Cultural Customized App for Chinese American with Depression

The culturally-customized screening tool and mindfulness intervention delivered through smartphone app will increase the engagement to seek depression care among Chinese Americans.

A pilot study to evaluate the feasibility of using a smartphone application featuring culturally-validated Chinese Bilingual version of the Patient Health Questionnaire (CB-PHQ-9) and loving-kindness mindfulness game among Chinese American with depression. We hypothesize that the culturally-customized screening tool and interactive mindfulness game delivered through smartphone app will increase the engagement to seek depression treatment among this population. This app aims to decrease mental health disparity for minority populations in U.S. through delivering culturally responsive treatment. It can be potentially utilized to provide mental health treatment that is appropriate for the socio-cultural context in developing countries as well. 

1.Some studies have posited that the reliance of Western standards and assessments of mental disorders might result in lower reliability and validity for depression diagnosis among Asians. Few studies have designed a cultural validated screening tool and intervention for depression treatment among Asian immigrants. 

2. Structural barriers have hindered Asian Americans from seeking for depression counseling and treatment. Many are not aware of or have access to local mental health services due to economic and geographic limitations. Currently, few research have addressed how to best improve communication strategies for ensuring access to mental health care for this population. 

As smartphone technology has become ubiquitous in the U.S. society, recent research indicated there is a high rate of smartphone ownership and medical apps use among ethnic minorities. Emerging data has shown interest and feasibility of utilizing smartphone apps to reduce health disparities and improve engagement with the health care system among low-income minorities. With the increased clinical evidence suggesting the feasibility of medical apps, in this study we are interested in evaluating if a customized smartphone application featuring cultural validated mental health screening and intervention tools for Chinese immigrants can encourage the engagement in depression treatment within this population. 

In this study, 25 participants who are Chinese ethnicity with diagnosis of depression confirmed by their outpatient provider or a baseline PHQ-9 >10 will be recruited at a community health center in Boston, Massachusetts. 

We hypothesize that Chinese American outpatients will be able to download the app to their personal smartphone and use it for 4 weeks. The culturally-customized screening tool and mindfulness intervention delivered through smartphone app will increase the engagement to seek depression treatment among Chinese Americans. 

This app can potentially decrease the cultural stigma associated with depression, and encourage help-seeking in depression care among Chinese Americans.

Track daily app login for 4 weeks - Participants will use this app daily for a 4-week study period

Track daily mindfulness game login for 4 weeks; gather user feedback via survey containing system usability scale (SUS) and a 5 minutes semi-structured verbal interview at the end of 4 weeks - Interactive loving-kindness mindfulness game can increase participants' engagement in mental health themed smartphone app

Record daily CB-PHQ-9 score, and generate graph for mood tracking data - The culturally-validated CB-PHQ-9 delivered through smartphone app can better monitor participants' mood fluctuation in real time setting

Many current apps are evaluating the features to increase consumer engagement. There is currently no smartphone app evaluating if providing culturally-oriented resources can be a factor to improve user app experience. Compared to the traditional mindfulness meditation app, this app incorporates the theory of loving-kindness mindfulness (LKM) and delivers the mindfulness exercise through an interactive puzzle game requiring simple motions. We hypothesize app-based LKM can facilitate monitoring daily emotional outcome, in order to evaluate the short-term effect of LKM. Smartphone app based mindfulness can also encourage daily LKM practice due to its ubiquitous nature.

This smartphone app aims to provide affordable, accessible, and culturally relevant screening and mindfulness tools for depression care among Chinese Americans. Many new Asian immigrants from lower socioeconomic backgrounds have to face challenges, including working multiple jobs, unable to get time off for medical appointments, lack of child care, and lack of transportation to distant facilities, even if they are willing to obtain mental health services. We think this app can serve as an innovated communication platform to ensure access to mental health care for this population. 

This smartphone app will be available in Android and Apple iTune Stores. Interested participants can download the app to their personal smartphone for free. 

The Principal Investigator and Co-Investigator of this research study are currently employed Psychiatrists at Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School in Boston, MA. 

The funding of this research study is provided through the American Psychiatric Association (APA) SAMHSA Minority Fellowship Award 2017-2018 (Grant number: 5T06SM060562-07; FAIN number: SM060562; CFDA number: 93.243).

. 

-Technical complexity and high cost in developing this smartphone app with the app development company.

-Difficult to recruit a large number of eligible participants from the affiliated clinic, therefore, the power of this study will be limited. Eligibility requirements include Chinese ethnicity, fluency in either English or Mandarin Chinese, a diagnosis of depression as confirmed by referring clinician or a baseline score of 10 or higher on the PHQ-9. 

-Difficult to obtain user feedback on how to improve the app design. 

-Limited literature evidence on culturally adapted depression screening and intervention tools for minority populations, specifically Chinese Americans. 

https://google.com

We are conducting a pilot study for this innovated smartphone app. So far, there is no existing mental health app in the market or research literature similar to our study. We want to obtain more mentorship and community collaboration to further improve the design of this app and the quality of this research study.

None

None