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.
Public Health Relevance Statement: Public Health Relevance: Refugees and victims of torture experience disproportionally high rates of mental illness, which contributes to an undue burden of illness. Multiple barriers prevent these individuals from accessing high quality care in times of crisis including language, economics, and transportation. Culturally adapted Mobile applications that rely on intuitive graphic interfaces, rather than text, to assist refugees in period of acute distress have the potential to address this significant public health concern and reduce disparities in care.
NIH Spending Category: Behavioral and Social Science; Brain Disorders; Clinical Research; Clinical Trials and Supportive Activities; Health Services; Mental Health; Mental Illness; Networking and Information Technology R&D; Violence Research
Project Terms: Acute; Address; Advocate; Atrocities; base; Benchmarking; burden of illness; Businesses; Chronic; Client; commercialization; Communication Barriers; Communities; community based participatory research; Complement; Computer software; Consultations; cost; Country; Coupled; Cultural Backgrounds; design; Development; disparity reduction; Distress; Economics; Ensure; Etiology; Evaluation; evidence base; Evidence based intervention; experience; Fee-for-Service Plans; Feedback; Generalized Anxiety Disorder; Goals; graphical user interface; handheld mobile device; Health; health care disparity; health disparity; Health Services Accessibility; Healthcare; Individual; Institutes; Instruction; Insurance; interest; Intervention; Language; Life Experience; Limited English Proficiency; Maintenance; Marketing; meetings; member; Mental Depression; Mental disorders; Mental Health; mHealth; migration; minority health; mobile application; mobile computing; Nature; Participant; Patients; Perception; Phase; Phase II Clinical Trials; Post-Traumatic Stress Disorders; Poverty; Preparation; prevent; Process; prototype; Provider; Public Health; Quality of Care; Refugees; Research; Research Design; Sampling; satisfaction; Services; skill acquisition; Small Business Innovation Research Grant; software development; Stress; stressor; Symptoms; Technology; Telephone; Testing; Text; Time; Torture; Transportation; Trauma; traumatic event; Travel; treatment center; United Nations; United States; United States National Institutes of Health; usability; user-friendly; War; web site; Woman; Work; World Health Organization
