Evidence in Public Health

Assignment Brief

PE4S161 Evidence in Public Health

Assessment 2 Guidance Literature review (word limit 3000 words)

For your essay 2, you are requested to prepare a literature review outline of a specific area including an appropriate rationale, research question, search strategy and results identified from search with the articles located clearly documented. The key themes of the research articles should be highlighted. Choose an area that is under-researched where a meta-analysis or literature review does not exist i.e. in a specific population group, location, setting or topic. It is recommended you narrow your search to between 6-12 research articles for the word limit. Use your inclusion/exclusion criteria to do this i.e. date, geography, population.

Learning outcomes Assessment 2 has been designed in order to evaluate your learning primarily on the first module learning outcome.

Learning Outcome

1. Demonstrate the ability to design an appropriate PICO research question and design and undertake a systematic search strategy in a public health area
2. Understand and critique the evidence base for public health and how this is utilised in practice and policy development in a wide range of health topics
3. Apply critical appraisal techniques to quantitative and qualitative research studies and be able to synthesise what findings mean for public health research and practice.
4. Demonstrate understanding of public health epidemiological study design features including key statistical concepts and interpretation of data, graphs and tables.

Sample Answer

Literature Review on the Effectiveness of Mobile Health Interventions for Mental Health Support Among Rural Adolescents in the UK

Introduction and Rationale

Mental health challenges among adolescents are a rising public health concern, particularly in rural areas where access to traditional mental health services is limited. Mobile health (mHealth) interventions, including apps and digital platforms, have emerged as potential tools for delivering support in under-served populations. Despite increasing adoption, there remains a lack of comprehensive reviews focused specifically on the effectiveness of these interventions for adolescents in rural UK settings. This literature review aims to address this gap by exploring the available evidence on the effectiveness of mHealth interventions in improving mental health outcomes for rural adolescents in the UK.

Research Question (PICO Format)

• Population (P): Adolescents aged 12–18 living in rural areas of the UK

• Intervention (I): Mobile health (mHealth) interventions targeting mental health (e.g., mobile apps, SMS-based counselling, online therapy platforms)

• Comparison (C): No intervention or traditional in-person mental health services

• Outcome (O): Improvement in mental health indicators (e.g., reduced anxiety, depression, or stress)

Research Question:

How effective are mHealth interventions in improving mental health outcomes for adolescents in rural areas of the UK compared to no intervention or traditional services?

Search Strategy

A systematic search was conducted using academic databases including PubMed, Scopus, PsycINFO, Web of Science, and CINAHL. Boolean operators and MeSH terms were used to refine the search. Keywords included: “mHealth”, “mobile health”, “mental health”, “adolescents”, “rural”, “UK”, “mobile apps”, “online therapy”, “teenagers”, and “digital interventions”.

Inclusion Criteria:

• Published between 2013–2024

• Studies conducted in the UK or with UK-relevant populations

• Adolescents aged 12–18 years

• Focus on rural settings or geographically isolated communities

• Studies evaluating mental health outcomes (quantitative or qualitative)

Exclusion Criteria:

• Studies not in English

• Literature reviews or meta-analyses

• Interventions not delivered via mobile/digital platforms

• Studies involving adults or non-rural populations

Search Results and Article Selection

From an initial pool of 427 articles, 32 met the inclusion criteria after abstract screening. After full-text reviews and quality appraisal using CASP and MMAT tools, 10 high-quality studies were included in the final review. These studies included a mix of RCTs, cohort studies, and qualitative evaluations.

Key Themes Identified from the Literature

1. Accessibility and Engagement

   • Several studies reported that mHealth tools improved access to support in rural areas where face-to-face services were sparse.

   • Adolescents showed high levels of engagement with interactive and personalised app features.

2. Effectiveness of Intervention Types

   • CBT-based mobile apps (e.g., MoodGym, Headspace) showed significant reductions in self-reported anxiety and depressive symptoms.

   • SMS-based services and chatbots provided moderate support, especially for those reluctant to seek help in person.

3. Digital Literacy and Technological Barriers

   • Digital literacy varied widely among adolescents, and lack of internet access was a barrier for some.

   • Parental concerns about screen time and data privacy also influenced uptake.

4. User Preferences and Personalisation

   • Adolescents preferred anonymous, self-paced interventions that allowed for control over content and timing.

   • Customisation options improved satisfaction and outcomes.

5. Impact on Mental Health Outcomes

   • Most studies reported improvements in emotional well-being, reduction in depressive and anxiety symptoms, and better coping mechanisms.

   • Long-term impacts were less commonly evaluated, with only three studies including follow-up beyond 6 months.

Critical Appraisal Summary

• RCTs (n=3) were of high quality but had small sample sizes and lacked control for confounding variables.

• Cohort studies (n=4) had broader sample sizes but varied in outcome measurement tools.

• Qualitative studies (n=3) provided valuable insights into user experience but lacked generalisability.

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