Participant Engagement in a Transmedia Storytelling Web-Based App Intervention for Mental Health of Latina Women: Qualitative Analysis

Abstract

Background Stigma, fear, and lack of knowledge regarding treatment options or where to get help create delays for Latina women in accessing needed mental health help. Story-based media interventions hold appeal for Latina women. Thus, we drew upon the Social Cognitive Theory by Bandura to create an evidence-based, transmedia storytelling web-based app for mental health called Catalina: Confronting My Emotions to connect Latina women to a curated set of mental health resources. Understanding how Latina women perceive various aspects of the web-based app will help design future expansions. Objective A previously published analysis led to the development of a category on how participants related to the lead character (Catalina) in the story line of the web-based app as a real person. However, the purpose of this analysis was to gain an understanding of participants’ experiences with the extension of the dramatic story line of the web-based app beyond Catalina to a Latina nurse-therapist character named Veronica, who was featured prominently in the app’s interactive content and bonus videos. Methods Qualitative analyses were conducted with interview data from a community-based sample of 28 English-speaking Latina women aged between 21 and 50 years who scored above the threshold for anxiety (Generalized Anxiety Disorder-7) and/or depression (Patient Health Questionnaire-9) but were not suicidal at screening. Data were collected 72 hours after participants engaged with our transmedia storytelling web-based app for mental health. Grounded theory methodology guided the analysis and interpretation of data that had been collected telephonically, recorded, and transcribed with identifiers removed. Analyses included initial and focused coding using process codes (gerund form of verbs in codes focused on action), informed by symbolic interactionism, and the development of categories with properties through constant comparison, memo writing, and the use of charts and diagrams. Results Our participants experienced a multiphase process that was most heavily related to Veronica, the Latina nurse-therapist character in our web-based app, who led them through a process to a place of action. We conceptualized this process as moving from passive viewer to active participant of a transmedia storytelling web-based app intervention. Overall, 3 new conceptual categories provided insight into women’s experiences, including encountering a trustworthy nurse-therapist character, taking in messages that dispel old beliefs, and preparing when and how to take action. Each category has nuanced properties that reflect participants’ experiences. Conclusions Active engagement with our web-based app led our sample to successfully transition from the viewpoint of the observer to the viewpoint of the experiencer, moving from a passive position of watching to active engagement that involved imagining, thinking, reflecting, and acting. Careful development of dramatic material for health-related web-based apps using transmedia story extension and bonus videos needs to be based on input from the target group from the start of development through evaluation and testing.

A systematic review of digital storytelling as psychotherapy for people with mental health needs.

“…The study populations in Table 2 show the studies mostly targeted adolescents, youths, or older adults. While gender differentiation of the study participants is unreported in some studies, four out of the six studies that reported, used either only females or mostly females as study participants (Heilemann et al, 2017; Moon & Park, 2020; Rincon et al, 2022; Soderlund et al, 2021). Table 2 shows that, where specified, the population groups included immigrant Latinas dealing with anxiety and depression, university students, company workers, dementia patients, military veterans suffering PTSD, grieving youths dealing with parental suicide, and youths in social care with mental health needs.…”

“…All 14 sources stated the specific problems and/or the rationales that necessitated the digital storytelling studies reported. The summarization of these rationales produced four categories, including: limited research on impact of digital storytelling ([5/14]; Bunnell et al, 2017; Ferrari et al, 2022; Heilemann et al, 2017; Litvin et al, 2020; Moon & Park, 2020), high use of online and digital social networking by target population ([5/14]; Gilliam et al, 2012; Hammond et al, 2021; Park et al, 2021; Rincon et al, 2022; Stargatt et al, 2022), effects of mental health experience ([2/14]; Hagstrom, 2017; Jamerson, 2017); and need to explore and describe a digital storytelling game or app ([2/14]; Consalvo & Phelps, 2020; Soderlund et al, 2021). With 10 out of the 14 reviewed, most sources reported that studies were undertaken because of either limited research on the impact or high use of online and digital social networking for storytelling.…”

“…While two sources studied the same target population with the same digital storytelling media, three digital media used transmedia video applications, making it the most common digital storytelling media platform or type found in the studies reviewed. This included the Transmedia Catalina app studied by Heilemann et al (2017) and Soderlund et al (2021) and the Game Changer Transmedia storytelling game studied by Gilliam et al (2012). Most of the sources reviewed used different study-specific digital media in their studies…”

“…DIGITAL STORYTELLING AND PSYCHOTHERAPY experiences of Latina women with mental health problems (Soderlund et al, 2021), theoretical framework analysis of the architecture and effects of a new digital game (Consalvo & Phelps, 2020), and an evaluative study of the lived experiences of veterans with PTSD (Bunnell et al, 2017). The qualitative studies were rather descriptive of the utilization of digital storytelling media in the different mental health contexts: "Guest Book" chat blog media for grieving bereaved youth (Hagstrom, 2017), and "Expressive Remix Therapy" (Jamerson, 2017) and "Memorify" (Hammond et al, 2021) applications for adolescents in care.…”

Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments

“…Qualitative measures allow for an in-depth assessment of behavioral, cognitive, and affective dimensions of engagement. Eight studies used qualitative measures to measure engagement [38,49,50,[60][61][62][63][64]. The use of qualitative data is especially suitable for assessing out-of-session effort and the dynamic change of overall engagement over time [19].…”