An Identity-Affirming Web Application to Help Sexual and Gender Minority Youth Cope With Minority Stress: Pilot Randomized Controlled Trial

Jose Bauermeister, Seul Ki Choi, Emma Bruehlman-Senecal, Jesse Golinkoff, Arianna Taboada, Joshua Lavra, Lionel Ramazzini, Fred Dillon, Jana Haritatos, Jose Bauermeister, Seul Ki Choi, Emma Bruehlman-Senecal, Jesse Golinkoff, Arianna Taboada, Joshua Lavra, Lionel Ramazzini, Fred Dillon, Jana Haritatos

Abstract

Background: Efficacious mental health interventions for sexual and gender minority youth have had limited reach, given their delivery as time-intensive, in-person sessions. Internet-based interventions may facilitate reach to sexual and gender minority youth; however, there is little research examining their efficacy.

Objective: This study aims to describe the results of a pilot randomized controlled trial of imi, a web application designed to improve mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice.

Methods: Sexual and gender minority youth (N=270) aged 13 to 19 (mean 16.5, SD 1.5) years and living in the United States were recruited through Instagram advertisements. Approximately 78% (210/270) of the sample identified as racial or ethnic minorities. Participants were randomized in a 1:1 fashion to the full imi intervention web application (treatment; 135/270, 50%) or a resource page-only version of the imi site (control; 135/270, 50%). The imi application covered four topical areas: gender identity; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity; stress and coping; and internalized homophobia and transphobia. Participants explored these areas by engaging with informational resources, exercises, and peer stories at a self-guided pace. Both arms were assessed via web-based surveys at baseline and 4-week follow-up for intervention satisfaction, stress appraisals (ie, challenge, threat, and resource), coping skills (ie, instrumental support, positive reframing, and planning), and mental health symptoms among other outcomes. Main intent-to-treat analyses compared the arms at week 4, controlling for baseline values on each outcome.

Results: Survey retention was 90.4% (244/270) at week 4. Participants in the treatment arm reported greater satisfaction with the intervention than participants in the control arm (t241=-2.98; P=.003). The treatment arm showed significantly greater improvement in challenge appraisals (ie, belief in one's coping abilities) than the control (Cohen d=0.26; P=.008). There were no differences between the arms for threat (d=0.10; P=.37) or resource (d=0.15; P=.14) appraisals. The treatment arm showed greater increases in coping skills than the control arm (instrumental support: d=0.24, P=.005; positive reframing: d=0.27, P=.02; planning: d=0.26, P=.02). Mental health symptoms improved across both the treatment and control arms; however, there were no differences between arms. Within the treatment arm, higher engagement with imi (≥5 sessions, >10 minutes, or >10 pages) predicted greater improvement in stress appraisals (all P values <.05).

Conclusions: The results provide initial evidence that asynchronous psychosocial interventions delivered via a web application to sexual and gender minority youth can support their ability to cope with minority stress. Further research is needed to examine the long-term effects of the imi application.

Trial registration: ClinicalTrials.gov NCT05061966; https://ichgcp.net/clinical-trials-registry/NCT05061966.

Keywords: LGBTQ+; SGM; adolescence; discrimination; intersectionality; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority; mental health; minority stress; resilience; sexual and gender minority; youth.

Conflict of interest statement

Conflicts of Interest: imi is a progressive web application codeveloped by Hopelab, CenterLink, and It Gets Better Project. Although all 3 organizations were involved in the development of the product, CenterLink will ultimately be responsible for the operation and distribution of the imi application. As a free digital tool created and distributed by nonprofit organizations, none of the organizations involved stand to profit financially from the product. The research reported here, as well as the development of the imi application, were supported by the nonprofit Hopelab Foundation. Hopelab develops behavioral interventions to improve the health and well-being of young people. The design, conduct, analysis, and reporting of this study represent a scientific collaboration between Hopelab and the Program on Sexuality, Technology, and Action Research at the University of Pennsylvania School of Nursing. EBS, FD, AT, JL, LR, and JH are employed by Hopelab Foundation. The study sponsor was involved in the study design; collection, analysis, and interpretation of data; writing of the article; and decision to submit it for publication.

©Jose Bauermeister, Seul Ki Choi, Emma Bruehlman-Senecal, Jesse Golinkoff, Arianna Taboada, Joshua Lavra, Lionel Ramazzini, Fred Dillon, Jana Haritatos. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 01.08.2022.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards for Reporting Trials) diagram.

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