解决的问题。一个资源包使用分级护理途径来指导提供者使用适当的简短干预措施。
本研究旨在探讨为毛利人口众多的初级保健环境中的青少年量身定制的YouthCHAT的实用性、可行性和可接受性。该研究的目的是评估YouthCHAT在新西兰北地大区的护士主导的青少年诊所、学校诊所和全科医疗中的实施情况；制定一个在更多环境中扩大使用YouthCHAT的框架；评估该工具对医疗服务提供者和青少年的可接受性；提高心理健康筛查率和寻求帮助行为；能够早期识别新出现的问题；并改善简短干预措施的实施。
采用双文化混合方法共同设计方法，在3年时间内分3个阶段对YouthCHAT的实用性、可行性和可接受性进行迭代评估，旨在创建一个大规模推广和实施的框架。
第一阶段的招募工作于2018年9月开始。YouthCHAT于2018年10月在第一个地点实施，预计在2019年1月下旬至2月上旬在另外两个地点实施。该研究预计在2021年底完成。
YouthCHAT有潜力成为一种用户友好、省时且文化安全的筛查工具，用于早期发现新西兰青少年中的MHB问题。资源包可帮助临床医生针对新出现的和已发展的青少年心理健康及生活方式问题提供适当的干预措施。纳入社区提供者、用户和利益相关者的意见将确保YouthCHAT的可修改元素能够根据每个具体环境的健康需求进行定制，并将对新西兰青少年未来的心理、身体和社会结果产生积极影响。
国际注册报告识别码（IRRID）：PRR1-10.2196/12108
