Personal relevance of psychotherapy for Asian Americans: A mHealth problem-solving intervention to reduce stress (PRoP-AA)

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Abstract The proposed intervention, Personal relevance of psychotherapy for Asian Americans: A mHealth problem- solving intervention to reduce stress, is designed 1) to increase the use of mental health services by a population that uses them at one third the rate of Whites,1 and 2) to develop a personally-relevant approach to stress-reduction. Practical and cultural barriers inhibit the use of mental health services by Asian Americans2 including a lack of fluency in English amongst specific subpopulations,3 insufficient health literacy,2 and stigma surrounding mental illness which stems from Asian American cultural beliefs shared across subpopulations.4-6 With the rise in discrimination against Asian Americans during the current health crisis related to Covid-19,7,8 their physical and mental health may be adversely impacted,9 reinforcing the need for an improved option that addresses these barriers. This proposal aims to develop a mHealth (mobile health) application that is systematically adapted to be culturally relevant to select Asian American subpopulations. If successful, future development would extend the app to additional groups. Identifying personally-relevant interventions has the potential to reduce persistent mental health disparities among ethnic minority groups10 by increasing engagement with mental health services. Problem-Solving Therapy (PST), the intervention that will be used for this project, is likely to be personally relevant to Asian Americans. PST is a skills-based, psychosocial intervention to assist individuals in managing the negative effects of stressful events which is an effective intervention for reducing psychopathology, such as depression11 and a variety of other psychological difficulties.12 An external problem-solving orientation is culturally-syntonic to Asian values.13 The proposed mHealth app first will be developed for Chinese Americans and Korean Americans. The project will assess and adapt the PST using a systematic approach that integrates two frameworks, the top- down Psychotherapy Adaptation and Modification Framework (PAMF)14 and the bottom-up Formative Method for Adapting Psychotherapy (FMAP).15 In addition, the app layout, text, video, and audio content will be localized. Users will have access to at least five modules in the app, an introduction and one module for each of the four skills that comprise PST. The app will include video modeling of skills by Asian Americans and interactive features that will allow users to apply skills learned like writing down ideas and developing a plan. In Phase I, the project team will: a) design and develop a minimum viable product using an iterative, user- centered approach. In Phase II, the project team will: a) complete content and app development, and b) conduct a randomized controlled trial to evaluate the efficacy of the intervention. When the study concludes, PRoP-AA will be the first evidence-based PST mobile app designed for Asian Americans.