Protocol and registration
This protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols 2015 (PRISMA-P), and is registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020187551) [20]. The planned systematic review will be reported in accordance with the PRISMA statement [31]. Any amendments to this protocol will be documented and published alongside the results of the systematic review.
Eligibility Criteria
Studies will be selected according to the criteria outlined in Table 1. We will limit studies selected for this review to randomized controlled trials, published in English or French between January 2005 to June 2020. Studies published prior to 2005 will be excluded given the reduced availability of online counselling and internet coverage in earlier years. To be included, trials must report changes in substance use, mental health, physical health, behavioural or social functioning, or symptom severity at the time of the follow up, or adherence to the program as outcomes. Symptom severity will be operationalized by using the sum-score of a validated rating scale or self-report questionnaire for assessing the symptoms. Adherence will be operationalized as the mean number of modules/sessions completed and the percentage of persons that completed the whole treatment.
Comparators may include standard care, control (wait-listed or no treatment), unguided online intervention, online individual intervention, or offline group or individual in-person intervention. Studies will be included if they evaluated an online group counselling program that provides at least weekly guidance through video or phone conferencing, or group-based texting. Studies will be included if the intervention program is delivered in a live, synchronous, group-based format. Interventions may be led by a group leader who has training in mental health, health coaching, life coaching, or mindfulness/ meditation including nurses, social workers, kinesiologists, or yoga teachers. Programs may be delivered to adults in any country who use substances, have acute or chronic mental health concerns, or physical health conditions. This may include programs for health care workers, although this is not a requirement for inclusion. Only studies involving participants living in community-based settings will be included. We will exclude non-randomized and observational studies.
Table 1
Inclusion and exclusion criteria
PICOS Strategy | Inclusion Criteria | Exclusion Criteria |
Population | Community-dwelling adults aged ≥ 18 | Youth, adolescents, individuals with end stage or palliative chronic conditions, individuals living in supportive living communities |
Intervention | Online group counselling programs delivered through synchronous (live) video, phone (teleconference), or group text and led by individuals with training in mental health, health coaching, or life coaching, mindfulness/meditation, nursing, social work, yoga, or kinesiology | Offline group counselling, individual online counselling, peer-based programs, and programs delivered by individuals that do not have training in mental health, health coaching, life coaching, mindfulness/meditation, nursing, social work, yoga, or kinesiology (e.g. Personal trainers) |
Comparison | Control (wait-listed or no treatment), unguided online intervention, online individual intervention, or group or individual in-person intervention, or standard care | |
Outcome | Primary: Changes in mental health or substance use Secondary: Changes in physical activity | |
Study Design | Randomized controlled trials, theses, dissertations | Non-randomized, observational studies |
Information Sources And Search Strategy
MEDLINE, PsycInfo, CINAHL, and the Cochrane Central Register of Controlled Trials will be screened for potential inclusion. Our search strategy, outlined in Table 2, combines MeSH terms and free-text words was developed by a subject librarian (DS) and the primary investigator (CC). Terms such as (mental health or mental disorders or behavioral symptoms) AND (Skype or Facetime or Zoom or Google + Hangouts) AND (counseling or psychotherapy or nursing or social work or yoga or meditation or mindfulness) were included in the search. In order to restrict our search to clinical trials, the search terms of (Randomized Controlled Trial or RCT* or randomi*) were also included.
Data Selection And Screening Process
Covidence will be used to manage records and data throughout the review [21]. Prior to screening, we will pilot test the screening instructions on five randomly selected studies to ensure consistency. If there is not a high percentage of agreement, we will further clarify the inclusion and exclusion criteria and re-test the process with five new studies. When 100% agreement is achieved, the team will start initial screening. Titles and abstracts will be independently screened by two reviewers (MLV, EH). In cases where a decision for exclusion or potential inclusion cannot be made by the title/abstract, the full text will be retrieved. Consensus meetings to reconcile disagreements will occur at each 30% interval of records screened. After initial screening, full text copies of the articles will be obtained and independently reviewed by two authors (MLV, EH) to ensure inclusion criteria are met. If needed, consensus on final inclusion will be achieved by discussing with a third reviewer (CC or RL).
Table 2
1. Mental Health/ [MeSH] 2. exp Mental Disorders/ [MeSH] 3. exp Behavioral Symptoms/ [MeSH] 4. (((mental* or psychological*) adj3 (health* or well* or disorder* or ill*)) or anxi* or depress* or neuros* or psychiatric or stress* or distress* or emotion* or aggress* or trauma* or suicid* or bereav* or grief or griev* or mourn* or addict* or alcoholism or ((substance* or drug* or alcohol*) adj3 (us* or misus* or abus* or dependen*))).mp. 5. or/1–4 6. exp Videoconferencing/ [MeSH] 7. exp Telemedicine/ {MeSH] 8. exp Internet/ {MeSH] or exp Telephone/ [MeSH] 9. (telehealth or telemedicine or ehealth or video*).mp. 10. (Skype or Facetime or Zoom or Google + Hangouts).mp. 11. (internet or web or online or telephon* or phone or phoning or phones or phoned or SMS or text messag* or texting or texted).mp. 12. (distance or remote).mp. 13. or/6–12 14. exp Counseling/ [MeSH] or exp Psychotherapy/ [MeSH] or exp Nursing/ [MeSH] or exp Social Work/ [MeSH] or Yoga/ [MeSH] or Meditation/ [MeSH] or Mindfulness/ [MeSH] 15. (counsel* or motivational interview* or coach* or psychotherap* or social work* or nurs* or kinesiolog* or yoga or meditat* or mindfulness).mp. 16. or/14–15 17. 13 and 16 18. Distance Counseling/ [MeSH] 19. (e-therap* or etherap* or e-counsel* or ecounsel* or telepsycholog* or "tele-mental health" or e-coach* or ecoach*).mp. 20. or/17–19 21. group*.mp. 22. exp Adult/ [MeSH] 23. adult*.mp. 24. or/22–23 25. exp Randomized Controlled Trial/ [MeSH] 26. (randomi* or randomly).mp, pt. 27. RCT*.mp 28. or/22–24 29. 5 and 20 and 21 and 24 and 28 30. limit 29 to (yr="2005 -Current" and (english or french)) |
Data Extraction, Evaluation, And Synthesis
Data will be extracted into prepared inclusion/exclusion checklists within Covidence and results collated. If there are multiple publications from the same data set or study that consider different outcomes, they will be retained but will be combined into one “study” or data point during the data extraction process. Given this is a rapid review, we will not obtain or confirm data from investigators. The Cochrane Handbook and Synthesis Without Meta-Analysis (SWiM) reporting guideline will be used to synthesize studies [23]. A narrative summary of findings will be presented in a Table that includes setting, design, country, population, sample size, analytic method, relationships between group online counselling and outcomes of interest, relevant results, and quality of evidence score for each article using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach [24]. Risk of bias will be assessed and reported on by MLV and EH using the Cochrane Risk of Bias tool [22]. Discrepancies will be resolved in a discussion with CC and RL. Risk of bias domains to be analyzed are: (a) random sequence generation, (b) allocation concealment, (c) blinding, (d) incomplete outcome data, (e) selective reporting and other bias. In psychological interventions blinding is not possible resulting in a high risk of bias rating of (c), which we will discuss in our findings. Higher quality records will be prioritized when drawing conclusions. Given this is a rapid review conducted with urgency within the context of COVID-19, we will not conduct a meta-analyses. The role of sex and gender will be considered as well as possible gender biases at all stages of the review process from article selection and synthesis to knowledge mobilization, e.g. creation of gender-specific guidelines for online therapies. Finally, we will narratively summarize the implications of findings as they may pertain to the documented impacts that COVID-19 has had on substance misuse, mental health and wellbeing within adult populations to inform the decisions of governments, communities, and health care organizations responding to the pandemic.
Patient And Public Involvement
We have developed this study in collaboration with various stakeholders and knowledge users to ensure its applicability. In particular, we are working with Indigenous stakeholders to ensure alignment with needs and priorities. Indigenous communities are concerned about the risk posed by COVID-19 for Elders, given their centrality within most Indigenous cultures, as well as the risk posed to adults with diabetes and other forms of chronic disease within their communities. There is a strong desire for immediate online programs to address substance use, mental health and physical health in an effort to strengthen resilience in the face of COVID-19. We are aware that Indigenous organizations are rapidly mobilizing to address this need in communities across many parts of Canada. We seek to provide a systematic review that will be of maximum utility to these efforts.
Dissemination
The findings of the review will be published in an academic peer-reviewed journal. We will create knowledge translation packages for stakeholders and government decision-makers that include a summary of findings and descriptions of promising programs identified in the review and a slide deck summarizing the results. We are collaborating with Indigenous stakeholders, Alberta’s Strategy for Patient-Orientated Research (SPOR), and Alberta Innovates to ensure materials address community and decision-maker needs.