Abstract
BackgroundThe proliferation of mental health apps purporting to target and improve psychological wellbeing is ever-growing and also concerning: Few apps have been rigorously evaluated, and, indeed, the safety of the vast majority of them has not been determined. Over 10,000 self-help apps exist but most are not used much after being downloaded. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers.ObjectiveThis paper presents pilot usage and acceptability data from the iBobbly suicide prevention app, an app distributed through a randomized controlled trial.MethodsAboriginal and Torres Strait Islander participants from the Kimberley region of Western Australia completed a survey measuring their technology use in general (n=13), and data on their experiences with and views of the iBobbly app were also collected in semistructured interviews (n=13) and thematically analyzed. Finally, engagement with the app, such as the number of sessions completed and time spent on various acceptance-based therapeutic activities, was analyzed (n=18). Both groups were participants in the iBobbly app pilot randomized controlled trial (n=61) completed in 2015.ResultsRegression analysis indicated that app use improved psychological outcomes, although only minimally, and effects were not significant. However, results of the thematic analysis indicated that the iBobbly app was deemed effective, acceptable, and culturally appropriate by those interviewed.ConclusionsThere is a scarcity of randomized controlled trials and eHealth interventions in Indigenous communities, while extremely high rates of psychological distress and suicide persist. In this environment, studies that can add evidence from mixed-methods approaches are important. While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use. The results on engagement with the iBobbly app were however positive. This study showed that Indigenous youth are early and frequent users of technology in general, and they regarded the iBobbly app to be culturally safe and of therapeutic value. Qualitative analyses demonstrated that iBobbly app use was associated with self-reported improvements in psychological wellbeing, mental health literacy, and reductions in shame. Importantly, participants reported that they would recommend other similar apps if available to their peers.
Highlights
Aboriginal and Torres Strait Islander suicide rates continue to be recorded at extraordinarily high levels, with rates of suicide among Indigenous Australians twice that of the non-Indigenous population [1]
Regression analysis indicated that app use improved psychological outcomes, only minimally, and effects were not significant
While the regression analysis in this study did not indicate a significant effect of app use on psychological wellbeing, this was predictable considering the small sample size (n=18) and typically brief app use
Summary
Aboriginal and Torres Strait Islander ( referred to as Indigenous Australian) suicide rates continue to be recorded at extraordinarily high levels, with rates of suicide among Indigenous Australians twice that of the non-Indigenous population [1]. The terms “mental health/illness” and much of the western biomedical terminology around suicide are of questionable value to Indigenous health experts and community members, who view mental health through their holistic interconnected model of Social and Emotional Wellbeing (SEWB) [4,5] This collectivist understanding of health care takes a community-wide view and values connection to family, culture, ancestry, land, and spirituality as some of the factors in maintaining wellness [4,5]. Disconnection, dispossession, and ongoing trauma since colonization have contributed to the severe health inequities Indigenous people suffer today [4,6,7] These social determinants of health are contributing to the disturbingly high rates of Indigenous youth suicide evident over recent decades [4,6,7]. Gathering and analyzing usage data and the acceptability of apps are critical to inform consumers, researchers, and app developers
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