Abstract
BackgroundTo date, we are aware of no interventions for anxiety and depression developed as mobile phone apps and tailored to young sexual minority men, a group especially at risk of anxiety and depression. We developed TODAY!, a culturally informed mobile phone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive behavioral therapy (CBT) and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (eg, tips for current distress and visualizations of mood by context).ObjectiveThe aim of this study was to conduct usability testing to understand how young sexual minority men interact with the app, to inform later stages of intervention development.MethodsParticipants (n=9) were young sexual minority men aged 18-20 years (Mean=19.00, standard deviation [SD]=0.71; 44% black, 44% white, and 11.1% Latino), who endorsed at least mild depression and anxiety symptoms. Participants were recruited via flyers, emails to college lesbian, gay, bisexual, and transgender (LGBT) organizations, Web-based advertisements, another researcher’s database of sexual minority youth interested in research participation, and word of mouth. During recorded interviews, participants were asked to think out loud while interacting with the TODAY! app on a mobile phone or with paper prototypes. Feedback identified from these recordings and from associated field notes were subjected to thematic analysis using a general inductive approach. To aid interpretation of results, methods and results are reported according to the consolidated criteria for reporting qualitative research (COREQ).ResultsThematic analysis of usability feedback revealed a theme of general positive feedback, as well as six recurring themes that informed continued development: (1) functionality (eg, highlight new material when available), (2) personalization (eg, more tailored feedback), (3) presentation (eg, keep content brief), (4) aesthetics (eg, use brighter colors), (5) LGBT or youth content (eg, add content about coming out), and (6) barriers to use (eg, perceiving psychoeducation as homework).ConclusionsFeedback from usability testing was vital to understanding what young sexual minority men desire from a mobile phone intervention for symptoms of anxiety and depression and was used to inform the ongoing development of such an intervention.
Highlights
Mental Health and Sexual Minority YouthIndividuals identifying as lesbian, gay, or bisexual experience mental health disparities relative to the general population [1]
Anxiety and depression have been linked with human immunodeficiency virus (HIV) risk behavior among young sexual minority men; this is especially salient given that rates of new HIV infections are high in young sexual minority men aged 13-24 years, accounting for 24% of new HIV diagnoses among all sexual minority men and 91% of new HIV diagnoses in all men their age [8]
There has been only limited research devoted to the development of psychological interventions for anxiety or depression that are tailored for sexual minority youth and the factors that may drive their higher rates of distress
Summary
Mental Health and Sexual Minority YouthIndividuals identifying as lesbian, gay, or bisexual experience mental health disparities relative to the general population [1]. Young sexual minority men are at greater risk for anxiety and depressive symptoms than their heterosexual peers [3], and male sexual minority youth experience more associated symptoms than adult sexual minority men [4]. There is evidence, that psychological treatments culturally tailored for use with sexual minority men can produce results more quickly than standard cognitive behavioral therapy (CBT) (eg, by producing more rapid decreases in methamphetamine use among methamphetamine-dependent gay and bisexual men) [11]. There has been only limited research devoted to the development of psychological interventions for anxiety or depression that are tailored for sexual minority youth and the factors that may drive their higher rates of distress. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive behavioral therapy (CBT) and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (eg, tips for current distress and visualizations of mood by context)
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