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

 描述(申请人提供)：数以千计的人在美国寻求庇护，以躲避他们原籍国的战争暴行和酷刑。压倒性多数 其中一些人继续与慢性创伤应激(CTS)、先前创伤事件的持续存在(例如，再次经历过去的创伤)以及移民后的日常压力(例如，贫穷、缺乏交通工具)作斗争。CTS显著增加了精神负担 难民所经历的疾病，大约70%符合创伤后应激障碍(PTSD)的标准以及包括抑郁症、广泛性焦虑症和躯体问题在内的共病。这些疾病的循证心理健康治疗依赖于工作表、移动应用程序、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，这导致护理质量存在很大差异。治疗 通过移动设备提供的课程能够通过使用直观的图形界面克服这一障碍，从而消除了对基于文本或语言的教学的需要。解决难民心理健康需求的适应文化的mHealth工具包将减少护理方面的显著差距，并符合国家卫生研究院、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。将使用以社区为基础的参与式研究方法，妇女拥有的小企业GameThey、为难民提供服务的心理健康临床医生和难民将创建一个顾问小组来开发工具包。小组将参与开发的方方面面，以确保应用程序符合社会的需要。将使用敏捷开发战略，该战略将分三个阶段进行，以符合项目的目标。目标1：工具包的设计和组件将使用敏捷开发与咨询小组的反馈一起创建。原型将根据社区成员的反馈进行创建、内部审查和修订。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并可直观地使用。目标2：将对该工具包进行正式原型评估，抽样对象为来自不同文化背景的n=24名难民和与难民社区合作的n=5名提供者。与敏捷开发相一致，将在4个浪潮中进行评估，在每个浪潮中获得反馈并集成到应用程序中。目的3：改进后的工具包将在文化适应治疗期间与n=5个提供者的n=20名患者进行阿尔法测试。将获得参与度、可用性和满意度的衡量标准，以指导对工具包的最终改进。还将获得招募、完成和遵从性的可行性指标，为第二阶段临床试验做准备。

 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.