Betterbot: Promoting Accessible and Inclusive Mental Health Support for Individuals with Brain Injury

Project Summary/Abstract Traumatic brain injury (TBI) is a significant public health challenge, profoundly affecting mental health, social participation, and quality of life. Individuals with TBI experience disproportionately high rates of depression and anxiety, with these conditions persisting over time and disproportionately impacting minoritized populations. Despite this, most individuals with TBI do not receive adequate mental health care, partly due to barriers such as provider shortages, stigma, transportation challenges, and lack of scalable solutions. This project aims to address these barriers by developing Betterbot, a short message service (SMS) chatbot that integrates artificial intelligence (AI) and large language models (LLM) to deliver evidence-based behavioral activation therapy tailored to individuals with TBI. Building on our team’s prior successes in chatbot development for moderate to severe TBI, Betterbot will serve as a stand-alone, clinician-supervised tool that provides direct access to structured, rewarding activities and motivational support on demand, requiring minimal real-time input from clinicians. Designed with clinical oversight to ensure safety and relevance, Betterbot aims to reduce disparities in access to care, improve mental health outcomes, and empower underserved communities to manage the effects of TBI in culturally relevant ways. The specific aims of this project are: Aim 1. Develop a prototype of Betterbot informed by iterative feedback from TBI patients and multidisciplinary providers, using qualitative research methods and theoretical frameworks such as the NIMHD Research Framework and the COM-B model of behavior change (Capability, Opportunity, and Motivation as determinants of Behavior). Aim 2. Evaluate the usability and feasibility of the Betterbot prototype in a diverse group of TBI patients and providers through formative usability testing and structured feedback using quantitative and qualitative methods. By aligning with a development framework and addressing critical barriers to care, Betterbot offers a pathway toward equitable health outcomes for underserved populations. By the end of Phase I, this project will deliver a validated, user-centered mHealth solution with demonstrated feasibility for integration into care pathways. The outcomes will lay the foundation for Phase II, involving a large-scale randomized controlled trial to evaluate the clinical effectiveness of Betterbot.