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Morales A, Burnett-Zeigler I. A Scoping Review of Culturally Adapted Mindfulness-Based Interventions for Communities of Color. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024. [PMID: 39093941 DOI: 10.1089/jicm.2023.0807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Introduction: Mindfulness-based interventions (MBIs) are effective in improving mental health outcomes, including depression, anxiety, and post-traumatic stress disorder (PTSD). However, research on how MBIs have been tailored for racial and ethnic minoritized communities is limited. To address this gap, this scoping review utilizes the Ecological Validity Framework to systematically explore cultural adaptations in MBIs for communities of color. Concurrently, this review examines the effectiveness of culturally adapted MBIs. Methods: Following PRISMA guidelines, the authors conducted a search on MEDLINE, PsycINFO, and Embase databases from 2010 to 2023. Inclusion criteria required studies to be published in English, accessible in full-text, and peer-reviewed, focusing primarily on communities of color or diverse non-White populations (comprising 75% or more of the sample). Exclusion criteria were studies primarily centered on behavioral interventions other than MBIs, studies lacking primary outcomes, and studies not explicitly addressing cultural adaptations. Results: Search results identified 371 publications, 13 of which met the inclusion criteria. The most frequently reported cultural adaptations were surface-level adaptations, which can enhance the relevance of MBIs by modifying the language, content, format, or intervention delivery. MBIs with surface-level adaptations reported significant improvements in mental health outcomes, including depression, anxiety, and stress levels. Conclusion: Findings from this review indicate that culturally adapted MBIs for communities of color could potentially make them more relevant and acceptable. Surface-level and deep structure adaptations are both necessary to ensure MBIs are responsive, relevant, and sustainable across diverse contexts and populations.
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Affiliation(s)
- Anthony Morales
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Inger Burnett-Zeigler
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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McCarthy MJ, Wicker A, Roddy J, Remiker M, Roy I, McCoy M, Cerino ES, Baldwin J. Feasibility and utility of mobile health interventions for depression and anxiety in rural populations: A scoping review. Internet Interv 2024; 35:100724. [PMID: 38352194 PMCID: PMC10863305 DOI: 10.1016/j.invent.2024.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
Despite the potential of mobile health (mHealth) to address high rates of depression and anxiety in underserved rural communities, most mHealth interventions do not explicitly consider the realities of rural life. The aim of this scoping review is to identify and examine the available literature on mHealth interventions that consider the needs of rural populations in order to gauge their feasibility and utility for addressing depression and anxiety. Additionally, we provide an overview of rural users' perceptions about and preferences for mHealth-delivered mental health screening and intervention systems. Out of 169 articles identified, 16 met inclusion criteria. Studies were conducted across a wide range of countries, age groups, and rural subpopulations including individuals with bipolar disorder, anxiety, perinatal depression, PTSD, and chronic pain, as well as refugees, veterans, and transgender and LGBTQ+ individuals. All interventions were in the feasibility/acceptability testing stage for rural users. Identified strengths included their simplicity, accessibility, convenience, availability of support between sessions with providers, and remote access to a care team. Weaknesses included problems with charging phone batteries and exceeding data limits, privacy concerns, and general lack of comfort with app-based support. Based upon this review, we provide recommendations for future mHealth intervention development including the value of developer-user coproduction methods, the need to consider user variation in access to and comfort with smartphones, and potential data or connectivity limitations, mental health stigma, and confidentiality concerns in rural communities.
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Affiliation(s)
- Michael J. McCarthy
- Department of Social Work, Northern Arizona University, 19 W McConnell Dr., Flagstaff, AZ 86011, United States of America
| | - Alexandra Wicker
- Department of Psychological Sciences, Northern Arizona University, 1100 S Beaver St., Flagstaff, AZ 86011, United States of America
| | - Juliette Roddy
- Department of Criminology & Criminal Justice, Northern Arizona University, 5 E McConnell Dr., Flagstaff, AZ 86011, United States of America
| | - Mark Remiker
- Center for Health Equity Research, Northern Arizona University, 1395 Knoles Drive, Flagstaff, AZ 86011, United States of America
| | - Indrakshi Roy
- Center for Health Equity Research, Northern Arizona University, 1395 Knoles Drive, Flagstaff, AZ 86011, United States of America
| | - Megan McCoy
- Department of Social Work, Northern Arizona University, 19 W McConnell Dr., Flagstaff, AZ 86011, United States of America
| | - Eric S. Cerino
- Department of Psychological Sciences, Northern Arizona University, 1100 S Beaver St., Flagstaff, AZ 86011, United States of America
| | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, 1395 Knoles Drive, Flagstaff, AZ 86011, United States of America
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Shaw G, Castro BA, Gunn LH, Norris K, Thorpe RJ. The Association of eHealth Literacy Skills and mHealth Application Use Among US Adults With Obesity: Analysis of Health Information National Trends Survey Data. JMIR Mhealth Uhealth 2024; 12:e46656. [PMID: 38198196 PMCID: PMC10809169 DOI: 10.2196/46656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Physical inactivity and a poor diet are modifiable behaviors that contribute to obesity. Obesity is a well-recognized risk factor for chronic diseases, including diabetes. Mobile health (mHealth) apps can play an important adjuvant role in preventing and treating chronic diseases and promoting positive health behavior change among people with obesity, and eHealth literacy skills have the potential to impact mHealth app use. OBJECTIVE The purpose of this study was to explore the associations between the 2 dimensions, access and application, of eHealth literacy skills and mHealth app use among US adults (≥18 years of age) with obesity (BMI ≥30 kg/m2). METHODS Data were obtained from February to June 2020 using the Health Information National Trends Survey 5. A total of 1079 respondents met the inclusion criteria of adults with obesity and owners of smartphones. Individual associations between mHealth app use and sociodemographic variables were explored using weighted chi-square and 2-tailed t tests. A multivariable weighted logistic regression model was fitted, and adjusted odds ratios (ORs) of using mHealth apps with corresponding 95% CIs were reported across multiple sociodemographic variables. An Ising model-weighted network visualization was produced. A receiver operating characteristic curve was calculated, and the area under the curve was reported with the corresponding Delong 95% CI. RESULTS A majority of respondents were female (550/923, 59.6%) or non-Hispanic White (543/923, 58.8%). Individuals in households earning less than US $50,000 comprised 41.4% (382/923) of the sample. All sociodemographic variables were found to be univariately significant at the 5% level, except employment and region. Results from the multivariable weighted logistic regression model showed that the adjusted odds of using an mHealth app are 3.13 (95% CI 1.69-5.80) and 2.99 (95% CI 1.67-5.37) times higher among those with an access eHealth literacy skill of using an electronic device to look for health or medical information for themselves and an application eHealth literacy skill of using electronic communications with a doctor or doctor's office, respectively. Several sociodemographic variables were found to be significant, such as education, where adjusted ORs comparing subgroups to the lowest educational attainment were substantial (ORs ≥7.77). The network visualization demonstrated that all eHealth literacy skills and the mHealth app use variable were positively associated to varying degrees. CONCLUSIONS This work provides an initial understanding of mHealth app use and eHealth literacy skills among people with obesity, identifying people with obesity subpopulations who are at risk of a digital health divide. Future studies should identify equitable solutions for people with obesity (as well as other groups) and their use of mHealth apps.
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Affiliation(s)
- George Shaw
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Bianca A Castro
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Laura H Gunn
- Department of Public Health Sciences, School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Keith Norris
- The University of California Los Angeles Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, United States
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
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Saad F, Eisenstadt M, Liverpool S, Carlsson C, Vainieri I. Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review. JMIR Ment Health 2023; 10:e48991. [PMID: 38055315 PMCID: PMC10733819 DOI: 10.2196/48991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 10/14/2023] [Accepted: 10/21/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups. OBJECTIVE In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature. METHODS A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis. RESULTS A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues. CONCLUSIONS Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted.
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Affiliation(s)
- Fiby Saad
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, London, United Kingdom
| | - Mia Eisenstadt
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, London, United Kingdom
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Shaun Liverpool
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, London, United Kingdom
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
- Department of Social Work & Wellbeing, Edge Hill University, Faculty of Health, Social Care and Medicine, Ormskirk, United Kingdom
| | | | - Isabella Vainieri
- Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, London, United Kingdom
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, United Kingdom
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Eustis EH, LoPresti J, Aguilera A, Schueller SM. Cultural Responsivity in Technology-Enabled Services: Integrating Culture Into Technology and Service Components. J Med Internet Res 2023; 25:e45409. [PMID: 37788050 PMCID: PMC10582817 DOI: 10.2196/45409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Technology-enabled services (TESs) are clinical interventions that combine technological and human components to provide health services. TESs for mental health are efficacious in the treatment of anxiety and depression and are currently being offered as frontline treatments around the world. It is hoped that these interventions will be able to reach diverse populations across a range of identities and ultimately decrease disparities in mental health treatment. However, this hope is largely unrealized. TESs include both technology and human service components, and we argue that cultural responsivity must be considered in each of these components to help address existing treatment disparities. To date, there is limited guidance on how to consider cultural responsivity within these interventions, including specific targets for the development, tailoring, or design of the technologies and services within TESs. In response, we propose a framework that provides specific recommendations for targets based on existing models, both at the technological component level (informed by the Behavioral Intervention Technology Model) and the human support level (informed by the Efficiency Model of Support). We hope that integrating culturally responsive considerations into these existing models will facilitate increased attention to cultural responsivity within TESs to ensure they are ethical and responsive for everyone.
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Affiliation(s)
- Elizabeth H Eustis
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, United States
| | - Jessica LoPresti
- Department of Psychology, Suffolk University, Boston, MA, United States
| | - Adrian Aguilera
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Stephen M Schueller
- Department of Psychological Science, University of California Irvine, Irvine, CA, United States
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Jones G, Herrmann F, Nock MK. A Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety: A Multiple-Baseline Pilot Study. JMIR Form Res 2023; 7:e49284. [PMID: 37585252 PMCID: PMC10468709 DOI: 10.2196/49284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Race-based anxiety is a substantial health issue for the Black community. Although mindfulness interventions have demonstrated efficacy for alleviating anxiety, three central barriers prevent Black Americans from accessing existing mindfulness treatments: high costs, excessive time commitments, and limited cultural relevance. There is a need for novel mindfulness interventions for the Black community that can overcome these barriers. OBJECTIVE The goal of this web-based study was to examine the preliminary efficacy, feasibility, and acceptability of a novel digital music-based mindfulness intervention for middle-to-low-income Black Americans with elevated race-based anxiety. METHODS This study used a nonconcurrent multiple-baseline design (n=5). The intervention featured contributions from Lama Rod Owens (a world-renowned meditation teacher and LA Times best-selling author) and Terry Edmonds (the former chief speechwriter for President Bill Clinton). We examined the effect of the intervention on state anxiety and assessed its feasibility and acceptability using quantitative and qualitative measures. RESULTS Results revealed that administration of the intervention led to significant decreases in state anxiety (Tau-U range -0.75 to -0.38; P values<.001). Virtually all feasibility and acceptability metrics were high (ie, the average likelihood of recommending the intervention was 98 out of 100). CONCLUSIONS This study offers preliminary evidence that a digital music-based mindfulness intervention can decrease race-based anxiety in Black Americans. Future research is needed to replicate these results, test whether the intervention can elicit lasting changes in anxiety, assess mechanisms of change, and explore the efficacy of the intervention in real-world contexts.
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Affiliation(s)
- Grant Jones
- Harvard University, Cambridge, MA, United States
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Stiles-Shields C, Cummings C, Montague E, Plevinsky JM, Psihogios AM, Williams KDA. A Call to Action: Using and Extending Human-Centered Design Methodologies to Improve Mental and Behavioral Health Equity. Front Digit Health 2022; 4:848052. [PMID: 35547091 PMCID: PMC9081673 DOI: 10.3389/fdgth.2022.848052] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/28/2022] [Indexed: 12/24/2022] Open
Abstract
Mental health disparities directly tie to structural racism. Digital mental health (DMH), the use of technologies to deliver services, have been touted as a way to expand access to care and reduce disparities. However, many DMH fail to mitigate the persistent disparities associated with structural racism that impact delivery (e.g., costs, dependable internet access)-and may even exacerbate them. Human-centered design (HCD) may be uniquely poised to design and test interventions alongside, rather than "for," marginalized individuals. In employing HCD methodologies, developers may proceed with a vested interest in understanding and establishing empathy with users and their needs, behaviors, environments, and constraints. As such, HCD used to mindfully address structural racism in behavioral health care may address shortcomings of prior interventions that have neglected to elevate the voices of marginalized individuals. We argue that a paradigm shift in behavioral health services research is critically needed-one that embraces HCD as a key methodological framework for developing and evaluating interventions with marginalized communities, to ultimately promote more accessible, useful, and equitable care. The current commentary illustrates practical examples of the use of HCD methodologies to develop and evaluate DMH designed with marginalized populations, while also highlighting its limitations and need for even greater inclusivity. Following this, calls to action to learn from and improve upon HCD methodologies will be detailed. Acknowledging potential limitations of current design practices, methodologies must ultimately engage representative voices beyond research participation and invest in their active role as compensated and true collaborators to intervention design.
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Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States,*Correspondence: Colleen Stiles-Shields
| | - Caroline Cummings
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, United States
| | - Enid Montague
- College of Computing and Digital Media, DePaul University, Chicago, IL, United States
| | - Jill M. Plevinsky
- Pediatric Transplant Center, Children's Hospital of Philadelphia, Philadelphia, PA, United States,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Alexandra M. Psihogios
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kofoworola D. A. Williams
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Abstract
Objectives Racism-related stress is associated with significant mental health costs, necessitating the development of coping strategies to mitigate the negative sequelae. Mindfulness and valued living (MVL)-based strategies may be uniquely beneficial in addressing the negative effects of racism-related stress for people of color (POC) by decreasing internalized messages, while increasing self-compassion, coping flexibility, and engagement in values-based actions. It is imperative that clinicians applying or recommending MVL strategies to POC for coping with racism-related stress understand the complex nature of racism and, given that complexity, consider how MVL may need to be adapted to be effective. This paper offers guidance to clinicians seeking to use MVL strategies with clients of color to cope with racism-related stress. Methods We provide a brief contextual literature review on the nature of racism, mental health impacts of racism-related stress for POC, and selected models of coping with racism-related stress. We also review existing mindfulness literature in relation to coping with racism-related stress, while offering considerations for adapting MVL strategies specifically for coping with racism-related stress. Results Altogether, the research points to the promise of MVL strategies as beneficial interventions for coping with racism-related stress, although more research is warranted. We recommend that clinicians consider the suggestions outlined to present MVL strategies to clients in culturally responsive, validating ways. Conclusions Further research is needed to evaluate links between MVL strategies and mental health, and to evaluate whether discrimination-specific adaptations are beneficial in mitigating the mental health impacts of racism-related stress.
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