Connecting Cultures and Technology: Addressing Disparities in Mental Health Intervention for Refugees

连接文化和技术：解决难民心理健康干预方面的差异

• 批准号: 8998852
• 负责人: Marguerite Dibble
• 金额: $ 20万
• 依托单位: GAMETHEORY, INC.
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-25 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8998852
• 关键词: Acute; Address; Advocate; Atrocities; Benchmarking; Businesses; Caring; Chronic; Client; Communication Barriers; Communities; Complement; Computer software; Consultations; Country; Coupled; Cultural Backgrounds; Development; Distress; Economics; Ensure; Etiology; Evaluation; Evidence based intervention; Fee-for-Service Plans; Feedback; Generalized Anxiety Disorder; Goals; Health Services Accessibility; Healthcare; Individual; Institutes; Instruction; Insurance; Intervention; Language; Life Experience; Limited English Proficiency; Maintenance; Marketing; Mental Depression; Mental Health; Mental disorders; Nature; Participant; Patients; Perception; Phase; Phase II Clinical Trials; Post-Traumatic Stress Disorders; Poverty; Preparation; Process; Provider; Public Health; Quality of Care; Refugees; Research; Research Design; Sampling; Services; Small Business Innovation Research Grant; Stress; Symptoms; Technology; Telephone; Testing; Text; Time; Torture; Transportation; Trauma; Travel; United Nations; United States; United States National Institutes of Health; War; Woman; Work; World Health Organization; base; burden of illness; commercialization; community based participatory research; cost; design; evidence base; experience; graphical user interface; handheld mobile device; health disparity; interest; mHealth; meetings; member; migration; minority health; mobile application; prevent; prototype; public health relevance; satisfaction; skill acquisition; software development; stressor; traumatic event; treatment center; usability; user-friendly; web site

 DESCRIPTION (provided by applicant): Thousands of individuals seek refuge in the United States to escape atrocities of war and torture in their country of origin. An overwhelming majority of these individuals continue to struggle with Chronic Traumatic Stress (CTS), the persistence of prior traumatic events (e.g., re-experiencing past trauma) coupled with daily post-migration stressors (e.g., poverty, lack of transportation). CTS significantly increases the burden of mental illness experienced by refugees such that approximately 70% meet criteria for posttraumatic stress disorder (PTSD) and comorbid conditions including depression, generalized anxiety disorder, and somatic concerns. Evidence-based mental health treatments for these conditions rely on worksheets, mobile applications, websites, or telephone calls to facilitate the use of skils and manage distress outside of session. Language barriers (e.g., most refugees have limited English proficiency) prevent these strategies from being incorporated into mental health treatment for refugees, which results in a significant disparity in the quality of care. Treatments delivered via mobile device are able to overcome this barrier through the use of intuitive graphical interfaces that eliminate the need for text or language-based instruction. Culturally adapted mHealth toolkits that address the mental health needs of refugees will reduce a significant disparity in care and is consistent with calls from the National Institutes of Health, World Health Organization, and United Nations High Commissioner for Refugees. The current SBIR Phase I project aims to develop, refine, and pilot an mHealth toolkit aimed at addressing the burden of mental illness in refugees. A community-based participatory research approach will be used in which GameTheory, a women-owned small business, mental health clinicians who serve refugees, and refugees will create an advisory panel to develop the toolkit. The panel will be involved in all aspects of development to ensure the application meet the needs of the community. An agile development strategy will be used that will proceed across three phases that correspond to the aims of the project. Aim 1: The design and components of the toolkit will be created with feedback from the advisory panel using agile development. Prototypes will be created, reviewed internally, and revised based on feedback from community members. Feedback from additional refugees will be solicited during the initial development to ensure that our toolkit is user-friendly and can be used intuitively. Aim 2: A formal prototype evaluation of the toolkit with a sample of n=24 refugees from different cultural backgrounds and n=5 providers who work with the refugee community will be conducted. Consistent with agile development, evaluation will occur across 4 waves in which feedback is obtained and integrated into the application at each wave. Aim 3: The refined toolkit will be alpha tested with n=20 patients across n=5 providers during culturally adapted treatment. Metrics of engagement, usability, and satisfaction will be obtained to guide final refinements to the toolkit. Feasibility metrics of recruitment, completion, and compliance will also be obtained in preparation for a Phase II Clinical Trial.

 描述（由申请人提供）：成千上万的人在美国寻求庇护，以逃避其原籍国的战争暴行和酷刑。绝大多数 这些人中的大多数继续与慢性创伤应激（CTS）作斗争，先前创伤事件的持续（例如，重新经历过去的创伤）加上日常的迁移后压力源（例如，贫困，交通不便）。CTS显著增加了精神负担 难民所经历的疾病，例如约70%符合创伤后应激障碍（PTSD）和共病条件的标准，包括抑郁症、广泛性焦虑症和躯体问题。针对这些情况的循证心理健康治疗依赖于电子邮件、移动的应用程序、网站或电话，以促进技能的使用并在会议之外管理痛苦。语言障碍（例如，大多数难民的英语水平有限），使这些战略无法纳入难民的心理健康治疗，从而造成护理质量的巨大差异。治疗 通过移动终端提供的信息能够通过使用直观的图形界面克服这一障碍，从而消除了对文本或基于语言的指令的需要。针对难民心理健康需求的文化适应性移动健康工具包将减少护理方面的显著差异，并符合美国国立卫生研究院，世界卫生组织和联合国难民事务高级专员的呼吁。目前的SBIR第一阶段项目旨在开发，完善和试点旨在解决难民精神疾病负担的mHealth工具包。将采用一种以社区为基础的参与性研究方法，其中妇女拥有的小企业GameTheory、为难民服务的心理健康临床医生和难民将建立一个咨询小组来开发工具包。该小组将参与开发的各个方面，以确保应用程序满足社区的需求。将采用敏捷开发战略，该战略将在与项目目标相对应的三个阶段进行。目标1：工具包的设计和组件将根据咨询小组的反馈使用敏捷开发创建。原型将被创建，内部审查，并根据社区成员的反馈进行修改。在最初的开发过程中，将征求更多难民的反馈意见，以确保我们的工具包方便用户，可以直观地使用。目标二：将对该工具包进行正式的原型评估，样本为来自不同文化背景的24名难民和5名与难民社区合作的提供者。与敏捷开发一致，评估将在4个波中进行，在每个波中获得反馈并集成到应用程序中。目标3：在文化适应性治疗期间，将对n=20名患者和n=5名提供者对改进的工具包进行alpha测试。将获得参与度、可用性和满意度的评价，以指导工具包的最终改进。在准备II期临床试验时，还将获得招募、完成和依从性的可行性指标。