BRAVE Study: Designing and Evaluating Technologies to Promote Adolescent Mental Health
Condition: Mental Health Wellness 1
Study type: Interventional

Summary: 
      The BRAVE study is a randomized controlled trial carried out by the Northwest Portland Area
      Indian Health Board and the mHealth Impact Lab. The team recruited 2,330 AI/AN teens and
      young adults nationwide (15-24 years old) via social media channels and text message and
      enrolled 1,030 to participate in the 9-month study. Teens and young adults enrolled in the
      study received either: 8 weeks of BRAVE text messages designed to improve mental health,
      help-seeking skills, and promote cultural pride and resilience; or 8 weeks of Science
      Technology Engineering and Math (STEM) text messages, designed to elevate and re-affirm
      Native voices in science, technology, engineering, math and medicine; and then received the
      other set of messages. Retention in the study was high, with 87% of participants completing
      both BRAVE and STEM intervention arms.
    

Detailed description: 
      There are approximately 2.1 million self-identified American Indian and Alaska Native (AI/AN
      or Native) youth under the age of 24 living in the United States. Like many teens, AI/AN
      youth report frequent technology use and poor mental health outcomes, including trauma,
      stress, anxiety, depression, and suicidality.

      To support Native youth, the Northwest Portland Area Indian Health Board (NPAIHB) launched We
      R Native in 2012, a holistic health resource for Native youth, by Native youth
      (www.weRnative.org).

      While this broad reach and utilization is promising, more focused research is needed to
      better understand the acceptability and usability of the mental health messages delivered by
      We R Native, and systematic research is needed to determine whether We R Native's messages
      actually improve mental health and resilience, teach mental health skills (like coping
      skills, mindfulness, help-seeking, and use of suicide prevention chat-lines, etc.), and
      promote healthy social norms - all protective factors against suicide and substance abuse.

      Housed at the Colorado School of Public Health, the mission of the mHealth Impact Lab is to
      facilitate the rapid and rigorous development, implementation, and evaluation of mobile and
      digital technology for health promotion and disease prevention that address inequalities in
      health outcomes.

      The research teams tested whether We R Native's BRAVE messages improved self-efficacy and
      behaviors related to mental health, resilience, and cultural pride; as well as the relative
      impact of user engagement.

      The BRAVE study will improve the relevance, efficacy, and utilization of mental health
      resources delivered through We R Native' messaging channels - reaching a high-risk,
      underserved population - and will create new mechanisms to monitor and evaluate the impact of
      mHealth interventions. Both teams are committed to sharing resultant data collection tools
      and processes with those working in the field.
    

Intervention name(s): BRAVE; STEM
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The BRAVE campaign included 3-5 text messages per week for 8 weeks, including 1 role model video per week and a related image. The role model videos (1-3 minutes each) featured relatable characters experiencing and addressing violent behavior, alcohol misuse, and suicidality (through the eyes of a perpetrator, an intimate partner violence survivor, and a peer bystander), intended to demonstrated important coping and help-seeking skills.; The STEM campaign included 3-5 text messages per week for 8 weeks, including 1 role model video per week and a related image. The series promoted STEM career pathways and highlighted Native professionals in Science, Technology, Engineering, Math, and Medical careers.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Teens and young adults enrolled in the study received either: 8 weeks of BRAVE text messages or 8 weeks of STEM text messages; and then crossed over to the other arm and received the next set of messages.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: adolescent