Adaptation models, barriers, and facilitators for cultural safety in telepsychiatry: A systematic scoping review

Abstract

Introduction: Indigenous peoples, and racial and ethnic minorities around the world experience significant mental health inequities. Telepsychiatry can contribute to addressing these inequities among these populations. However, it is first crucial to ensure the cultural safety of this tool as a critical step toward health equity. This review aimed to collate evidence regarding cultural adaptations, barriers, opportunities, and facilitators for telepsychiatry services supporting minority groups. Method: Using the PRISMA extension for scoping reviews (PRISMA-ScR) guideline, we conducted a systematic scoping review and thematic analysis. Six databases were searched using the PICO framework, i.e., population, intervention, comparison, and outcomes.. Additional literature was identified through reference lists screening. We developed a table for data extraction, and the extracted data were further analyzed following Braun and Clarke's approach for thematic analysis. Results: A total of 1514 citations were screened with a final total of 58 articles included in the review. The themes related to telepsychiatry cultural adaptations emphasize the crucial role of community involvement and quality service delivery. Identified barriers were associated with service and infrastructure, and service users’ socioeconomic and cultural contexts. Opportunities and facilitators for telepsychiatry were enhanced access and rapport, and multi-organizational collaborations and partnerships. Discussion: This review identified factors that can guide the adaptation of telepsychiatry evidence-based interventions to meet the needs of Indigenous peoples and racial and ethnic minorities. Telepsychiatry programs must be specifically designed for the population they seek to serve, and this review offers emerging insights into critical factors to consider in their development.

Prioritising a culturally safe e-Mental Health research agenda in Aotearoa New Zealand: A sector survey report

“…In particular, the importance of incorporating their voices in identifying the necessary competencies required for delivering the service, setting up milestones and meaningful outcomes to be achieved by the service and developing standards and regulations to benchmark the service. These findings support Ruiz-Cosignani and colleagues’ 6 claim that it is indispensable for service providers to engage with communities when developing a service to ensure it is best suited to support the population it seeks to serve.…”

“…The survey, developed on Qualtrics, was informed by the findings of a recent systematic scoping review of publications exploring culturally safe telepsychiatry. 6 This review helped the authors identified cultural adaptations, facilitators and barriers for the implementation of telepsychiatry services for Indigenous populations and ethnic minority groups. The survey was also informed by two stakeholder Hui (cultural gathering/meeting) in Auckland and Whangarei, New Zealand.…”

The use of telepsychiatry during COVID-19 in Aotearoa New Zealand: experiences, learnings and cultural safety

“…Ease of access to cultural liaisons, flexibility of sessions and wh anau (family) involvement during telepsychiatry sessions were also considered vital to ensure the best outcome for M aori both at a wh anau level and with the wider aspirations of M aori health outcomes. These principles pertaining to cultural safety are echoed in the recently published scoping review of telehealth services for indigenous populations and an international review on cultural safety (Moecke et al, 2023;Ruiz-Cosignani et al, 2022).…”

“…Aotearoa’s Asian population is the fastest growing and second largest ethnic group; future planning of psychiatric services to serve them will also need to be considered (Soon Chow and Mulder, 2017; Statistics New Zealand, 2021). There is evidence that telepsychiatry could reduce inequalities in under-served populations (New Zealand Telehealth Resource Centre, 2021; RANZCP, 2021; Ruiz-Cosignani et al , 2022). Therefore, it is important for clinicians to provide culturally safe telepsychiatry services to optimise outcomes and not to further increase equity gaps for all ethnic groups in Aotearoa (Rahman et al , 2022; Ruiz-Cosignani et al , 2022).…”

“…There is evidence that telepsychiatry could reduce inequalities in under-served populations (New Zealand Telehealth Resource Centre, 2021; RANZCP, 2021; Ruiz-Cosignani et al , 2022). Therefore, it is important for clinicians to provide culturally safe telepsychiatry services to optimise outcomes and not to further increase equity gaps for all ethnic groups in Aotearoa (Rahman et al , 2022; Ruiz-Cosignani et al , 2022).…”