2017 Code for the Mission
Service: Apps for a More Livable LA
Depression is anticipated to be the second leading cause of disability worldwide by 2020. Moreover, it is a particularly challenging issue to address in under-resourced communities of color, where depression is common and often goes untreated because evidence-based interventions, such as Cognitive-Behavioral Therapy (CBT), are often not available or services may not be trusted in such communities. Partnered research approaches have been shown to be effective for addressing disparities in health service use and research participation in under-resourced communities by fostering respect and trust development through two-way knowledge exchange. Concurrently, mobile health interventions have opened new avenues for delivering health care services while addressing disparities, yet they often have substantial financial and resource constraints that limit their implementation. Identifying low-cost, effective mobile health interventions to support depression self-management offers much promise for reducing disparities and improving depression outcomes in under-resourced communities. We developed a resiliency-based mobile intervention for depression self-management (B-RESILIENT) created using the Community-Partnered Participatory Approach. The B-RESILIENT texting intervention was born out of community and patient partners’ requests to increase the availability of coping resources used in Building Resiliency in Communities for Health (B-RICH)--a manualized, 7-week class led by lay health workers to introduce CBT concepts--that emerged as a key innovation in Community Partners in Care (CPIC). Consistent with tracking and building on community input and engagement in interventions, the present study uses the same community engagement approach to expand access and availability to core coping and symptom self-management resources as well as information on and encouragement to receive needed services, through a mobile platform (Chorus). Chorus (developed by Armen Arevian) applies Community-Partnered Participatory Research (CPPR) principles to enable Participatory Technology Development in which engaged stakeholders create mobile apps (such as text messaging, interactive voice and smartphone web-apps) during workgroups and then test/deploy their apps in real-time. Importantly, this process enables a shift in the locus of control for development and maintenance of mobile interventions to stakeholders directly, increasing the group’s ability to develop and maintain mobile interventions in the community more generally, while building trust and community capacity. Chorus is uniquely designed to facilitate participatory co-development of the mobile app with community partners and personalization of features by individual app users. These features are well-suited to engagement and development of trust in self-management tasks in under-resourced communities. Specifically, our B-RESILIENT intervention is a text-messaging application that introduces and reinforces principles of Cognitive-Behavioral Therapy (CBT) in order to support personal resiliency and reduce the risk for and impact of depressive symptoms and promote symptom self-management in response to multiple stressors in under-resourced communities of color. The B-RESILIENT intervention is a prime application of Participatory Technology Development; it involves both a text messaging-based mobile app and a community-partnered process to support tailoring of the app to specific community needs. In addition, the app development process promotes sustainable maintenance of the technology by stakeholders directly through Chorus, the participatory technology platform. We created a mobile web application in which participants followed-up on their experience with B-RESILIENT through surveys and also monitored their depression over one month to see the impact the B-RESILIENT app had.