Initial design of culturally informed behavioral intervention technologies: developing an mHealth intervention for young sexual minority men with generalized anxiety disorder and major depression

Michelle Nicole Burns, Enid Montague, David C Mohr, Michelle Nicole Burns, Enid Montague, David C Mohr

Abstract

Background: To our knowledge, there is no well-articulated process for the design of culturally informed behavioral intervention technologies.

Objective: This paper describes the early stages of such a process, illustrated by the methodology for the ongoing development of a behavioral intervention technology targeting generalized anxiety disorder and major depression among young sexual minority men.

Methods: We integrated instructional design for Internet behavioral intervention technologies with greater detail on information sources that can identify user needs in understudied populations, as well as advances in the understanding of technology-specific behavioral intervention technology dimensions that may need to be culturally tailored.

Results: General psychological theory describing how to effect change in the clinical target is first integrated with theory describing potentially malleable factors that help explain the clinical problem within the population. Additional information sources are then used to (1) evaluate the theory, (2) identify population-specific factors that may affect users' ability to relate to and benefit from the behavioral intervention technology, and (3) establish specific skills, attitudes, knowledge, etc, required to change malleable factors posited in the theory. User needs result from synthesis of this information. Product requirements are then generated through application of the user needs to specific behavioral intervention technology dimensions (eg, technology platform). We provide examples of considerations relevant to each stage of this process and how they were applied.

Conclusions: This process can guide the initial design of other culturally informed behavioral intervention technologies. This first attempt to create a systematic design process can spur development of guidelines for design of behavioral intervention technologies aimed to reduce health disparities.

Keywords: anxiety; cultural competency; depression; eHealth; male adolescents; male homosexuality; minority health; mobile health; young adult.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Process for the initial design of a behavioral intervention technology targeting generalized anxiety disorder and major depression among male sexual minority youth (rectangle=internal processes; trapezoid=process resulting in the input of information).
Figure 2
Figure 2
The population-specific theory of affective change used to guide the design of a behavioral intervention technology targeting generalized anxiety disorder and major depression among male sexual minority youth.

References

    1. Burns MN, Mohr DC. eHealth and behavioral intervention technologies. In: Gellman MD, Turner JR, editors. Encyclopedia of Behavioral Medicine. New York: Springer-Verlag; 2013. pp. 659–664.
    1. National Research Council . Adolescent health services: missing opportunities. Washington, DC: National Academies Press; 2009.
    1. Institute of Medicine; Board on the Health of Select Populations; Committee on LGBT Health Issues and Research Gaps and Opportunities . The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) People: Building a Foundation for Better Understanding. Washington, D.C: National Academies Press; 2011.
    1. Coker TR, Austin SB, Schuster MA. The health and health care of lesbian, gay, and bisexual adolescents. Annu Rev Public Health. 2010;31:457–77. doi: 10.1146/annurev.publhealth.012809.103636.
    1. Lyons HZ, Bieschke KJ, Dendy AK, Worthington RL, Georgemiller R. Psychologists' competence to treat lesbian, gay and bisexual clients: state of the field and strategies for improvement. Prof Psychol-Res Pr. 2010 Oct;41(5):424–434.
    1. Kipke MD, Kubicek K, Weiss G, Wong C, Lopez D, Iverson E, Ford W. The health and health behaviors of young men who have sex with men. J Adolesc Health. 2007 Apr;40(4):342–50. doi: 10.1016/j.jadohealth.2006.10.019.
    1. Cochran SD. Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter? American Psychologist. 2001;56(11):931–947.
    1. Hilgart MM, Ritterband LM, Thorndike FP, Kinzie MB. Using instructional design process to improve design and development of Internet interventions. J Med Internet Res. 2012 Jun;14(3):e89. doi: 10.2196/jmir.1890.
    1. Valdez R, Gibbons MC, Siegel ER, Kukafka R, Brennan PF. Designing consumer health IT to enhance usability among different racial and ethnic groups within the United States. Health Technol. 2012;2(4):225–233.
    1. Maguire M. Methods to support human-centred design. Int J Hum-Comput St. 2001 Oct;55(4):587–634.
    1. Friedman MS, Silvestre AJ, Gold MA, Markovic N, Savin-Williams RC, Huggins J, Sell RL. Adolescents define sexual orientation and suggest ways to measure it. J Adolesc. 2004 Jun;27(3):303–17. doi: 10.1016/j.adolescence.2004.03.006.
    1. Almeida J, Johnson RM, Corliss HL, Molnar BE, Azrael D. Emotional distress among LGBT youth: the influence of perceived discrimination based on sexual orientation. J Youth Adolesc. 2009 Aug;38(7):1001–14. doi: 10.1007/s10964-009-9397-9.
    1. Pachankis JE, Goldfried MR. Social anxiety in young gay men. J Anxiety Disord. 2006;20(8):996–1015. doi: 10.1016/j.janxdis.2006.01.001.
    1. Spek V, Cuijpers P, Nyklícek I, Riper H, Keyzer J, Pop V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med. 2007 Mar;37(3):319–28. doi: 10.1017/S0033291706008944.
    1. Richardson T, Stallard P, Velleman S. Computerised cognitive behavioural therapy for the prevention and treatment of depression and anxiety in children and adolescents: a systematic review. Clin Child Fam Psychol Rev. 2010 Sep;13(3):275–90. doi: 10.1007/s10567-010-0069-9.
    1. Barlow DH, Allen LS, Choate ML. Toward a unified treatment for emotional disorders. Behav Ther. 2004;35(2):205–230.
    1. Ehrenreich JT, Goldstein CM, Wright LR, Barlow DH. Development of a unified protocol for the treatment of emotional disorders in youth. Child Fam Behav Ther. 2009 Jan;31(1):20–37. doi: 10.1080/07317100802701228.
    1. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003 Sep;129(5):674–97. doi: 10.1037/0033-2909.129.5.674.
    1. Meyer IH. Minority stress and mental health in gay men. J Health Soc Behav. 1995 Mar;36(1):38–56.
    1. D'Augelli AR, Hershberger SL, Pilkington NW. Lesbian, gay, and bisexual youth and their families: disclosure of sexual orientation and its consequences. Am J Orthopsychiatry. 1998 Jul;68(3):361–71; discussion 372.
    1. D'Augelli AR, Grossman AH, Starks MT. Parents' awareness of lesbian, gay, and bisexual youths' sexual orientation. J Marriage Fam. 2005 May;67(2):474–482.
    1. Hatzenbuehler ML. How does sexual minority stigma "get under the skin"? A psychological mediation framework. Psychol Bull. 2009 Sep;135(5):707–30. doi: 10.1037/a0016441.
    1. Pachankis JE. The psychological implications of concealing a stigma: a cognitive-affective-behavioral model. Psychol Bull. 2007 Mar;133(2):328–45. doi: 10.1037/0033-2909.133.2.328.
    1. Vincke J, van Heeringen K. Confidant support and the mental wellbeing of lesbian and gay young adults: a longitudinal analysis. J Community & Appl Soc Psychol. 2002;12:181–193.
    1. Rosario M, Schrimshaw EW, Hunter J. A model of sexual risk behaviors among young gay and bisexual men: longitudinal associations of mental health, substance abuse, sexual abuse, and the coming-out process. AIDS Educ Prev. 2006 Oct;18(5):444–60. doi: 10.1521/aeap.2006.18.5.444.
    1. Rosario M, Rotherarn-Borus MJ, Reid H. Gay-related stress and its correlates among gay and bisexual male adolescents of predominantly Black and Hispanic background. J Community Psychol. 1996;24(2):136–159.
    1. Bowen A. Internet sexuality research with rural men who have sex with men: can we recruit and retain them? J Sex Res. 2005 Nov;42(4):317–23. doi: 10.1080/00224490509552287.
    1. Szymanski DM, Gupta A. Examining the relationship between multiple internalized oppressions and African American lesbian, gay, bisexual, and questioning persons' self-esteem and psychological distress. J Couns Psychol. 2009;56(1):110–118.
    1. Corrigan PW, Larson JE, Hautamaki J, Matthews A, Kuwabara S, Rafacz J, Walton J, Wassel A, O'Shaughnessy J. What lessons do coming out as gay men or lesbians have for people stigmatized by mental illness? Community Ment Health J. 2009 Oct;45(5):366–74. doi: 10.1007/s10597-009-9187-6.
    1. Russell ST, Seif H, Truong NL. School outcomes of sexual minority youth in the United States: evidence from a national study. J Adolesc. 2001 Feb;24(1):111–27. doi: 10.1006/jado.2000.0365.
    1. Murdock TB, Bolch MB. Risk and protective factors for poor school adjustment in lesbian, gay, and bisexual (lgb) high school youth: variable and person-centered analyses. Psychol Schools. 2005 Feb;42(2):159–172.
    1. Pilkington NW, D'Augelli AR. Victimization of lesbian, gay, and bisexual youth in community settings. J Community Psychol. 1995;23(1):34–56. doi: 10.1002/1520-6629(199501)199523:199501<199534::AID-JCOP2290230105>;2290230102-N.
    1. Saewyc EM, Bauer GR, Skay CL, Bearinger LH, Resnick MD, Reis E, Murphy A. Measuring sexual orientation in adolescent health surveys: evaluation of eight school-based surveys. J Adolesc Health. 2004 Oct;35(4):345.e1–15.
    1. Glover JA, Galliher RV, Lamere TG. Identity development and exploration among sexual minority adolescents: examination of a multidimensional model. J Homosex. 2009;56(1):77–101. doi: 10.1080/00918360802551555.
    1. Havighurst RJ. Developmental Tasks and Education. 2nd ed. New York: Longmans, Green; 1952.
    1. Slife BD, Weaver CA. Depression, cognitive skill, and metacognitive skill in problem solving. Cognition & Emotion. 1992 Jan;6(1):1–22. doi: 10.1080/02699939208411055.
    1. Eich E, Macaulay D. Are real moods required to reveal mood-congruent and mood-dependent memory? Psychol Sci. 2000 May;11(3):244–8.
    1. Mustanski B, Johnson AK, Garofalo R, Ryan D, Birkett M. Perceived likelihood of using HIV pre-exposure prophylaxis medications among young men who have sex with men. AIDS Behav. 2013 Jul;17(6):2173–9. doi: 10.1007/s10461-012-0359-y.
    1. Heckathorn DD. Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems. 1997 May;44(2):174–199. doi: 10.2307/3096941.
    1. Scourfield J, Roen K, McDermott L. Lesbian, gay, bisexual and transgender young people's experiences of distress: resilience, ambivalence and self-destructive behaviour. Health Soc Care Community. 2008 May;16(3):329–36. doi: 10.1111/j.1365-2524.2008.00769.x.
    1. Patrick K, Intille SS, Zabinski MF. An ecological framework for cancer communication: implications for research. J Med Internet Res. 2005 Jul 1;7(3):e23. doi: 10.2196/jmir.7.3.e23.
    1. Clark RC. Four architectures of instruction. Performance Improvement. 2000 Nov;39(10):31–38. doi: 10.1002/pfi.4140391011.
    1. Najavits L. Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: The Guilford Press; 2002.
    1. Linehan M. Skills training manual for treating borderline personality disorder. New York: Guilford Press; 1993.
    1. Mohr DC, Cuijpers P, Lehman K. Supportive accountability: a model for providing human support to enhance adherence to eHealth interventions. J Med Internet Res. 2011;13(1):e30. doi: 10.2196/jmir.1602.
    1. Mohr DC, Duffecy J, Jin L, Ludman EJ, Lewis A, Begale M, McCarthy M. Multimodal e-mental health treatment for depression: a feasibility trial. J Med Internet Res. 2010;12(5):e48. doi: 10.2196/jmir.1370.
    1. Miller WR, Rollnick S. Motivational Interviewing, Second Edition: Preparing People for Change. New York: The Guilford Press; 2002.
    1. Hankivsky O. Women's health, men's health, and gender and health: implications of intersectionality. Soc Sci Med. 2012 Jun;74(11):1712–20. doi: 10.1016/j.socscimed.2011.11.029.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit