The Acceptability of Text Messaging to Help African American Women Manage Anxiety and Depression: Cross-Sectional Survey Study

Abstract

Background The rates of mental illness among African American women are comparable with the general population; however, they significantly underutilize mental health services compared with their white counterparts. Previous studies revealed that interventions delivered via text messaging are effective and can be used to increase access to services and resources. More insight into whether or not this modality is acceptable for use to deliver mental health care to help African American women manage anxiety and depression is needed. Objective This exploratory study aimed to gain insight into the acceptability of using text messaging to help African American women manage anxiety and depression. Methods A self-administered Web-based survey was launched in June 2018 and closed in August 2018. Eligible participants were African American women (18 years or older) who reside in the United States. Participants were recruited through convenience sampling (eg, email sent via listservs and social media posts). Respondents were provided an anonymous link to the questionnaire. The survey consisted of 53 questions on the following subjects: sociodemographic characteristics, attitudes toward seeking professional psychological help, mobile phone use, and acceptability of using a mobile phone to receive mental health care. Results The results of this exploratory study (N=101) showed that fewer than half of respondents endorsed the use of text messaging to communicate with a professional to receive help to manage anxiety (49/101, 48.5%) and depression (43/101, 42.6%). Approximately 51.4% (52/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with anxiety would be helpful. Similarly, 48.5% (49/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with depression would be helpful. Among participants who agreed that text messaging would be helpful, more than 80% noted being comfortable with its use to receive help for managing anxiety (approximately 86%, 45/52) and depression (approximately 82%, 40/49; highly significant positive association, all P<.001). More than 50% of respondents (56/101, 55.4%) indicated having concerns about using text messaging. No statistically significant associations were found between age and agreement with the use of text messaging to communicate with a professional to receive help for managing anxiety (P=.26) or depression (P=.27). Conclusions The use of text messaging was not highly endorsed by African American women as an acceptable mode of communication with a professional to help them manage anxiety or depression. Concerns around privacy, confidentiality, and the impersonal feel of communicating about sensitive issues via text messages must be addressed for this modality to be a viable option. The findings of this study demonstrated the need for further research into the use of mobile technology to provide this population with more accessible and convenient options for mental health care.

The Acceptability of Text Messaging to Help African American Women Manage Anxiety and Depression: Cross-Sectional Survey Study (Preprint)

“…This study adds to the literature by providing insight into the attitudes of African American women toward seeking mental health services to manage anxiety and depression and the acceptability of using text messaging to communicate with a professional to receive help for managing anxiety and depression. Although the use of text messaging was not highly endorsed by African American women as an acceptable mode to converse with a professional (<50% endorsed), our prior work found that mobile video calls were viewed favorably by the majority of respondents (>70% endorsed) [22]. Concerns around privacy, confidentiality, and the impersonal feel of communicating about sensitive issues via text messages must be addressed for successful participation in text message-based interventions among this population.…”

“…Descriptive statistics were calculated for sample characteristics and responses to text messaging questions as mean, standard deviation, and range for continuous variables and as frequencies and percentages for categorical variables. As reported in prior work, age was dichotomized into 2 groups (<50 years and ≥50 years), education was categorized into 3 levels (less than bachelor's degree, bachelor's degree, and graduate degree), and response options were dichotomized as agree/somewhat agree and disagree/somewhat disagree [22]. Fisher exact test was used to determine whether an association exists between the response to each text messaging question and age group and to test for association between agreement with comfortability and perceived helpfulness of having the option to communicate with a professional through text messaging to receive help for managing anxiety and depression, respectively.…”

“…Furthermore, mobile health (mHealth) interventions have been increasingly used because of the potential to reduce access issues, such as geographic proximity to a preferred mental health care professional (eg, therapist). Previous studies have shown that African American women are comfortable with participating in mHealth research and interventions [22,23], and 80% of African American women own smartphones [24]. This presents a great opportunity to use mobile technology to help reduce the disparity in mental health service utilization and improve health outcomes for this population.…”

Suitability of Text-Based Communications for the Delivery of Psychological Therapeutic Services to Rural and Remote Communities: Scoping Review

“…Three studies did not report positive therapeutic outcomes following text-based counseling. Almost half of a sample of African American women reported that text-based interventions for depression and anxiety were not a desirable form of treatment [43]. A randomized controlled trial [44] showed that depression symptoms were reduced for a standard treatment with automated internet-delivered depression management more than with standard care plus optional text-based chat with a therapist.…”

Patient Interaction Phenotypes With an Automated Remote Hypertension Monitoring Program and Their Association With Blood Pressure Control: Observational Study

“…It is possible that the structured format even deterred engagement. In a study of text message communication for mental health among black women, participants commonly cited an impersonal feel and inadequate communication as barriers to adoption [ 30 ], and restrictive automated communication may contribute to similar sentiments in this cohort. In comparison with other communication style clusters, the student group tended to skew older and were randomized more frequently without the social support group, which may have affected their behavior.…”