B-RESILIENT: An Engaging Text Messaging and Mobile App Created by the Community for the Community

Our organization seeks to launch an expansion of the B-RESILIENT texting/mobile app to promote resiliency and improve moderate to mild depression in Los Angeles, specifically under-resourced communities.

LA is the best place to LEARN

UCLA Center for Health Services and Society collaborated with Healthy African American Families to develop B-RESILIENT, a resiliency-based mobile intervention for depression self-management using the Community-Partnered Participatory Approach to enhance mental health quality of life and to help improve patient engagement and outcomes for individuals living with mild to moderate depression. The B-RESILIENT texting intervention was born out of community and patient partners’ requests to increase the availability of coping resources used in Building Resiliency in Communities for Health (B-RICH)--a manualized, 7-week class led by lay health workers to introduce CBT concepts--that emerged as a key innovation in Community Partners in Care (CPIC). Consistent with tracking and building on community input and engagement in interventions, the present study uses the same community engagement approach to expand access and availability to core coping and symptom self-management resources as well as information on and encouragement to receive needed services, through a mobile platform (Chorus). Our B-RESILIENT intervention introduces and reinforces principles of Cognitive-Behavioral Therapy (CBT) in order to support personal resiliency and reduce the risk for and impact of depressive symptoms and promote symptom self-management in response to multiple stressors in under-resourced communities of color. This app is a 30 day program where users will receive daily affirmations to start off their day and education on how to improve their mood ("boost"), reward themselves/enjoy activities ("break") and how to ask for support ("buddy") through interactive texts. After the 30 days, a user can convert to the mobile app to refer to as a guide if still needed. We then created a mobile web application in which participants followed-up on their experience with B-RESILIENT through surveys and also monitored their depression over one month to see the impact the B-RESILIENT app had. For this new iteration, we would like to expand the app to include content 7 days a week for one month instead of just doing the week. We would also like to make this app accessible to more populations in Los Angeles, especially under-resourced communities (ages 18 and over), in improving the mental health of more communities and how a person can better manage depressive symptoms. We would also like to add more features, such as creating professional videos to complement the text messages and provide more encouragement. We plan to add interactive features, such as fun games as a way to provide "breaks" and a simple distraction, daily mood ratings and tips for boosting low moods, and activity schedules. The previous piloting of the app made a positive impact on users, especially the daily affirmations and our biggest feedback was that users wanted more content.

A healthier LA is a happier LA. Individuals living with depression have been presented with many barriers, from lack of resources, access to care (psychiatrists/therapists) to the cost of medications and therapy along with the uncertainty of their effectiveness, not to mention the time it takes to find the right therapist and medication. One of the biggest challenges, though, is fighting through the stigma and getting the support from family and friends to aid in the recovery. It is this challenge that makes it difficult to get help and treatment. We want to change this with the B-RESILIENT app. We have spent many years working with under-resourced communities and improving depression care in those communities, specifically South Los Angeles and the Hollywood Metro area. After the success of our Community Partners in Care study where we worked with over 95 agencies in the community and gained the trust of the community, we used this expertise in developing the B-RESILIENT texting app which we have piloted twice to positive results which included positive reinforcement for those experiencing low moods, educated clients on resources available for depression, provided mentorship on how to reach out to family and friends for support (“Do You Need a Buddy?”), and encouraged clients to reward themselves with pleasurable activities and breaks. We believe this app will continue to make an impact on more populations and communities in Los Angeles.

Success will be measured through data obtained through using the App on: 1) number of users; 2) frequency of use and of interactions with specific features; 3) a measure of how people are doing on days of use; 4) a daily mood measure on days of use. Independent of use of the App, we will also field monthly brief mental wellness measures such as a three-item measure from prior studies (Wells et al., 2013). We will track how many users are "core" and use the App at least 5-6 times and how many are familiar with the App (used at least once) to be a resource for future needs. In addition, for the adapter work group, we will have more extensive measures of user feasibility, accessibility and effectiveness. We will also examine feasibility on first use of brief demographic measures that maintain confidentiality (e.g., age, gender, race/ethnicity) to allow review of uptake, reach, response and effectiveness for different demographic groups. In addition, we will track the number of people who visit the webpage about the overall project to understand basic awareness of the program.

In five years, our organization hopes we will be continuing our work in Los Angeles communities to improve mental health care and access in Los Angeles as well as implementing our community models across the nation as we begin collaborations with New York City and Baton Rouge, Louisiana.