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

项目总结/摘要 当前的COVID-19大流行对黑人和拉丁美洲人的影响不成比例， 现有的健康差距。这些种族/民族人口面临着更大的压力，缺乏获得病人- 面向健康服务。因此，数字健康平台（DHP）的利用有可能解决覆盖范围， 交付、有效性、可扩展性和可持续性，以减少这些人群中与COVID-19相关的压力。 这项研究建立在我们以前的DHP，生物反馈辅助恢复力训练（BART）的基础上， 有针对性地改善心率变异性（HRV）的生理指标，作为自主调节的指标 来管理服役人员的压力现在，我们将联合国卫生部患者门户网站（UNCH-PHRs）， 针对COVID相关压力量身定制的基于正念的减压计划，可穿戴心率传感器， 和移动的健康应用程序（mHealth）收集心理健康的生理和心理量表，并将其纳入我们的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）。 本提案的总体目标是调查我们DHP模式的有效性和可持续性， 通过测量心理自我报告的变化来描绘正念相关的行动机制 指标和自主平衡，并检查COVID-19相关压力与 心理健康结果，弹性和HRV。理解这些相互关系，重点是 种族/族裔群体对于提供个性化治疗至关重要。核心假设是， SMILE将缓解COVID-19相关的压力。我们将用一个三组随机化的 对照试验参与者将被随机分配到三个小组之一：1）互联网授课的教练- 管理基于正念的压力管理培训（MTIA），2）自我管理的正念培训 通过市售的mHealth应用程序Headspace（MAPP），或3）等待列表控制（WLC）。DHP将 在研究的各个点（基线、08周期间每周一次和3个月随访时）捕获进展， up）。我们的理由是，我们的DHP模式能够接触到广泛的人群，促进推广 并提供有针对性的DHP干预措施，如正念，同时收集心理生理指标， 评估治疗效果和心理健康的预测因素。更广泛的影响是，我们提出的DHP可以 用于评估新的治疗效果，并增加种族/民族人群的健康公平性。

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.