Digital health platform (DHP) to deliver Mindfulness as a Stress Management Intervention Leveraging Electronic (SMILE) health records for racial and ethnic populations during the COVID-19 pandemic

项目摘要/摘要 目前的新冠肺炎大流行对黑人和拉丁裔个人的影响不成比例，而且越来越多 现有的健康差距。这些种族/民族人口面临着放大的压力，无法接触到患者- 以健康服务为导向。因此，数字健康平台(DHP)的利用具有解决覆盖范围的潜力， 交付、有效性、可扩展性和可持续性，以减少这些人群中的新冠肺炎相关压力。 这项拟议的研究建立在我们之前的DHP，生物反馈辅助复原力训练(BART)的基础上，即 有针对性地改善心率变异性(HRV)生理指标作为自主神经调节的指标 来管理服役人员的压力。现在，我们整合了北卡罗来纳大学健康患者门户网站(unch-PHR)， 基于正念的压力缓解计划，专为COVID相关压力量身定做，可穿戴心率传感器， 和移动健康应用程序(MHealth)收集心理健康的生理和心理量表，进入我们的DHP 利用电子健康记录提供文化敏感的压力管理干预的模式 (微笑)。 这项建议的总体目标是调查我们的DHP模式的有效性和可持续性，以 通过测量心理自我报告的变化来描绘与正念相关的行动机制 指标和自主神经平衡使用心率变异性，并检查之间的关联新冠肺炎相关压力和 心理健康结果、恢复力和HRV。理解这些相互关系，重点放在 种族/族裔群体对提供个性化治疗至关重要。中心假设是 微笑会缓解新冠肺炎相关的压力。我们将用三臂随机试验来检验我们的中心假说 对照试验。参与者将被随机分成三组：1)互联网授课的讲师- 实施正念压力管理训练(MTIA)，2)自我正念训练 通过商业上可用的mHealth应用程序Headspace(Mapp)，或3)等待列表控制(WLC)。DHP将会 记录研究不同阶段的进展情况(08周内每周一次的基线，以及3个月后的跟踪情况- 向上)。我们的理由是，我们的DHP模式能够接触到广泛的人群，促进了 并提供有针对性的DHP干预，如正念，同时收集心理生理指标以 评估治疗效果和心理健康的预测因素。更广泛的影响是，我们提议的DHP可能 用于评估新的治疗效果和增加种族/族裔人口的健康公平。

PROJECT SUMMARY/ABSTRACT The current COVID-19 pandemic is disproportionately affecting Black and Latino individuals and increasing existing health disparities. These racial/ethnic populations are facing magnified stress and lack access to patient- oriented health services. Thus, utilization of Digital Health Platforms (DHP) has the potential to address reach, delivery, effectiveness, scalability, and sustainability to decrease COVID-19 related stress in these populations. The proposed study builds on our previous DHP, the Biofeedback Assisted Resilience Training (BART), that targeted improving physiological metrics of Heart Rate Variability (HRV) as a measure of autonomic regulation to manage stress in service members. Now, we incorporate UNC Health patient portal (UNCH- PHRs), Mindfulness-Based Stress Reduction program tailored for COVID-related stress, wearable heart rate sensor, and mobile health app (mHealth) to collect physiological and psychological scales of mental health, into our DHP model to deliver a culturally sensitive Stress Management Intervention Leveraging Electronic health records (SMILE). The overall objective of this proposal is to investigate effectiveness and sustainability of our DHP model, to delineate mindfulness-related mechanisms of action by measuring changes in psychological self-reported metrics and autonomic balance using HRV, and to examine associations between COVID-19 related stress and mental health outcomes, resilience, and HRV. Understanding these interrelationships with a focus on racial/ethnic groups is of utmost importance to provide personalized treatment. The central hypothesis is that SMILE will mitigate COVID-19 related stress. We will test our central hypothesis with a 3-arm randomized controlled trial. Participants will be randomized to one of three arms: 1) an internet-delivered, instructor- administered Mindfulness-Based Stress Management training (MTIA), 2) self-administered Mindfulness training through the commercially available mHealth app Headspace (MAPP), or 3) Waitlist control (WLC). The DHP will capture progress at various points of the study (baseline, weekly during the 08 weeks and at 3-months follow- up). Our rationale is that our DHP model enables access to a wide range of populations, facilitating the promotion and delivery of targeted DHP interventions, such as mindfulness, while collecting psychophysiological metrics to assess treatment efficacy and predictors of mental health. The broader impact is that our proposed DHP could be used to assess new treatment effects and increase health equity for racial/ethnic populations.