The BRAVE Study: Formative Research to Design a Multimedia Intervention for American Indian and Alaska Native Young Adults

Rushing, Stephanie Craig; Kelley, Allyson; Hafner, Stephen; Stephens, David; Singer, Michelle; Bingham, Dyani; Caughlan, Colbie; Fatupaito, Bethany; Gaston, Amanda; Dog, Thomas Ghost; Smith, Paige; Brown, Danica Love; McCray, Celena

doi:10.5820/aian.2801.2021.71

Cited by 6 publications

(24 citation statements)

References 10 publications

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“…Two studies described shared decision-making processes with study participants and outlined their voting methods to determine the look and feel of design elements (31,76). Most studies demonstrated Indigenous leadership or governance, which resulted in improved engagement (31,61,65,73,77,86), tailoring of study processes (31,61,65,87), and likely the success of most projects. In several studies, it was difficult to determine leadership and governance structures.…”

Section: Digital Mental Health Interventionsmentioning

confidence: 99%

“…In several studies, it was difficult to determine leadership and governance structures. Indigenous leadership was evidenced through the inclusion of Indigenous people in various project roles, including as lead investigators (61,64,85), coauthors or investigators (31,66,87,88), reference group members (31,58), governance boards (72,73,83), or as advisors, community elders or key informants (70,87).…”

Section: Digital Mental Health Interventionsmentioning

confidence: 99%

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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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Section: Digital Mental Health Interventionsmentioning

confidence: 99%

Section: Digital Mental Health Interventionsmentioning

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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“…From 2015 to 2018, the Northwest Portland Area Indian Health Board (NPAIHB) carried out formative research involving youth as co-designers to create a behavioral intervention addressing alcohol misuse, intimate partner violence, and suicidality among AI/AN teenagers and young adults living across the United States. In 2015, we conducted key informant interviews with 10 Native young men to better understand their perceptions on alcohol misuse and the context of violence in their communities [ 17 ]. In 2016, we designed a series of theoretically informed, culturally relevant SMS text messages and a role model script to demonstrate and reinforce the skills described in the SMS text messages.…”

Section: Introductionmentioning

confidence: 99%

“…Grounded in the principles of inclusion, equity, belonging, and diversity, the NPAIHB confirmed that the intervention could reflect the rich cultural diversity of tribes and urban youth living throughout the United States, and multiple phases of youth-driven research informed the design of the BRAVE intervention, the first mHealth intervention delivered via SMS text messages that uses culturally relevant images, narrative role model videos, and help-seeking resources [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…These interviews also informed the final design of the BRAVE intervention, highlighting common coping strategies (ie, alcohol and drug misuse), preferred wellness strategies (ie, goal setting and self-care), help-seeking skills (ie, reaching out for help for themselves or a friend), and related protective factors, including cultural resilience, identity, and cultural pride [ 17 ]. Participants and key informants recommended expanding the inclusion criteria for BRAVE to females and expanding the age group to 15-24 years.…”

Section: Introductionmentioning

confidence: 99%

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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

Rushing¹,

Kelley²,

Bull³

et al. 2021

JMIR Ment Health

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Background Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program 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 We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. Conclusions This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481

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Indigenous youth engagement in research: a scoping review of community-based participatory action research (CBPAR) in Canada and the USA

Melro,

Bombay,

Robinson

et al. 2024

International Journal of Adolescence and Youth

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The BRAVE Study: Formative Research to Design a Multimedia Intervention for American Indian and Alaska Native Young Adults

Cited by 6 publications

References 10 publications

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

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

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

Indigenous youth engagement in research: a scoping review of community-based participatory action research (CBPAR) in Canada and the USA

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