Integrating Cultural Relevance into a Behavioral mHealth Intervention for Native American Youth

Morgan Vigil-Hayes, Ann Futterman Collier, Shelby Hagemann, Giovanni Castillo, Keller Mikkelson, Joshua Dingman, Andrew Muñoz, Jade Luther, Alexandra McLaughlin, Morgan Vigil-Hayes, Ann Futterman Collier, Shelby Hagemann, Giovanni Castillo, Keller Mikkelson, Joshua Dingman, Andrew Muñoz, Jade Luther, Alexandra McLaughlin

Abstract

Native American communities are disproportionately affected by a number of behavioral health disparities, including higher rates of depression, substance abuse, and suicide. As mobile health (mHealth) interventions gain traction as methods for addressing these disparities, they continue to lack relevance to Native American youth. In an effort to explore the design of relevant behavioral mHealth intervention for Native American communities, we have developed ARORA (Amplifying Resilience Over Restricted Internet Access), a prototype behavioral mHealth intervention that has been co-designed with Native American youth, a community advisory board, and a clinical psychologist. In this paper, we qualitatively analyze our co-design and focus group sessions using a grounded theory approach and identify the key themes that Native American community members have identified as being critical components of relevant mHealth designs. Notably, we find that the Native American youth who participated in our focus groups desired a greater level of didactic interaction with cultural and behavioral health elements. We conclude with a discussion of the significant challenges we faced in our efforts to co-design software with Native American stakeholders and provide recommendations that might guide other HCI researchers and designers through challenges that arise during the process of cross-cultural design.

Keywords: Native American; Participatory design; Ubiquitous and mobile devices; behavioral health; mHealth; rural computing; • Human-centered computing → User centered design.

Figures

Figure 1.
Figure 1.
Demographic data for (a) areas in which participants live and (b) participants’ counseling experience.
Figure 2.
Figure 2.
Flowchart of ARORA user activities.
Figure 3.
Figure 3.
Mood survey screen used to collect data from users adapted from the Affect Balance Scale [9]. ©Duane Koyawena.
Figure 4.
Figure 4.
Screenshots of (a) M1, (b) M2, and (c) M3 Mindfulness Learning Activities. We note that the butterfly in M1 is a less stylized butterfly than what is presented in the mood survey home screen (Figure 3) because we wanted to explore users’ reactions to visuals had more generic designs and visuals with culturally grounded designs.
Figure 5.
Figure 5.
Participant drawings suggested customizable main menus they would like to see. Depicted scenes focused on nature, including (a) fire theme, (b) galaxy theme, (c) windy meadow theme, and (d) sunset theme.

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