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      Participant Engagement in a Transmedia Storytelling Web-Based App Intervention for Mental Health of Latina Women: Qualitative Analysis

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          Abstract

          Background

          Stigma, fear, and lack of knowledge regarding treatment options or where to get help create delays for Latina women in accessing needed mental health help. Story-based media interventions hold appeal for Latina women. Thus, we drew upon the Social Cognitive Theory by Bandura to create an evidence-based, transmedia storytelling web-based app for mental health called Catalina: Confronting My Emotions to connect Latina women to a curated set of mental health resources. Understanding how Latina women perceive various aspects of the web-based app will help design future expansions.

          Objective

          A previously published analysis led to the development of a category on how participants related to the lead character (Catalina) in the story line of the web-based app as a real person. However, the purpose of this analysis was to gain an understanding of participants’ experiences with the extension of the dramatic story line of the web-based app beyond Catalina to a Latina nurse-therapist character named Veronica, who was featured prominently in the app’s interactive content and bonus videos.

          Methods

          Qualitative analyses were conducted with interview data from a community-based sample of 28 English-speaking Latina women aged between 21 and 50 years who scored above the threshold for anxiety (Generalized Anxiety Disorder-7) and/or depression (Patient Health Questionnaire-9) but were not suicidal at screening. Data were collected 72 hours after participants engaged with our transmedia storytelling web-based app for mental health. Grounded theory methodology guided the analysis and interpretation of data that had been collected telephonically, recorded, and transcribed with identifiers removed. Analyses included initial and focused coding using process codes (gerund form of verbs in codes focused on action), informed by symbolic interactionism, and the development of categories with properties through constant comparison, memo writing, and the use of charts and diagrams.

          Results

          Our participants experienced a multiphase process that was most heavily related to Veronica, the Latina nurse-therapist character in our web-based app, who led them through a process to a place of action. We conceptualized this process as moving from passive viewer to active participant of a transmedia storytelling web-based app intervention. Overall, 3 new conceptual categories provided insight into women’s experiences, including encountering a trustworthy nurse-therapist character, taking in messages that dispel old beliefs, and preparing when and how to take action. Each category has nuanced properties that reflect participants’ experiences.

          Conclusions

          Active engagement with our web-based app led our sample to successfully transition from the viewpoint of the observer to the viewpoint of the experiencer, moving from a passive position of watching to active engagement that involved imagining, thinking, reflecting, and acting. Careful development of dramatic material for health-related web-based apps using transmedia story extension and bonus videos needs to be based on input from the target group from the start of development through evaluation and testing.

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          Most cited references48

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            While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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              Constructing Grounded Theory

              <p>Lecturers, request your electronic inspection copy<br> <br> Kathy Charmaz presents the definitive guide to doing grounded theory from a constructivist perspective. This second edition of her groundbreaking text retains the accessibility and warmth of the first edition whilst introducing cutting edge examples and practical tips.<br> <br> This expanded second edition:<br> <br> - explores how to effectively focus on data collection<br> <br> - demonstrates how to use data for theorizing<br> <br> - adds two new chapters that guide you through conducting and analysing interviews in grounded theory <br> <br> - adds a new chapter on symbolic interactionism and grounded theory<br> <br> - considers recent epistemological debates about the place of prior theory<br> <br> - discusses the legacy of Anselm Strauss for grounded theory.</p> <p>This is a seminal title for anyone serious about understanding and doing grounded theory research. </p>
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                Author and article information

                Contributors
                Journal
                JMIR Ment Health
                JMIR Ment Health
                JMH
                JMIR Mental Health
                JMIR Publications (Toronto, Canada )
                2368-7959
                January 2021
                13 January 2021
                : 8
                : 1
                : e22575
                Affiliations
                [1 ] School of Medicine University of Minnesota, Duluth Duluth, MN United States
                [2 ] Department of Internal Medicine, UCLA School of Medicine National Clinician Scholars Program University of California, Los Angeles Los Angeles, CA United States
                [3 ] School of Nursing University of California, Los Angeles Los Angeles, CA United States
                Author notes
                Corresponding Author: MarySue V Heilemann mheilema@ 123456sonnet.ucla.edu
                Author information
                https://orcid.org/0000-0002-2519-5209
                https://orcid.org/0000-0003-3756-6377
                https://orcid.org/0000-0001-5490-6076
                Article
                v8i1e22575
                10.2196/22575
                7840278
                33439137
                b638f2bd-f952-4503-8a9f-950765cd57b6
                ©Patricia D Soderlund, Adrienne S Martinez Hollingsworth, MarySue V Heilemann. Originally published in JMIR Mental Health (http://mental.jmir.org), 13.01.2021.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on http://mental.jmir.org/, as well as this copyright and license information must be included.

                History
                : 16 July 2020
                : 28 September 2020
                : 23 November 2020
                : 5 December 2020
                Categories
                Original Paper
                Original Paper

                transmedia,latina,mental health,mobile applications,internet,depression,anxiety,storytelling,mobile phone

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