mHealth for Mental Health: Culturally-tailored Interventions for Managing Anxiety and Depression in African American Women

The rates of mental illness among African American women are comparable to the general population, however, they significantly underutilize mental health services compared to their white counterparts. Previous studies revealed that mHealth interventions increase access to mental health services and resources, and are effective in reducing anxiety and depression. Approximately 80% of African American women own smartphones. This presents a great opportunity to use mobile technology to help reduce the disparity in mental health service utilization and improve health outcomes. The purpose of this dissertation study is to examine the attitudes and perceptions of African American women towards using mental health services, and the feasibility of using mobile technology to deliver mental health services and resources. Eligible participants were African American women (≥ 18 years of age). Participants were recruited through convenience sampling methods (e.g., social media) to complete a web-based survey (n=395), participate in a focus group (4 groups of 5 participants), or test and evaluate a mental health app developed to help African American women manage anxiety and depression (n=15). Results from the study revealed that African American women have favorable views toward seeking mental health services. However, respondents identified many barriers to seeking treatment. Most of the barriers were related to cost, not knowing where to get services, lack of time, and concern of stigma. Findings from the study showed that respondents were more comfortable with using voice call or video call when compared with text messaging or use of a mobile app to communicate with mental health professionals for help in managing anxiety and depression. User-centered recommendations focused on the type of content (e.g., information to find a Black female therapist) and features (e.g., group chat rooms) that should be included in an app culturally-tailored for African American women. Suggestions to increase app usage (e.g., ability to learn coping techniques) and establish trust (e.g., transparency on how user data is protected) were also discussed. The findings of this study demonstrated the need for additional research into the use of mobile technology to provide African American women with more accessible and convenient options for mental health care.Doctor of Philosoph

Content and Social Network Analyses of Depression-related Tweets of African American College Students

The prevalence of depression is higher among African American college students compared to their White counterparts. They are also more likely to disclose feelings of depression on Twitter. The aim of this exploratory study was to answer the following questions: What are the most common themes of depression-related tweets among African American college students? Are there differences in the social network characteristics of college students that have posted a depression-related tweet or retweet and those who have not? Content and social network analyses were conducted. The study results showed the most common themes focused on feelings of depression, casual mentions, and supportive messages. In addition, we observed that the social networks of users posting depression-related tweets have more mutual connections with their friends than the users who did not post a depression-related tweet. These findings may help to inform the design of social media interventions for African American college students

A Socio-Ecological Approach to Addressing Digital Redlining in the United States: A Call to Action for Health Equity

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining—the systematic process by which specific groups are deprived of equal access to digital tools such as the internet—creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity

Recommendations for design of a mobile application to support management of anxiety and depression among Black American women

Black American women experience adverse health outcomes due to anxiety and depression. They face systemic barriers to accessing culturally appropriate mental health care leading to the underutilization of mental health services and resources. Mobile technology can be leveraged to increase access to culturally relevant resources, however, the specific needs and preferences that Black women feel are useful in an app to support management of anxiety and depression are rarely reflected in existing digital health tools. This study aims to assess what types of content, features, and important considerations should be included in the design of a mobile app tailored to support management of anxiety and depression among Black women. Focus groups were conducted with 20 women (mean age 36.6 years, SD 17.8 years), with 5 participants per group. Focus groups were led by a moderator, with notetaker present, using an interview guide to discuss topics, such as participants' attitudes and perceptions towards mental health and use of mental health services, and content, features, and concerns for design of a mobile app to support management of anxiety and depression. Descriptive qualitative content analysis was conducted. Recommendations for content were either informational (e.g., information to find a Black woman therapist) or inspirational (e.g., encouraging stories about overcoming adversity). Suggested features allow users to monitor their progress, practice healthy coping techniques, and connect with others. The importance of feeling “a sense of community” was emphasized. Transparency about who created and owns the app, and how users' data will be used and protected was recommended to establish trust. The findings from this study were consistent with previous literature which highlighted the need for educational, psychotherapy, and personal development components for mental health apps. There has been exponential growth in the digital mental health space due to the COVID-19 pandemic; however, a one-size-fits-all approach may lead to more options but continued disparity in receiving mental health care. Designing a mental health app for and with Black women may help to advance digital health equity by providing a tool that addresses their specific needs and preferences, and increase engagement

Assessing the Satisfaction of Citizens Using Teleconsent in Clinical Research

Researchers tested the functionality, and evaluated the feasibility of a telemedicine software, Doxy.me, to complete informed teleconsent sessions remotely with prospective research participants. Twenty healthy volunteers completed a teleconsent session, and web survey assessing overall experience and satisfaction with the Doxy.me software. There was a statistically significant correlation found between age and mean response for the overall reaction category (r = 0.398, p = 0.091) and the systems capabilities category (r = 0.380, p = 0.099). Results suggested that younger users are more satisfied than older users with using teleconsent as a modality for informed consenting. This information will be used to improve the software design and functionality of the Doxy.me software to make the teleconsent experience as simple and intuitive as possible

A Socio-Ecological Approach to Addressing Digital Redlining in the United States:A Call to Action for Health Equity

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining—the systematic process by which specific groups are deprived of equal access to digital tools such as the internet—creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity

Personal Health Libraries for People Returning From Incarceration: Protocol for a Qualitative Study

BACKGROUND: Individuals released from carceral facilities have high rates of hospitalization and death, especially in the weeks immediately after their return to community settings. During this transitional process, individuals leaving incarceration are expected to engage with multiple providers working in separate, complex systems, including health care clinics, social service agencies, community-based organizations, and probation and parole services. This navigation is often complicated by individuals\u27 physical and mental health, literacy and fluency, and socioeconomic status. Personal health information technology, which can help people access and organize their health information, could improve the transition from carceral systems to the community and mitigate health risks upon release. Yet, personal health information technologies have not been designed to meet the needs and preferences of this population nor tested for acceptability or use. OBJECTIVE: The objective of our study is to develop a mobile app to create personal health libraries for individuals returning from incarceration to help bridge the transition from carceral settings to community living. METHODS: Participants were recruited through Transitions Clinic Network clinic encounters and professional networking with justice-involved organizations. We used qualitative research methods to assess the facilitators and barriers to developing and using personal health information technology for individuals returning from incarceration. We conducted individual interviews with people just released from carceral facilities (n=~20) and providers (n=~10) from the local community and carceral facilities involved with the transition for returning community members. We used rigorous rapid qualitative analysis to generate thematic output characterizing the unique circumstances impacting the development and use of personal health information technology for individuals returning from incarceration and to identify content and features for the mobile app based on the preferences and needs of our participants. RESULTS: As of February 2023, we have completed 27 qualitative interviews with individuals recently released from carceral systems (n=20) and stakeholders (n=7) who support justice-involved individuals from various organizations in the community. CONCLUSIONS: We anticipate that the study will characterize the experiences of people transitioning from prison and jails to community settings; describe the information, technology resources, and needs upon reentry to the community; and create potential pathways for fostering engagement with personal health information technology. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44748