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

Stephanie Craig Rushing, Allyson Kelley, Sheana Bull, David Stephens, Julia Wrobel, Joshva Silvasstar, Roger Peterson, Corey Begay, Thomas Ghost Dog, Celena McCray, Danica Love Brown, Morgan Thomas, Colbie Caughlan, Michelle Singer, Paige Smith, Kanku Sumbundu, Stephanie Craig Rushing, Allyson Kelley, Sheana Bull, David Stephens, Julia Wrobel, Joshva Silvasstar, Roger Peterson, Corey Begay, Thomas Ghost Dog, Celena McCray, Danica Love Brown, Morgan Thomas, Colbie Caughlan, Michelle Singer, Paige Smith, Kanku Sumbundu

Abstract

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://ichgcp.net/clinical-trials-registry/NCT04979481.

Keywords: Alaska Native; American Indian; Indian health; adolescent; help-seeking skills, text messaging; mHealth, behavioral intervention; mental health; mobile phone.

Conflict of interest statement

Conflicts of Interest: Authors SCR, DS, RP, CB, TGD, CM, DLB, MT, CC, MS, and PS are employees of Northwest Portland Area Indian Health Board, which developed the BRAVE intervention.

©Stephanie Craig Rushing, Allyson Kelley, Sheana Bull, David Stephens, Julia Wrobel, Joshva Silvasstar, Roger Peterson, Corey Begay, Thomas Ghost Dog, Celena McCray, Danica Love Brown, Morgan Thomas, Colbie Caughlan, Michelle Singer, Paige Smith, Kanku Sumbundu. Originally published in JMIR Mental Health (https://mental.jmir.org), 15.09.2021.

Figures

Figure 1
Figure 1
Participant recruitment and retention flow chart. AI/AN: American Indian and Alaska Native; STEM: science, technology, engineering, and math.
Figure 2
Figure 2
Map of the number of study participants by state in the United States.

References

    1. American Indian and Alaska Native Alone or in Combination With One or More Races, 2013-2018 American Community Survey 5-year Estimates (B02010) United States Census Bureau. 2013. [2020-11-20]. .
    1. National Academies of Sciences, Engineering, and Medicine . Advancing Health Equity for Native American Youth. Washington, USA: The National Academies Press; 2016.
    1. Gone JP, Trimble JE. American Indian and Alaska Native mental health: diverse perspectives on enduring disparities. Annu Rev Clin Psychol. 2012;8:131–60. doi: 10.1146/annurev-clinpsy-032511-143127.
    1. Strickland CJ, Walsh E, Cooper M. Healing fractured families: parents' and elders' perspectives on the impact of colonization and youth suicide prevention in a pacific northwest American Indian tribe. J Transcult Nurs. 2006 Jan;17(1):5–12. doi: 10.1177/1043659605281982.17/1/5
    1. Kelley A, Small C. Documenting resiliency of American Indian youth: preliminary results from native PRIDE’s intergenerational connections project. J Indig Stud. 2020;8:5. doi: 10.26077/88kd-n107.
    1. Rushing SC, Stephens D. Use of media technologies by Native American teens and young adults in the Pacific Northwest: exploring their utility for designing culturally appropriate technology-based health interventions. J Prim Prev. 2011 Aug;32(3-4):135–45. doi: 10.1007/s10935-011-0242-z.
    1. Around Him D, Weilin Li, Gross E, Warren J, DeMand A, Garcia-Baza I, Habteselasse S. Twitter Analysis Can Help Practitioners, Policymakers, and Researchers Better Understand Topics Relevant to American Indian/Alaska Native Youth. Child Trends. [2020-11-20]. .
    1. Around HD, Weilin L, Gross E, Warren J, DeMand A, Garcia-Baza I, Habteselasse S. Twitter Analysis Can Help Practitioners, Policymakers, and Researchers Better Understand Topics Relevant to American Indian/Alaska Native Youth. Child Trends. 2020. [2020-11-20]. .
    1. Reed N, Craig RS. Youth Health Tech Surveys. Healthy Native Youth. 2020. [2021-02-25]. .
    1. Gurol-Urganci I, de Jongh T, Vodopivec-Jamsek V, Atun R, Car J. Mobile phone messaging reminders for attendance at healthcare appointments. Cochrane Database Syst Rev. 2013 Dec 5;(12):CD007458. doi: 10.1002/14651858.CD007458.pub3.
    1. de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007459. doi: 10.1002/14651858.CD007459.pub2.
    1. Vodopivec-Jamsek V, de Jongh T, Gurol-Urganci I, Atun R, Car J. Mobile phone messaging for preventive health care. Cochrane Database Syst Rev. 2012 Dec 12;12:CD007457. doi: 10.1002/14651858.CD007457.pub2.
    1. Head KJ, Noar SM, Iannarino NT, Harrington NG. Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Soc Sci Med. 2013 Nov;97:41–8. doi: 10.1016/j.socscimed.2013.08.003.S0277-9536(13)00447-4
    1. Craig Rushing S, Gaston A, Kaufman CE, Markham C, Jessen C, Gorman G, Koogei Revels T. Using Technology to Promote Health and Wellbeing among American Indian and Alaska Native Teens and Young Adults. In: Dyson LE, Grant S, Hendriks M, editors. Indigenous People and Mobile Technologies. New York, NY: Routledge; 2015. pp. 163–178.
    1. Schnall R, Rojas M, Bakken S, Brown W, Carballo-Dieguez A, Carry M, Gelaude D, Mosley JP, Travers J. A user-centered model for designing consumer mobile health (mHealth) applications (apps) J Biomed Inform. 2016 Apr;60:243–51. doi: 10.1016/j.jbi.2016.02.002. S1532-0464(16)00024-1
    1. Kaufman CE, Schwinn TM, Black K, Keane EM, Big Crow CK. The Promise of Technology to Advance Rigorous Evaluation of Adolescent Pregnancy Prevention Programs in American Indian and Alaska Native Tribal Communities. Am J Public Health. 2016 Sep;106(S1):S18–S20. doi: 10.2105/AJPH.2016.303335.
    1. Craig Rushing Stephanie, Kelley Allyson, Hafner Stephen, Stephens David, Singer Michelle, Bingham Dyani, Caughlan Colbie, Fatupaito Bethany, Gaston Amanda, Ghost Dog Thomas, Smith Paige, Love Brown Danica, McCray Celena. The BRAVE Study: Formative Research to Design a Multimedia Intervention for American Indian and Alaska Native Young Adults. Am Indian Alsk Native Ment Health Res. 2021;28(1):71–102. doi: 10.5820/aian.2801.2021.71.
    1. Fisher P, Ball T. Tribal participatory research: mechanisms of a collaborative model. Am J Community Psychol. 2003 Dec;32(3-4):207–16. doi: 10.1023/b:ajcp.0000004742.39858.c5.
    1. Freedland KE, Mohr DC, Davidson KW, Schwartz JE. Usual and unusual care: existing practice control groups in randomized controlled trials of behavioral interventions. Psychosom Med. 2011 May;73(4):323–35. doi: 10.1097/PSY.0b013e318218e1fb. PSY.0b013e318218e1fb
    1. Stephens D, Peterson R, Singer M, Johnson J, Rushing S, Kelley A. Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-Seeking Intervention: Lessons Learned from the BRAVE Study. Int J Environ Res Public Health. 2020 Dec 16;17(24):12. doi: 10.3390/ijerph17249437. ijerph17249437
    1. Qualtrics 2020. Qualtrics. [2020-11-20].
    1. Grunbaum J, Kann L, Kinchen S, Williams B, Ross J, Lowry R, Kolbe L. Youth risk behavior surveillance--United States, 2001. J Sch Health. 2002 Oct;72(8):313–28. doi: 10.1111/j.1746-1561.2002.tb07917.x.
    1. Hernandez B, Vigna J, Kelley Mary L. The Youth Coping Responses Inventory: development and initial validation. J Clin Psychol. 2010 Sep;66(9):1008–25. doi: 10.1002/jclp.20697.
    1. Ungar M, Liebenberg L. Assessing Resilience Across Cultures Using Mixed Methods: Construction of the Child and Youth Resilience Measure. Journal of Mixed Methods Research. 2011 Apr;5(2):126–149. doi: 10.1177/1558689811400607.
    1. Bandura A. Self-efficacy beliefs of adolescents. Charlotte: Information Age Publishing; 2006. Guide for constructing self-efficacy scales; pp. 307–37.
    1. Dauphinais P, LaFromboise T, Rowe W. Perceived problems and sources of help for American Indian Students. Counselor Education and Supervision. 1980;20:37–44.
    1. Rosenberg M. Princeton University Press. Princeton: Princeton University Press; 1965. Society the adolescent self-image; pp. 1–326.
    1. Donovan D, Thomas L, Sigo R, Price L, Lonczak H, Lawrence N, Ahvakana K, Austin L, Lawrence A, Price J, Purser A, Bagley Lenora. Am Indian Alsk Native Ment Health Res. Healing of the Canoe: Preliminary results of a culturally grounded intervention to prevent substance abuse and promote tribal identity for Native youth in two Pacific Northwest tribe. Am Indian Alsk Native Ment Health Res (Online); 2015. Healing of the canoe: preliminary results of a culturally tailored intervention to prevent substance abuse and promote tribal identity for Native youth in two Pacific Northwest tribes; pp. 42–76.
    1. SAS. [2020-12-25]. .
    1. The R Project for Statistical Computing. [2020-12-23].
    1. Stevens S, Andrade R, Page M. Motivating Young Native American Students to Pursue STEM Learning Through a Culturally Relevant Science Program. J Sci Educ Technol. 2016 Jun 6;25(6):947–960. doi: 10.1007/s10956-016-9629-1.
    1. Brown RA, Dickerson DL, D'Amico EJ. Cultural Identity Among Urban American Indian/Alaska Native Youth: Implications for Alcohol and Drug Use. Prev Sci. 2016 Oct;17(7):852–61. doi: 10.1007/s11121-016-0680-1. 10.1007/s11121-016-0680-1
    1. Elmquist DL, McLaughlin CL. Social Media Use Among Adolescents Coping with Mental Health. Contemp School Psychol. 2017 Nov 16;22(4):503–511. doi: 10.1007/s40688-017-0167-5.
    1. Gulliver A, Griffiths KM, Christensen H, Brewer JL. A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC Psychiatry. 2012 Jul 16;12:81. doi: 10.1186/1471-244X-12-81. 1471-244X-12-81
    1. BRAVE Users Guide. Healthy Native Youth. [2021-02-24].

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner