Reducing Health Disparities among African American Women: A Mobile Cognitive Behavioral Stress Management Intervention

Isa Associates, Inc., Alexandria VA

Investigators

Abstract

PROJECT SUMMARY/ABSTRACT The unjust social, economic, and environmental conditions that all African Americans face throughout their lives leads to pervasive health disparities. Substandard medical care due to systematic bias in the healthcare system and a substantial wealth gap between Black and White households all lead to poorer health. And yet, the association between race and health persists even when controlling for these social determinants. One reason for this: stress. African Americans experience more stress than their White peers and have fewer resources to manage these stressors. The story is even more dire for African American women who simultaneously face both racial discrimination and sexism. Indeed, the experience of gendered racial discrimination is nearly ubiquitous for Black women at all socioeconomic levels. It is also a distinct form of stress with unique outcomes compared to other non-race-or-gender-related stressors. Finally, stress has clear downstream effects on health, both through physiological processes and through health behaviors. While several investigators have specifically developed stress management interventions for African Americans, much more needs to be done. Culturally sensitive behavioral health programs are more effective than generic programs for minority groups. Because stress significantly drives health disparities over and above other social determinants, developing effective stress management programs for African American women is vital to closing this gap. One cost-effective solution is mHealth. Ninety-eight percent of African Americans own a mobile phone. Most are smartphones (70%). And smartphone ownership is higher among Black women than White women. To our knowledge, no mobile cognitive behavioral stress management intervention has been developed for African American women to manage racial and nonracial sources of stress. We intend to fill this void. When completed, supportive texts will inspire, motivate, and affirm the life experiences of African American women. Educational texts will increase knowledge, develop skills, and reduce barriers to adaptive coping. A library of individually tailored videos will be delivered to each user depending on a theory-based assessment of stress (including perceived discrimination) and coping. All mobile web content will be effortlessly and efficiently accessed via touch-based links embedded within text messages. Eight healthcare staff members will be recruited for a focus group discussion to help shape the proposed intervention. Similarly, 24 African American women will be recruited for predevelopment focus group discussions. When the prototype is completed, the 24 target end-users will return for usability testing. The usability test will include a series of tasks intended to highlight the different features of the proposed intervention. Three usability metrics will be assessed: efficiency, accuracy, and subjective satisfaction.