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Digital literacy is increasingly recognized as a key determinant of health, yet the mechanisms linking it to self-rated health in transitional economies like China remain underexplored. This study examines how digital literacy influences self-rated health, directly and indirectly through mental health, while exploring heterogeneity across age and gender groups. Using data from the 2023 Chinese General Social Survey (n=8,039 adults aged 18 and above), we constructed a multidimensional digital literacy index via entropy weighting and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS), integrating dimensions of digital access, usage, and entertainment. Structural equation modeling (SEM) and multi-group analyses were employed to test relationships, controlling for gender, age, and education. Model fit was assessed using RMSEA, CFI, and other indices; robustness was verified through alternative specifications, sensitivity checks, and outlier trimming. Digital literacy had a significant positive effect on self-rated health (β=0.115, p<0.001), comprising a direct effect (β=0.076, p<0.001) and an indirect effect via mental health (β=0.039, p<0.001; mediation proportion=33.9%). Multi-group SEM revealed heterogeneity: effects were strongest in young and middle-aged females (β=0.141-0.143, p<0.001) and weaker in older adults (eg, β=0.050 for females >60, p<0.01). Mental health mediated more strongly in older groups (β=0.500, p<0.001). The model explained 38.5% of variance in self-rated health. Digital literacy positively influences self-rated health by enhancing resource access and mental well-being, with pronounced benefits for younger and female populations. Policymakers should prioritize age-appropriate digital literacy initiatives with psychological support to reduce disparities, aligning with China's \"Healthy China 2030\" and \"Digital China\" strategies.

Background The barriers and facilitating factors for integrating mental health into primary health care have been well documented in the literature, but little is known about the perspectives of primary health care workers (who provide integrated mental health care) on barriers and facilitating factors of the health system for scaling up mental health interventions in low and middle income countries. This study aimed to explore these perspectives of primary health care workers within the health system, and identify possible strategies to optimize the integration of mental health in primary health care. Methods The study was conducted in the Chitwan district of Nepal with 55 purposively selected primary health care workers representing prescribers ( N  = 35), non-prescribers ( N  = 12) and Female Community Health Volunteers ( N  = 8). Using a semi-structured interview guide, experienced qualitative researchers collected data between September 2016 and May 2017. The interviews were audio-taped, transcribed and then translated into English. The transcripts were coded using Nvivo 10 software and themes were generated for the thematic analysis. Results According to the health workers, the facilitating factors for scaling up mental health services in primary health care setting in Nepal included; (1) availability of guidelines, protocols and awareness raising materials, (2) provision of supervision, (3) referral systems being in place, (4) patient record keeping, (5) community sensitizations and home visits, and (6) provision of psychosocial counseling. The barriers identified included; (1) shortage of psychotropic medicines, (2) lack of private space for counseling, (3) workload and health workers’ grievances regarding incentives, and (4) perceived stigma causing dropouts. Conclusions The findings suggest that implementation of mental health services through primary health care workers in resource-poor setting is possible when health system level barriers are addressed and facilitating factors are strengthened. In order to address these barriers the health workers suggested a few strategies which included; ensuring dedicated staff available at health facility, allocating dedicated and confidential space for counseling, improving on incentives and motivational benefits to existing health staff, organizing policy level advocacy for mental health, improving medicine supply chain management and strengthening systems for supervision, referral and mental health information management.

According to this strategic framework, we have put forward a series of five broad recommendations, covering reproductive health, maternal and newborn health, child and adolescent health, the health system, and social contexts. [...]RMNCAH not only plays a pivotal role in guaranteeing the health of each individual woman, child, and adolescent, but is also a cornerstone for the development of the next generation and the sustainable development of the whole society. RMNCAH have direct effects on the majority of family members—women and children—and men play an important role in contributing to RMNCAH. Because of the forecasted trends for population ageing and low fertility, the proportion of the Chinese population covered by RMNCAH (children aged 0–19 years and female individuals aged 20–49 years) will decline from 46·8% in 2015 to 39·9% in 2030 (appendix pp 1–2).2 Improving RMNCAH is vital for China in the context of rapid ageing and decreasing fertility. Following this, the Global Health Strategy for Women, Children and Adolescents (2016–30), which was developed under the framework of the Sustainable Development Goals (SDGs), explicitly recognised the need to extend the focus beyond mortality alone and to promote health across the developmental years: “By 2030, a world in which every woman, child and adolescent in every setting realizes their rights to physical and mental health and wellbeing, has social and economic opportunities, and is able to participate fully in shaping prosperous and sustainable societies”.

Background In order to respond to the dearth of mental health data in Rwanda where large-scale prevalence studies were not existing, Rwanda Mental Health Survey was conducted to measure the prevalence of mental disorders, associated co-morbidities and knowledge and utilization of mental health services nationwide within Rwanda. Methods This cross-sectional study was conducted between July and August 2018, among the general population, including survivors of the 1994 Genocide against the Tutsi. Participants (14–65 years) completed the Mini-International Neuropsychiatric Interview (Version 7.0.2), sociodemographic and epilepsy-related questionnaires. General population participants were selected first by random sampling of 240 clusters, followed by systematic sampling of 30 households per cluster. Genocide survivors within each cluster were identified using the 2007–2008 Genocide Survivors Census. Results Of 19,110 general survey participants, most were female ( n  = 11,233; 58.8%). Mental disorders were more prevalent among women (23.2%) than men (16.6%) ( p  < 0.05). The most prevalent mental disorders were major depressive episode (12.0%), panic disorder (8.1%) and post-traumatic stress disorder (PTSD) (3.6%). Overall, 61.7% had awareness of mental health services while only 5.3% reported to have used existing services. Of the 1271 genocide survivors interviewed, 74.7% ( n  = 949) were female; prevalence of any mental disorder was 53.3% for women and 48.8% for men. Most prevalent disorders were major depressive episode (35.0%), PTSD (27.9%) and panic disorder (26.8%). Among genocide survivors, 76.2% were aware of availability of mental health services, with 14.1% reported having used mental health services. Conclusions Despite high prevalence of mental disorders among the general population and genocide survivors, utilization of available mental health services was low. A comprehensive approach to mental health is needed for prevention of mental illness and to promote mental healthcare services.

Background Mental disorders significantly burden Indigenous communities, worsened by limited culturally appropriate services. Spatial inequalities in access further disadvantage Indigenous peoples, especially in socio-economically challenged areas. This paper measures the spatial accessibility of Indigenous community-controlled mental health services in South East Queensland, Australia and examines its social inequalities across the region. Methods We considered both population and health service providers’ capacity to maximise service coverage in measuring potential access to the services. Using Geographical Information Systems (GIS) technologies, a Gaussian-based two-step floating catchment area (G2SFCA) method was applied to quantify accessibility under four driving time thresholds ranging from 15 to 60 minutes. Bivariate global and local Moran’s I statistics were used to analyse social inequalities in accessibility across various geographical areas. Results Accessibility was higher in urban areas than those towards the peri-urban and rural areas; the overall spatial coverage was relatively limited for service access within the 15- or 30-minute driving time threshold, compared with the 45- or 60-minute driving time threshold. Lower levels of accessibility were identified in areas with a concentration of Indigenous and socio-economically disadvantaged populations. Conclusions This study advances a socially informed spatial inequality assessment framework. Unlike previous research exploring accessibility qualitatively, our framework innovatively integrates spatial analysis, Indigenous-specific population data and culturally sensitive provider capacity metrics within an advanced G2SFCA model. This approach uniquely exposes the compounded socio-spatial barriers to mental health services for Indigenous populations across South East Queensland’s urban-rural continuum. The resulting accessibility and inequality maps, combined with a summary of focus areas and their associated socio-demographic profiles, provide a direct policy lever to prioritise intervention for Indigenous communities experiencing the greatest disadvantage. By bridging spatial analysis with Indigenous cultural contexts, this work offers a replicable model for equitable, community-driven healthcare resource allocation for Indigenous peoples globally.

Deaf and hard of hearing (DHH) American Sign Language users experience significant mental health-related disparities compared with non-DHH English speakers. Yet there is little empirical evidence documenting this priority population's communication access in mental health and substance use treatment facilities. This study measured mental health and substance use treatment facilities' noncompliance to Section 1557 of the Affordable Care Act (ACA), which requires health care facilities receiving government funds to provide effective communication access, such as a sign language interpreter, to DHH patients. Using nationally representative data from the Substance Abuse and Mental Health Services Administration, we found that 41 percent of mental health facilities and 59 percent of substance use treatment facilities receiving public funds reported not providing services in sign language in 2019 and were thus noncompliant with the ACA's mandate to provide accessible communication to DHH patients. We mapped these data to display state-level noncompliance, and we make detailed recommendations at the policy, facility, and provider levels. These include monitoring noncompliance among government-funded facilities, expanding state-by-state mental health licensure reciprocity and telehealth policies to improve access to American Sign Language-fluent mental health professionals and addiction counselors, establishing systematic processes to collect information on disability-related accommodation needs, and increasing the workforce of DHH American Sign Language-fluent providers.

This article emerges from a scoping review of over two decades of relevant literature on immigrants’ access to mental health services in Canada. Key online databases were searched to explore the gaps and opportunities for improving access to mental health services using a review framework provided by Arksey and O’Malley (Int J Soc Res Methodol 8:19–32, 2005). Immigrants and refugees came from diverse religious and cultural backgrounds and had complex mental health-related concerns that were not currently being adequately addressed by existing services. The major barriers to the utilization of mental health services included: those related to the uptake of existing health information and services; those that were related to the process of immigrant settlement; and barriers related to availability of appropriate services. A thematic analysis of the range of recommendations that emerge from these studies for improvement of research, practice and policy is provided.

The Affordable Care Act, along with Medicaid expansions, offers the opportunity to redesign the nation's highly flawed mental health system. It promotes new programs and tools, such as health homes, interdisciplinary care teams, the broadening of the Medicaid Home and Community-Based Services option, co-location of physical health and behavioral services, and collaborative care. Provisions of the act offer extraordinary opportunities, for instance, to insure many more people, reimburse previously unreimbursed services, integrate care using new information technology tools and treatment teams, confront complex chronic comorbidities, and adopt underused evidence-based interventions. The Centers for Medicare and Medicaid Services and its Center for Medicare and Medicaid Innovation should work intensively with the states to implement these new programs and other arrangements and begin to fulfill the many unmet promises of community mental health care. [PUBLICATION ABSTRACT]

Now, more than ever, broadband Internet access (BIA) must be recognized as a social determinant of health. Disparities in access should be treated as a public health issue because they affect \"the health of people and communities where they live, learn, work and play.\" The COVID-19 pandemic demonstrates that lack of BIA influences each of the six social determinant of health domains defined by the American Medical Association.2 It also affects an additional domain, which is particularly pertinent during a pandemic-access to credible information (Figure 1). Reduced BIA, particularly during this pandemic, has the potential to exacerbate this country's existing health disparities because it disproportionately affects those who are already vulnerable. Indeed, those who are older, are racial/ ethnic minorities, have lower incomes, are less educated, or live in rural areas may experience worse health outcomes under normal circumstances and are even less able to access healthenhancing resources during social-distancing orders.

Background The global burden of mental health disorders is on the increase, which has contributed to discussions on mitigation strategies. While mental health discourses in respect of access to services are still ongoing, there is limited focus on vulnerable groups. Deaf persons are at risk of exclusion from health services due to their unique modes of communication. In order to advocate for the inclusion of deaf persons in mental health services, there is a need for a study eliciting information on their knowledge about mental health and accessibility to services. Method The study was guided by a mixed-methods design and a two-phase data collection. In phase one, a questionnaire was distributed to 284 deaf persons to gather information on their knowledge of mental health conditions, causes, sources of information, and accessibility of services. Frequencies were used to report the trends identified in the data. Following this, an interview guide was designed based on the trends identified in the first phase to develop an in-depth insight into the experiences of deaf persons ( n  = 40) in respect of awareness and accessibility to mental health services. Results The results showed convergences and divergence between the qualitative and quantitative data. For instance, they were convergences between both datasets relative to knowledge on and causes of mental health conditions. Conclusion The study highlights the need for health policymakers to leverage the information gathered on the study participants’ knowledge to develop appropriate mental health training programmes for deaf persons.