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Background Approximately 50% of cardiovascular disease (CVD) cases are attributable to lifestyle risk factors. Despite widespread education, personal knowledge, and efficacy, many individuals fail to adequately modify these risk factors, even after a cardiovascular event. Digital technology interventions have been suggested as a viable equivalent and potential alternative to conventional cardiac rehabilitation care centers. However, little is known about the clinical effectiveness of these technologies in bringing about behavioral changes in patients with CVD at an individual level. Objective The aim of this study is to identify and measure the effectiveness of digital technology (eg, mobile phones, the internet, software applications, wearables, etc) interventions in randomized controlled trials (RCTs) and determine which behavior change constructs are effective at achieving risk factor modification in patients with CVD. Methods This study is a systematic review and meta-analysis of RCTs designed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) statement standard. Mixed data from studies extracted from selected research databases and filtered for RCTs only were analyzed using quantitative methods. Outcome hypothesis testing was set at 95% CI and P=.05 for statistical significance. Results Digital interventions were delivered using devices such as cell phones, smartphones, personal computers, and wearables coupled with technologies such as the internet, SMS, software applications, and mobile sensors. Behavioral change constructs such as cognition, follow-up, goal setting, record keeping, perceived benefit, persuasion, socialization, personalization, rewards and incentives, support, and self-management were used. The meta-analyzed effect estimates (mean difference [MD]; standard mean difference [SMD]; and risk ratio [RR]) calculated for outcomes showed benefits in total cholesterol SMD at −0.29 [−0.44, −0.15], P Conclusions Digital interventions may improve healthy behavioral factors (PA, healthy diet, and medication adherence) and are even more potent when used to treat multiple behavioral outcomes (eg, medication adherence plus). However, they did not appear to reduce unhealthy behavioral factors (smoking, alcohol intake, and unhealthy diet) and clinical outcomes (BMI, triglycerides, diastolic and systolic BP, and HbA1c).

Background Health and social care workers (HSCWs) have carried a heavy burden during the COVID-19 crisis and, in the challenge to control the virus, have directly faced its consequences. Supporting their psychological wellbeing continues, therefore, to be a priority. This rapid review was carried out to establish whether there are any identifiable risk factors for adverse mental health outcomes amongst HSCWs during the COVID-19 crisis. Methods We undertook a rapid review of the literature following guidelines by the WHO and the Cochrane Collaboration’s recommendations. We searched across 14 databases, executing the search at two different time points. We included published, observational and experimental studies that reported the psychological effects on HSCWs during the COVID-19 pandemic. Results The 24 studies included in this review reported data predominantly from China (18 out of 24 included studies) and most sampled urban hospital staff. Our study indicates that COVID-19 has a considerable impact on the psychological wellbeing of front-line hospital staff. Results suggest that nurses may be at higher risk of adverse mental health outcomes during this pandemic, but no studies compare this group with the primary care workforce. Furthermore, no studies investigated the psychological impact of the COVID-19 pandemic on social care staff. Other risk factors identified were underlying organic illness, gender (female), concern about family, fear of infection, lack of personal protective equipment (PPE) and close contact with COVID-19. Systemic support, adequate knowledge and resilience were identified as factors protecting against adverse mental health outcomes. Conclusions The evidence to date suggests that female nurses with close contact with COVID-19 patients may have the most to gain from efforts aimed at supporting psychological well-being. However, inconsistencies in findings and a lack of data collected outside of hospital settings, suggest that we should not exclude any groups when addressing psychological well-being in health and social care workers. Whilst psychological interventions aimed at enhancing resilience in the individual may be of benefit, it is evident that to build a resilient workforce, occupational and environmental factors must be addressed. Further research including social care workers and analysis of wider societal structural factors is recommended.

The goal of our study was to provide a situation analysis of clinical psychology services in South Africa’s public rural primary healthcare sector. In this setting, the treatment gap between human resources for and the burden of disease for mental illness is as high as 85%. The majority of South Africa’s mental health specialists – clinical psychologists and psychiatrists – practice in the country’s urban and peri-urban private sector. At the advent of South Africa’s democracy, public clinical psychological services were negligible, and the country is still facing challenges in providing human resources. The study was based on the analysis of both primary and secondary data. Primary data were collected by interviewing the heads of 160 public hospitals classified as rural by the Department of Health, while secondary data comprised a literature review. The number of clinical psychologists working in the public sector indicated a substantial growth over the last 20 years, while the number employed and/or doing out-reach to public rural primary healthcare areas shows a shortfall. Clinical psychology’s numbers, however, compare favourably to that of other mental health specialists in public rural primary healthcare settings. Since the National Mental Health Summit of 2012, strategies have been implemented to improve access to mental health care. In clinical psychology’s case relating to human resources, these strategies have showed encouraging results with a substantial amount of participating institutions reporting that clinical psychologists form a part of their proposed future staff establishment.

Background: South Africa (SA) has been facing serious challenges in providing human resources for the delivery of essential mental health (MH) services. The majority of its prescribing MH specialists, psychiatrists, practise in private, urban and peri-urban areas. The findings of a situation analysis audit of psychiatrist human resources in the public rural primary healthcare (PRPHC) sector are presented in this paper.Method: This audit was based on both primary and secondary data. The primary data were obtained from key informant interviews with the clinical heads of 160 PRPHC facilities, while the secondary data comprised a literature review.Results: The results indicate that psychiatrists are severely underrepresented, employed at a rate of 0.03 per 100 000 population in SA’s PRPHC settings.Conclusions: Because of a lack of MH nurses and medical officers dedicated to MH in PRPHC facilities, recommendations are made that the current task shifting strategy be revisited to include more cadres of MH professionals with specialised psychopharmacological training, as non-medical prescribers at PRPHC level. It is advised that visiting psychiatrists and family physicians be involved in the construction of training and supervision programmes for non-medical prescribers at the primary healthcare level.

Introduction South Africa is a middle-income country with serious socioeconomic risk factors for mental illness. Of its population of 52 million, 53% live below the poverty line, 24% are unemployed and 11% live with HIV/AIDS, all of which are factors associated with an increased burden of neuropsychiatric disease. The negative social implications due to the mortality caused by AIDS are immense: thousands of children are being orphaned, increasing the risk of intergenerational mental illness. Ensuring sufficient mental health human resources has been a challenge, with South Africa displaying lower workforce numbers than many low- and middle-income countries. It is in South Africa's public rural primary healthcare (PRPHC) areas where access to mental healthcare services, especially medical prescribers, is most dire. In 1994, primary healthcare (PHC) was mainstreamed into South Africa's public healthcare system as an inclusive, people-orientated healthcare system. Nurses provide for the majority of the human resources at PHC level and are therefore seen as the backbone of this sector. Efforts to decentralize mental healthcare and integrate it into the PHC system rely on the availability of mental health nurses (MHNs), to whom the task of diagnosing mental illness and prescribing psychotropic medications can be shifted. The goal of this situation analysis was to fill knowledge gaps with regard to MHN human resources in South Africa's PRPHC settings, where an estimated 40% of South Africa's population reside. Methods Both primary and secondary data were analysed. Primary data was collected by inviting 160 (98%) of South African rural hospitals' clinical heads to participate in an interview schedule regarding mental health human resources at their institutions. Primary data were collated and then analysed using descriptive quantitative analysis to produce lists of MHNs per institution and per province. Secondary data was obtained from an extensive literature review of MHNs in South Africa, but also of mental healthcare services in other low- and middle-income countries. The literature review included reports by the National Department of Health and the South African Nursing Council, academic publications and dissertations as well as census data from Statistics South Africa, including findings from the 2011 general household survey. International secondary data was obtained from the WHO's most recent reports on global mental health. Results The findings suggest a distressing shortage of MHNs in South Africa's rural public areas. Only 62 (38.7%) of the 160 facilities employ MHNs, a total of 116 MHNs. These MHNs serve an estimated population of more than 17 million people, suggesting that MHNs are employed at a rate of 0.68 per 100 000 population in South Africa's PRPHC areas. Conclusions Secondary data analysis indicates that MHNs are practicing in South Africa at a national rate of 9.7 per 100 000 population. This unequal distribution calls for a redistribution of MHNs to PRPHC areas. Further recommendations are made to address the mental healthcare workforce crisis by upscaling human resources in PRPHC areas. Revisiting policy surrounding training programs and the current evidence-based approach of task shifting is advised. Innovative approaches such as extending mental healthcare professions' roles and scopes of practice at PHC level are necessary to ensure adequate mental health care for all South Africans.