Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial

Rushing, Stephanie Craig; Kelley, Allyson; Bull, Sheana; Stephens, David; Wrobel, Julia; Silvasstar, Joshva; Peterson, Roger L.; Begay, Corey; Dog, Thomas Ghost; McCray, Celena; Brown, Danica Love; Thomas, Morgan; Caughlan, Colbie; Singer, Michelle; Smith, Paige; Sumbundu, Kanku

doi:10.2196/26158

Cited by 26 publications

(51 citation statements)

References 27 publications

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“…Finally, we analyzed the correlation between the number of links clicked and composite scores for the psychosocial outcome measures described in the BRAVE efficacy paper [ 23 , 24 ]. The measure scores are on a continuous scale of 1 to 5, which is a composite score across survey questions that were used and reported in BRAVE efficacy paper [ 23 , 24 ]. Plots of composite scores at baseline for each efficacy measure against the number of clicks are shown in Figure 2 .…”

Section: Resultsmentioning

confidence: 99%

“…Outcomes of interest included health, help-seeking behavior, identification with cultural heritage (cultural identity), self-efficacy, self-esteem, negative coping behavior (alcohol and drug misuse), positive coping behavior, and resilience. Each measure is an aggregate score calculated from multiple survey questions, as defined in [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…In this paper, we focus on a review of system data for a study conducted to assess the efficacy of an SMS text messaging intervention to promote mental wellness in AI/AN teens and young adults. Prior papers have focused on the formative design of the intervention, recruitment methods, and the efficacy of the BRAVE intervention [ 23 , 24 ]. Here, we analyze an array of patterns in user engagement using passively collected backend user data.…”

Section: Introductionmentioning

confidence: 99%

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Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns

Wrobel¹,

Silvasstar²,

Peterson³

et al. 2022

JMIR Form Res

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Background Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. Methods The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. Results Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks. Conclusions This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. Trial Registration ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns

Wrobel¹,

Silvasstar²,

Peterson³

et al. 2022

JMIR Form Res

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“…Most studies acknowledged youth diversity and considered representativeness in sample selection or interpretation of results. As a result, almost all studies recruited participants from several sites, with five specifically targeting rural or remote communities (31,58,60,73,74,77) or national samples (63,82). Author reflection and discussion around power considerations and stakeholder and young people's involvement in decision-making and research planning was infrequent but evident in at least one study (31).…”

Section: Digital Mental Health Interventionsmentioning

confidence: 99%

“…All studies made adaptions to respect local cultural protocols, leading to increased recruitment (74,82), quality of data collected (31,87), and acceptability of study outcomes and processes (61,65,72,77,82). Several studies considered Indigenous constructs of wellbeing (61,65,74), Indigenous language groups (58), family groups (61), or tribal affiliations (68) when planning study procedures to ensure these aligned with community protocols.…”

Section: Engagementmentioning

confidence: 99%

Involvement of Indigenous young people in the design and evaluation of digital mental health interventions: A scoping review of best practice principles

Povey

Raphiphatthana

Torok

et al. 2023

Preprint

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Background Indigenous young people worldwide possess unique protective factors that support wellbeing. However, they experience mental illness at higher rates than their non-indigenous counterparts. Digital mental health (dMH) resources can increase access to structured, timely, and culturally tailored mental health interventions by reducing structural and attitudinal barriers to accessing treatment. The involvement of Indigenous young people in dMH resource development is recommended, however, no guidelines exist on how this can best be facilitated. Methods A scoping review examining processes to involve Indigenous young people in developing or evaluating dMH interventions was conducted. Studies reported between 1990–2022 involving Indigenous young people aged 12–24 years, originating from Canada, the United States of America, New Zealand, and Australia, in the development or evaluation of dMH interventions were eligible for inclusion. Following a three-step search process, four electronic databases were searched. Data were extracted, synthesised, and described under three categories: dMH intervention attributes, study design, and alignment with research best practice. Best practice recommendations for Indigenous research and participatory design were identified and synthesised. Included studies were assessed against these recommendations. Consultation with two Senior Indigenous Research Officers ensured Indigenous worldviews informed analysis. Results Nineteen studies describing ten dMH interventions met inclusion criteria. Studies included formative, design, pilot, and efficacy studies. Overall, most included studies demonstrated a high degree of Indigenous governance, capacity building, and community benefit. All studies adapted their research processes to ensure that local community protocols were followed and most aligned these within an Indigenous research paradigm. Formal agreements regarding existing and created intellectual property and implementation evaluations were rare. Outcomes were the primary focus of reporting, with limited detailed descriptions of governance and decision-making processes or strategies for managing predictable tensions between co-design stakeholders. Conclusions This study identified best practice recommendations in participatory design with Indigenous young people and evaluated the current literature against these criteria. Common gaps were evident in the reporting of study processes. Consistent, in-depth reporting is needed to allow assessment of best practice approaches for this hard-to-reach population. An emergent best practice model, informed by our findings, for guiding the involvement of Indigenous young people in the design and evaluation of dMH tools is presented. Systematic review registration: available via osf.io/2nkc6

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Interventions with Digital Tools for Mental Health Promotion among 11–18 Year Olds: A Systematic Review and Meta-Analysis

Wright

Reitegger

Cela

et al. 2023

J Youth Adolescence

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The availability of digital tools aiming to promote adolescent mental health is rapidly increasing. However, the field lacks an up-to-date and focused review of current evidence. This study thus looked into the characteristics and efficacy of digital, evidence-based mental health programs for youth (11–18 years). The selection procedure followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines and resulted in 27 eligible studies. The high heterogeneity of the results calls for careful interpretation. Nevertheless, small, but promising, effects of digital tools were found with respect to promoting well-being, relieving anxiety, and enhancing protective factors. Some important factors influencing overall efficacy include the given setting, the level of guidance and support, and the adherence to the intervention.

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Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial

Cited by 26 publications

References 27 publications

Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns

Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns

Involvement of Indigenous young people in the design and evaluation of digital mental health interventions: A scoping review of best practice principles

Interventions with Digital Tools for Mental Health Promotion among 11–18 Year Olds: A Systematic Review and Meta-Analysis

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