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

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 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 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 A formal prototype evaluation of the toolkit with a sample of n refugees from different cultural backgrounds and n providers who work with the refugee community will be conducted Consistent with agile development evaluation will occur across waves in which feedback is obtained and integrated into the application at each wave Aim The refined toolkit will be alpha tested with n patients across n 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 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