Efficacy and Impact of an mHealth Intervention to promote Mental Wellness for American Indian and Alaska Native Teens and Young Adults: A Randomized Controlled Trial of the BRAVE Study (Preprint)

2020 ◽  
Author(s):  
Stephanie Craig Rushing ◽  
Allyson Kelley ◽  
Sheana Bull ◽  
David Stephens ◽  
Julia Wrobel ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Young Adults ◽  
Alaska Native ◽  
Help Seeking ◽  
Culturally Relevant ◽  
Controlled Trial ◽  
Text Message ◽  
Text Messages ◽  
Randomized Controlled ◽  
Mental Wellness

BACKGROUND Culturally-relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teens and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. We R Native – a multimedia health resource for Native teens and young adults – designed an intervention for Native youth, delivered via text message, that includes role model videos, mental wellness strategies, and links to culturally-relevant resources (hotlines, chat-lines, websites, etc.) and social support. OBJECTIVE This study aims to test the efficacy of BRAVE to improve participant’s physical, mental, and spiritual health, their use of mental wellness strategies, their help-seeking skills, and associated factors, including cultural resilience, identity, and cultural pride. METHODS The randomized controlled trial was carried out by the Northwest Portland Area Indian Health Board and the mHealth Impact Lab. The team recruited 2,334 AI/AN teens and young adults nationwide (15-24 years old) via social media channels and text message and enrolled 1,044 to participate. AI/AN teens and young adults enrolled in the study received either: 8 weeks of BRAVE text messages designed to improve mental health, help-seeking skills, and cultural resilience; or 8 weeks of STEM text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine (STEM); and then received the other set of messages. Primary and secondary outcomes were tested using linear mixed-effect models and linear regressions. RESULTS A total of 833 AI/AN teens 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 primary outcomes except cultural identity and help seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.027), positive coping (P<.001), self-efficacy (P=.021), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant for those exhibiting risky behavior at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average, but no difference in risky drug and alcohol use (P<.001). The number of participants that used text messages to help themselves increased from 69% at 3-months (427/618) to 75% at 8-months (381/501) (P<.001). Similarly, the number of participants that used text messages to help a friend or family member increased from 22% at 3-months (138/616) to 55% at 8-months (272/498). CONCLUSIONS This is the first nationwide randomized controlled trial for AI/AN teens and young adults to test the efficacy of an mHealth intervention on mental wellness. The findings suggest that culturally-relevant multimedia, mHealth interventions can improve help-seeking behavior. Lessons learned from this study may help other AI/AN-serving organizations, prevention programs, policymakers, researchers, and educators as they support the next generation of AI/AN change-makers.

scholarly journals Effect of automated messaging on oral hygiene in adolescent orthodontic patients: A randomized controlled trial

2018 ◽  
Vol 89 (2) ◽  
pp. 262-267 ◽  
Author(s):  
Mike C. Ross ◽  
Phillip M. Campbell ◽  
Larry P. Tadlock ◽  
Reginald W. Taylor ◽  
Peter H. Buschang
Keyword(s):  
Randomized Controlled Trial ◽  
Oral Hygiene ◽  
Treatment Time ◽  
Controlled Trial ◽  
Text Message ◽  
Text Messages ◽  
Randomized Controlled ◽  
Prospective Randomized Controlled Trial ◽  
Orthodontic Patients ◽  
Hygiene Compliance

ABSTRACTObjective:To determine whether automated text messages sent daily to adolescent orthodontic patients improves oral hygiene more than weekly reminders.Materials and Methods:A blinded, prospective, randomized controlled trial was designed to evaluate the effects of automated messages on oral hygiene. Subjects were recruited from patients undergoing orthodontic treatment at the Texas A&M University College of Dentistry, Department of Orthodontics. They were being treated with a variety of fixed full appliances in both arches. Subjects were randomly assigned to either a once-a-week text message group or a daily text message group. There were 52 females and 27 males who were 12 to 17 years of age. Oral hygiene was measured at the beginning of the study and again 8.6 ± 0.9 weeks later.Results:The daily reminder group (N = 42) had significantly greater improvements in oral hygiene compliance than the weekly reminder group (N = 37). The daily score decreases were 48%, 21% and 19% for the bleeding index (BI), plaque index (PI), and gingival index (GI), respectively. The weekly score decreases were 27%, 14% and 13% for the BI, PI, and GI. There were no sex differences in hygiene changes during the study. The 42% of patients who completed the survey at the end of the study wanted more frequent messages and reported that messages related to decreasing treatment time were the most effective, while those related to oral hygiene were the least effective.Conclusions:Daily text messages are more effective at improving oral hygiene than weekly text messages.

scholarly journals Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Chia-Lei Lin ◽  
Nila Mistry ◽  
Jordana Boneh ◽  
Hong Li ◽  
Rina Lazebnik
Keyword(s):  
Randomized Controlled Trial ◽  
African American ◽  
Controlled Trial ◽  
Intervention Group ◽  
Text Message ◽  
Text Messages ◽  
Pediatric Practice ◽  
Appointment Adherence ◽  
Randomized Controlled ◽  
Text Message Reminder

Background. High no-show rates can burden clinic productivity and affect patient care. Although multiple studies have shown that text messages improve appointment adherence, very little research has focused on low-income and predominantly African American populations in resident clinic settings. Objectives. To determine whether incorporating a text message reminder reduces the no-show rate at an urban, pediatric resident clinic. Methods. A randomized controlled trial was conducted at a tertiary level ambulatory pediatric practice between August 2014 and February 2015. Following a demographic survey, 170 patients were enrolled. Patients were randomized into control or intervention groups. All patients received the standard voice message appointment reminder, but the intervention group additionally received a text message reminder. The primary outcome was no-show rate. Results. 95.3% of the participants were African American, and the overall no-show rate was 30.8%. No-show rate was significantly lower in the intervention group (23.5%) than the control group (38.1%) representing a difference of 14.6% (p=0.04). No demographic factors were found to alter the association between no-show rate and text message intervention. Conclusions. Text message reminders effectively improve show rates at a resident pediatric practice with high no-show rates, representing a promising approach to improving appointment adherence.

scholarly journals Improving Calcium Knowledge and Intake in Young Adults Via Social Media and Text Messages: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Anika Rouf ◽  
Monica Nour ◽  
Margaret Allman-Farinelli
Keyword(s):  
Social Media ◽  
Randomized Controlled Trial ◽  
Young Adults ◽  
Calcium Intake ◽  
Text Messaging ◽  
Habit Formation ◽  
Controlled Trial ◽  
Text Messages ◽  
Control Group ◽  
Randomized Controlled

BACKGROUND Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterized as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth. OBJECTIVE The aim of the CAlcium Nutrition-Dietary Opportunities (CAN-DO) study was to conduct a randomized controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake. METHODS The intervention was a 3-arm parallel trial. Young adults aged 18 to 25 years were recruited through university and social media for a 6-week trial. Participants were randomized to 1 of the 3 arms (ie, Facebook posts, Facebook posts plus text messages, and control group that received an electronic leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods, and secondary outcomes were knowledge, self-efficacy, motivation, and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention, and the differences in change between groups were compared using multivariate regression models with multiple imputations for missing data. RESULTS A total of 211 participants (64/211, 30.3% males) participated (mean age 21.4 years, SD 2.1) in this study. At the end of the program, no increase in milk intake (odds ratio [OR] 1.51, 95% CI 0.61-3.75 Facebook; OR 1.77, 95% CI 0.74-4.24 Facebook plus text messages; <i>P</i>=.41) nor calcium-rich food was detected (<i>P</i>=.57). There was a significant improvement in knowledge in the Facebook plus text messages group (<i>P</i>&lt;.001), but habit formation improved less than that in the other 2 groups (<i>P</i>=.01). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants. CONCLUSIONS The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimize the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods. CLINICALTRIAL Australian New Zealand Clinical Trials Registry ACTRN12620000097943; http://www.anzctr.org.au/ACTRN12620000097943.aspx

scholarly journals The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial

10.2196/13065 ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. e13065 ◽  
Author(s):  
Long Khanh-Dao Le ◽  
Lena Sanci ◽  
Mary Lou Chatterton ◽  
Sylvia Kauer ◽  
Kerrie Buhagiar ◽  
...  
Keyword(s):  
Mental Health ◽  
Randomized Controlled Trial ◽  
Young Adults ◽  
Cost Effectiveness ◽  
Help Seeking ◽  
Controlled Trial ◽  
Internet Intervention ◽  
Randomized Controlled ◽  
The Cost

scholarly journals Improving Calcium Knowledge and Intake in Young Adults Via Social Media and Text Messages: Randomized Controlled Trial

10.2196/16499 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e16499
Author(s):  
Anika Rouf ◽  
Monica Nour ◽  
Margaret Allman-Farinelli
Keyword(s):  
Social Media ◽  
Randomized Controlled Trial ◽  
Young Adults ◽  
Calcium Intake ◽  
Text Messaging ◽  
Habit Formation ◽  
Controlled Trial ◽  
Text Messages ◽  
Control Group ◽  
Randomized Controlled

Background Calcium is an important nutrient for the attainment of peak bone mass during adolescence and young adulthood. However, these life phases are characterized as hard to reach for health promotion. Social media platforms offer a promising channel as they are relatively low cost but used ubiquitously by youth. Objective The aim of the CAlcium Nutrition-Dietary Opportunities (CAN-DO) study was to conduct a randomized controlled trial to test the effectiveness of Facebook alone or with text messaging as channels to deliver a theory-based program to encourage optimal calcium intake. Methods The intervention was a 3-arm parallel trial. Young adults aged 18 to 25 years were recruited through university and social media for a 6-week trial. Participants were randomized to 1 of the 3 arms (ie, Facebook posts, Facebook posts plus text messages, and control group that received an electronic leaflet containing information on calcium intake). The primary outcome was change in intake of milk and other calcium-rich foods, and secondary outcomes were knowledge, self-efficacy, motivation, and habit formation concerning calcium-rich foods. Changes were assessed before and after the intervention, and the differences in change between groups were compared using multivariate regression models with multiple imputations for missing data. Results A total of 211 participants (64/211, 30.3% males) participated (mean age 21.4 years, SD 2.1) in this study. At the end of the program, no increase in milk intake (odds ratio [OR] 1.51, 95% CI 0.61-3.75 Facebook; OR 1.77, 95% CI 0.74-4.24 Facebook plus text messages; P=.41) nor calcium-rich food was detected (P=.57). There was a significant improvement in knowledge in the Facebook plus text messages group (P<.001), but habit formation improved less than that in the other 2 groups (P=.01). Our results showed a moderate level of engagement with intervention content and positive qualitative feedback from participants. Conclusions The CAN-DO study delivered via Facebook (with the additional support of text messages) was found to improve knowledge and was acceptable among young adults. However, further research is needed to better understand social media engagement and how to optimize the program for participants to be sufficiently motivated to increase their intake of calcium-rich foods. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000097943; http://www.anzctr.org.au/ACTRN12620000097943.aspx

Patterns of User Engagement in the BRAVE Study (Preprint)

2021 ◽  
Author(s):  
Julia Wrobel ◽  
Joshva Silvasstar ◽  
Roger Peterson ◽  
Kanku Sumbundu ◽  
Allyson Kelley ◽  
...  
Keyword(s):  
Young Adults ◽  
Alaska Native ◽  
Help Seeking ◽  
Role Model ◽  
Text Message ◽  
Poor Mental Health ◽  
Text Messages ◽  
User Engagement ◽  
Mhealth Intervention ◽  
The Impact

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 for AI/AN youth. OBJECTIVE This study explored system data from the BRAVE intervention to determine patterns of user engagement. METHODS The BRAVE study included 1,030 AI/AN teens and young adults nationwide (15-24 years old). The message series in the BRAVE and STEM study arms included 3–5 text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons, a mobile messaging provider that supports text, picture, and video SMS. This study utilized two sets of data. The first dataset included 23,004 records of messages sent teens and young adults and 874 records of messages clicked with time stamp and content. The second dataset was created by aggregating the clicks in the first dataset to calculate a total number of clicks for each user. RESULTS Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least one trackable click on a study text message. Of these, 68% were female (n = 184), 19% were male (n = 50), and 13% selected another gender category (n = 36). The average participant was 20.6 years-old, with a minimum and maximum of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2, mean 3.4), while others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing one of 7 role model videos), with 64.8% of total clicks coming from the role model videos, and earlier episodes seeing 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 one-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study 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. CLINICALTRIAL 1384639

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