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

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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.