Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns

Julia Wrobel, Joshva Silvasstar, Roger Peterson, Kanku Sumbundu, Allyson Kelley, David Stephens, Stephanie Craig Rushing, Sheana Bull, Julia Wrobel, Joshva Silvasstar, Roger Peterson, Kanku Sumbundu, Allyson Kelley, David Stephens, Stephanie Craig Rushing, Sheana Bull

Abstract

Background: Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE 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: The aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content.

Methods: The BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS.

Results: Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each 1-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study content clicks.

Conclusions: This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants.

Trial registration: ClinicalTrials.gov NCT04979481; https://ichgcp.net/clinical-trials-registry/NCT04979481.

Keywords: Alaska Native; American Indian; adolescent; engagement; feasibility; help-seeking skills, text messaging; intervention; low-touch; mHealth, behavioral intervention; mental health; user engagement.

Conflict of interest statement

Conflicts of Interest: Authors JW, JS, KS, and SB are employees of the University of Colorado co-led the BRAVE intervention. RP, DS, and SCR are employees of the NPAIHB, which developed the BRAVE intervention.

©Julia Wrobel, Joshva Silvasstar, Roger Peterson, Kanku Sumbundu, Allyson Kelley, David Stephens, Stephanie Craig Rushing, Sheana Bull. Originally published in JMIR Formative Research (https://formative.jmir.org), 25.02.2022.

Figures

Figure 1
Figure 1
Flowchart summarizing participant recruitment and randomization.
Figure 2
Figure 2
Total clicks by hour and weekday.
Figure 3
Figure 3
Scatter plots of the composite score at baseline for each efficacy measure against the number of clicks.

References

    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. Anderson RN. Deaths: leading causes for 2000. Natl Vital Stat Rep. 2002 Sep 16;50(16):1–85.
    1. Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999 Jul;56(7):617–26. doi: 10.1001/archpsyc.56.7.617.
    1. Womble A. Teen life, interrupted. Crisis Text Line. [2021-06-01].
    1. 2018 state of Native youth report: generation Indigenous. Center for Native American Youth. 2018. [2022-01-06]. .
    1. Subica AM, Wu L. Substance use and suicide in Pacific Islander, American Indian, and multiracial youth. Am J Prev Med. 2018 Jun;54(6):795–805. doi: 10.1016/j.amepre.2018.02.003. S0749-3797(18)30076-X
    1. Wexler L, Chandler M, Gone JP, Cwik M, Kirmayer LJ, LaFromboise T, Brockie T, O’Keefe V, Walkup J, Allen J. Advancing suicide prevention research With rural American Indian and Alaska Native populations. Am J Public Health. 2015 May;105(5):891–899. doi: 10.2105/ajph.2014.302517.
    1. Bartgis J, Albright G. Online role-play simulations with emotionally responsive avatars for the early detection of Native youth psychological distress, including depression and suicidal ideation. Am Indian Alsk Native Ment Health Res. 2016;23(2):1–27. doi: 10.5820/aian.2302.2016.1.
    1. Center for American Indian Health Culture forward: a strengths and culture based tool to protect our Native youth from suicide. Center for American Indian Health. [2021-06-01]. .
    1. Kannisto Kati Anneli, Koivunen Marita Hannele, Välimäki Maritta Anneli. Use of mobile phone text message reminders in health care services: a narrative literature review. J Med Internet Res. 2014 Oct 17;16(10):e222. doi: 10.2196/jmir.3442. v16i10e222
    1. Devine S, Bull S, Dreisbach S, Shlay J. Enhancing a teen pregnancy prevention program with text messaging: engaging minority youth to develop TOP ® Plus Text. J Adolesc Health. 2014 Mar;54(3 Suppl):S78–83. doi: 10.1016/j.jadohealth.2013.12.005. S1054-139X(13)00799-4
    1. Psihogios AM, Li Y, Butler E, Hamilton J, Daniel LC, Barakat LP, Bonafide CP, Schwartz LA. Text message responsivity in a 2-way short message service pilot intervention With adolescent and young adult survivors of cancer. JMIR Mhealth Uhealth. 2019 Apr 18;7(4):e12547. doi: 10.2196/12547. v7i4e12547
    1. Head KJ, Noar SM, Iannarino NT, Grant HN. 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. Short CE, DeSmet A, Woods C, Williams SL, Maher C, Middelweerd A, Müller AM, Wark PA, Vandelanotte C, Poppe L, Hingle MD, Crutzen R. Measuring engagement in eHealth and mHealth behavior change interventions: viewpoint of methodologies. J Med Internet Res. 2018 Nov 16;20(11):e292. doi: 10.2196/jmir.9397. v20i11e292
    1. McVay MA, Bennett GG, Steinberg D, Voils CI. Dose-response research in digital health interventions: concepts, considerations, and challenges. Health Psychol. 2019 Dec;38(12):1168–1174. doi: 10.1037/hea0000805. 2019-58555-001
    1. Evans W, Nielsen PE, Szekely DR, Bihm JW, Murray EA, Snider J, Abroms LC. Dose-response effects of the text4baby mobile health program: randomized controlled trial. JMIR Mhealth Uhealth. 2015;3(1):e12. doi: 10.2196/mhealth.3909. v3i1e12
    1. Perski O, Blandford A, West R, Michie S. Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Transl Behav Med. 2017 Jun;7(2):254–267. doi: 10.1007/s13142-016-0453-1. 10.1007/s13142-016-0453-1
    1. Vandelanotte C, Müller AM, Short CE, Hingle M, Nathan N, Williams SL, Lopez ML, Parekh S, Maher CA. Past, present, and future of eHealth and mHealth research to improve physical activity and dietary behaviors. J Nutr Educ Behav. 2016 Mar;48(3):219–228.e1. doi: 10.1016/j.jneb.2015.12.006.S1499-4046(15)00806-4
    1. Michie S, Yardley L, West R, Patrick K, Greaves F. Developing and evaluating digital interventions to promote behavior change in health and health care: recommendations resulting From an international workshop. J Med Internet Res. 2017 Jun 29;19(6):e232. doi: 10.2196/jmir.7126. v19i6e232
    1. Kelders SM, Kok RN, Ossebaard HC, Van Gemert-Pijnen JE. Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res. 2012 Nov 14;14(6):e152. doi: 10.2196/jmir.2104. v14i6e152
    1. Devine S, Leeds C, Shlay JC, Leytem A, Beum R, Bull S. Methods to assess youth engagement in a text messaging supplement to an effective teen pregnancy program. J Biomed Inform. 2015 Aug;56:379–86. doi: 10.1016/j.jbi.2015.07.003. S1532-0464(15)00143-4
    1. Bull S, Schmiege S, Hammes A, Devine S, Gutierrez Y, Shlay J. Measurement and impacts of engagement with a text message program on pregnancy prevention among youth. In: Moreno M, Hoopes A, editors. Technology and Adolescent Health: In Schools and Beyond. Amsterdam, the Netherlands: Elsevier; 2020.
    1. Craig Rushing S, Kelley A, Bull S, Stephens D, Wrobel J, Silvasstar J, Peterson R, Begay C, Ghost Dog T, McCray C, Love Brown D, Thomas M, Caughlan C, Singer M, Smith P, Sumbundu S. Efficacy of an mHealth intervention (BRAVE) to promote mental wellness for American Indian and Alaska Native teenagers and young adults: randomized controlled trial. JMIR Ment Health. 2021 Sep 15;8(9):e26158. doi: 10.2196/26158. v8i9e26158
    1. Stephens D, Peterson R, Singer M, Johnson J, Rushing SC, 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):9437. doi: 10.3390/ijerph17249437. ijerph17249437
    1. SMS marketing software and API that drives action. Upland.
    1. Donovan D, Thomas L, Sigo R, Price L, Lonczak H, Lawrence N, Ahvakana K, Austin L, Lawrence A, Price J, Purser A, Bagley L. 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. Am Indian Alsk Native Ment Health Res. 2015;22(1):42–76. doi: 10.5820/aian.2201.2015.42.
    1. Grunbaum J, Kann L, Kinchen S, Williams B, Ross J, Lowry R, Kolbe L. Youth risk behavior surveillance--United States, 2001. MMWR Surveill Summ. 2002 Jun 28;51(4):1–62.
    1. Hernandez B, Vigna J, Kelley ML. 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. J Mix Methods Res. 2011 Apr;5(2):126–149. doi: 10.1177/1558689811400607.
    1. Bandura A. Guide for constructing self-efficacy scales. In: Pajares F, Urban T, editors. Self-Efficacy Beliefs of Adolescents. Charlotte, NC: Information Age Publishing; 2006. pp. 307–37.
    1. Dauphinais P, LaFromboise T, Rowe W. Perceived problems and sources of help for American Indian Students. CES. 1980;20(1):37–44. doi: 10.1002/j.1556-6978.1980.tb02030.x.
    1. Rosenberg M. Society and the Adolescent Self-Image. Princeton, NJ: Princeton University Press; 1965. pp. 1–326.
    1. R-Project.
    1. Hobson GR, Caffery LJ, Neuhaus M, Langbecker DH. Mobile health for First Nations populations: systematic review. JMIR Mhealth Uhealth. 2019 Oct 07;7(10):e14877. doi: 10.2196/14877. v7i10e14877
    1. Tomayko EJ, Webber EJ, Cronin KA, Prince RJ, Adams AK. Use of text messaging and Facebook groups to support the Healthy Children, Strong Families 2 healthy lifestyle intervention for American Indian families. Curr Dev Nutr. 2021 Jun;5(Suppl 4):32–39. doi: 10.1093/cdn/nzaa110. nzaa110
    1. Donkin L, Hickie IB, Christensen H, Naismith SL, Neal B, Cockayne NL, Glozier N. Rethinking the dose-response relationship between usage and outcome in an online intervention for depression: randomized controlled trial. J Med Internet Res. 2013 Oct 17;15(10):e231. doi: 10.2196/jmir.2771. v15i10e231
    1. Mohammed A, Acheampong PR, Otupiri E, Osei FA, Larson-Reindorf R, Owusu-Dabo E. Mobile phone short message service (SMS) as a malaria control tool: a quasi-experimental study. BMC Public Health. 2019 Aug 29;19(1):1193. doi: 10.1186/s12889-019-7336-6. 10.1186/s12889-019-7336-6
    1. Linde D, Korsholm M, Katanga J, Rasch V, Lundh A, Andersen MS. One-way SMS and healthcare outcomes in Africa: systematic review of randomised trials with meta-analysis. PLoS One. 2019;14(6):e0217485. doi: 10.1371/journal.pone.0217485. PONE-D-18-35958
    1. Twilio. Twilio. 2021.
    1. Messenger.
    1. Whittaker R, Matoff-Stepp S, Meehan J, Kendrick J, Jordan E, Stange P, Cash A, Meyer P, Baitty J, Johnson P, Ratzan S, Rhee K. Text4baby: development and implementation of a national text messaging health information service. Am J Public Health. 2012 Dec;102(12):2207–13. doi: 10.2105/AJPH.2012.300736.
    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 05;(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.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться