Feasibility, acceptability, and effectiveness of a web-based therapeutic intervention for post-traumatic stress disorder among American Indian/Alaska Native adults in primary care (Preprint)
Authors: Hiratsuka Vanessa , Moore Laurie , Avey Jaedon P , Dirks Lisa G , Beach Barbara D , Dillard Denise A , Novins Douglas K 
Published: February 2019

BACKGROUND

Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native (AI/AN) populations. Primary care clinics are often the first point of contact for AI/AN people seeking health care and are feasible locations for trauma-focused interventions.

OBJECTIVE

Web-based therapeutic interventions (WBTI) for PTSD have the potential to reduce PTSD symptoms in AI/AN primary care patients by offering culturally tailored psychoeducation and symptom self-management tools. In this study, we investigate the feasibility and acceptability in two AI/AN serving primary care sites and effectiveness of a WBTI on trauma symptom changes in a 12-week period.

METHODS

A community-based participatory research process was used to refine the WBTI adaptations and content, and conduct a feasibility test of the resultant 16-guide intervention “Health is Our Tradition: Balance and Harmony after Trauma” within two AI/AN healthcare settings. AI/AN people ages 18 years and older who were not in crisis and scored positive on the primary care PTSD instrument completed baseline measures and were trained on WBTI usage. Participants were provided weekly tip via text message during the 12-week intervention. Content was devised to reinforce website use, complement website content, and remind participants about follow-up visits. At each visit, participants completed follow-up versions of all baseline measures (except demographics) including the PC-PTSD and a satisfaction/acceptability questionnaire. Electronic health records were collected for the periods extending to 12 months prior to study enrollment and 3 months following study enrollment. Changes in perceptions of acceptability/feasibility between the 6-week and 12-week follow-up were examined with paired t-tests. Analysts explored changes in symptomatology over the 12-week intervention with one-way ANOVAs for repeated measures or repeated measures logistic regression tests. To examine the effect of the intervention on service utilization, analysts compared clinic visit frequency from the health record data in the 12 months before the intervention (divided by 4 for comparison) and the 3 months after it with paired t-tests. The Wilcoxon Signed Rank Test for non-parametric data was used to test significance for non-normally distributed data.

RESULTS

In a sample of N=24, the WBTI was well received with no difference in use, engagement, satisfaction or technical skills needed for use by age or gender. Website usage decreased significantly over the course of the 12-week intervention period yet participants reported significant reductions in PTSD, depression, and physical symptoms related to PTSD, and problematic alcohol use over the same period of WBTI usage.

CONCLUSIONS

The website shows promise for integration into primary care and behavioral health settings to augment and improve access to treatment of the health consequences of trauma exposure among adult AI/AN primary care patients.