We R Native

Below are excerpts from this grantee’s quarterly reports.

Final Report

Project 1

Aims

Year 1, Aim 1: Carryout formative research to evaluate the quality and usability of the mental health messages delivered by We R Native through its multimedia messaging channels (including the http://www.weRnative.org website, the Ask Auntie Q&A service, our text messaging service, and our social media platforms) with 45+ AI/AN youth 15-24 years old.

Year 2, Aim 1: During the first year of the project, we were able to identify several gaps in We R Native’s mental health (MH) and wellness messaging. The second year of the project we aimed to fill these gaps by creating youth-designed media campaigns (at a 3-day Mental Health Springboard Lab) – bringing together Native youth, filmmakers, technologists, and We R Native’s communication team. We planned to evaluate the MH campaigns the second half of Year 2, using Marketcast’s network analysis capabilities, to assess the campaign’s uptake, reach, and impact on youth’s social media conversations.

What was accomplished under those aims

During the first year of the project, our team carried out formative research to evaluate the quality and usability of the mental health messages delivered by We R Native (WRN), by reviewing analytics from the http://www.weRnative.org website. We also interviewed 13 AI/AN young adults (15-24 years old) who use WRN, to better understand their perceptions of WRN’s mental health messages.

To fill the MH messaging gaps that were identified, We R Native hosted a virtual Springboard Lab to design and produce new wellness messages.

  • The participants included 23 AI/AN teens and young adults from across the U.S.
  • Co-Facilitators included: We R Native staff, a graphic artist and mental health advocate, Jeremy Fields (THRIVE), a mental health coach (Shelby Rowe Lived Experience), a poet, Kinsale (Changing Womxn Collective) and filmmakers (SkyBear Media).

During the Springboard Lab, participants developed a multimedia MH and Wellness campaign entitled Self-Love: IndigiLove begins with I

  • Theme 1: Reaching out for help. Asking for help when you need it is a form of self-love. It can be scary to ask for help if you don’t know what will happen next. Let’s talk about the process of getting support.
  • Theme 2: Managing our mental health everyday. Show compassion towards yourself by checking in with your emotions. Let’s talk about anxiety, depression, and healthy coping practices.
  • Theme 3: Self-care. It looks different for everyone. How do you practice self-care?

To promote mental health and wellness skills among AI/AN teens and young adults across the U.S., we posted the #IndigiLOVE campaign poems, videos, and art across We R Native’s social media channels.

To learn more about Native youth’s conversations on social platforms related to mental health and wellness skills, we contracted with MarketCast. Their Phase #1 Report and Phase #2 Report identified positive trends in relation to #IndigiLOVE, #WeNeedYouHere, and self-care driven by We R Native’s social media messaging.

Finally, we used the tips and topics discussed at the Springboard Lab to build a new “My Mind” hub for mental health wellness skills on We R Native’s website: https://www.wernative.org/my-mind/building-mental-resilience/feeling-good.

Unexpected aspects of the project (setbacks, new collaborations, opportunities, lessons learned)

Due to COVID we had to shift our in-person Springboard Lab to a virtual delivery model. No significant problems were encountered, but it did require a great deal of flexibility to re-orient our plans and activities to engage youth participants.

Specific statements about the take home points from this project

The MarketCast Reports have been particularly informative for our team – offering a new perspective on the topics (and events) that drive conversations about mental health on social media channels for Native youth.

Products from the project: papers, presentations, blog posts, other products

The new wellness pages on http://www.weRnative.org include the youth-designed #IndigiLOVE Campaign, with articles and videos that role-model reaching out for help, combatting stress, self-care, and managing anxiety. The complete #IndigiLOVE series is also featured on WRN’s YouTube channel: https://youtube.com/playlist?list=PLvLfi7yZ2zQGKuMCu-CFOmedDQZcsuPyG

As a result of the TAM project, we also have access to a google dashboard that allows us to monitor website usage by health topic.

The “My Mind” section also features a caring text message service designed by THRIVE (the NPAIHB’s suicide prevention team) to increase protective factors: https://www.wernative.org/my-mind/getting-help/caring-messages.

Project 2

Aims

Year 1, Aim 2: Rigorously test whether We R Native’s messages impact youth norms, intentions, self-efficacy and behaviors related to mental health, resilience, and cultural pride; as well as the relative impact of each communication channel (including its website, Ask Auntie Q&A service, text messaging service, and social media channels) and user engagement.

Year 2, Aim 2: We will disseminate the BRAVE intervention to tribal health educators and teachers, the second half of Year 2. The BRAVE Facilitator’s Guide will be made available on the http://www.HealthyNativeYouth.org website – a one-stop-shop for tribal health educators, teachers, and parents – providing the training and tools needed to access and deliver effective, age-appropriate health programs.

What was accomplished under those aims

Recruitment for the BRAVE study took place from September-November 2019. Youth who enrolled in the study were randomized to receive either: 8 weeks of BRAVE text messages + role model videos designed to improve mental health, help-seeking skills, and promote cultural pride and resilience; or 8 weeks of STEM text messages + role model videos designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine. Afterwards, the two groups switched arms and received the other set of text messages. See: http://www.npaihb.org/brave/

Altogether, over 1,000 eligible AI/AN youth joined the study by texting BRAVE to 97779 and completing the pre-survey.

At the conclusion of the study, BRAVE study participants reported improvements in mental health, reductions in A&D misuse, improvements in resilience and coping skills, and better self-esteem (despite delivery in the midst of a pandemic). These findings suggest that mHealth interventions can be feasibly used to improve mental health and help-seeking skills, reaching geographically disbursed youth.

To share the intervention more broadly, We R Native designed a User’s Guide that is available on the Healthy Native Youth website. The guide includes three formats for Lesson delivery:

  • Option 1: Self-Reflection Activity + Youth Sign-up to Receive the video series and Text Message Series (total activity time = 10-30 min)
  • Option 2: Facilitator shows the full-length video beginning to end, followed by a 35-minute individual activity and discussion (45 min)
  • Option 3: Facilitator shows one of the 7 episodes of the BRAVE video, followed by a 30-minute group activity (45 minutes, 7 lessons).

Unexpected aspects of the project (setbacks, new collaborations, opportunities, lessons learned

Unfortunately, we had a few detrimental set-backs occur during the dissemination phase of the BRAVE study:

  • We had to pause/discontinue media promotions depicting the lead-actor, due to problematic content posted on his TikTok channel. We removed his promotional videos and assets from our social media channels – a significant setback to our planned marketing strategy, that relied heavily on his celebrity endorsement.
  • Without warning or leeway, the FCC is discontinuing the use of shared short codes (like 97779) this year. We are now in the process of purchasing a new short code (94449). We’ll need to transfer the BRAVE campaign to the new short code and re-brand it in 2022.

Specific statements about the take home points from this project

The need for mental health interventions and wellness campaigns remains critical right now, as is the need for programs that can be delivered virtually. The BRAVE intervention was deployed at the right time at the right place to address both needs.

Products from the project: papers, presentations, blog posts, other products

Youth can text BRAVE to 97779 to receive the text message sequence on their own. See: https://www.wernative.org/my-mind/getting-help/brave

The facilitator’s manual can be accessed on the Healthy Native Youth website. So far, the BRAVE curriculum has been viewed 1,270 times on the Healthy Native Youth website since its release in August 2020. We also featured the intervention on a Community of Practice webinar, hosted in 2021: https://www.youtube.com/watch?v=thIlj34_fRY

In Year 2, we prepared four articles for publication:

  • Formative Paper: Published
    • Title: Designing a multimedia help-seeking intervention for American Indian and Alaska Native Teens and Young Adults, American Indian and Alaska Native Mental Health Research Journal o Formative Research to Design the BRAVE Intervention
  • Implementation Paper (Recruitment, Enrollment, Engagement): Accepted
    • Manuscript ID: ijerph-998619 Title: Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-seeking Intervention: Lessons Learned from the BRAVE Study
    • Social and Digital Media: Implications and Opportunities for Health Equity https://www.mdpi.com/journal/ijerph/special_issues/digital_med
    • Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-Seeking Intervention
  • Efficacy Paper: Published
    • JMIR Mental Health
    • Title: “Efficacy and Impact of an mHealth Intervention to promote Mental Wellness for American Indian and Alaska Native Teens and Young Adults: A Randomized Controlled Trial of the BRAVE Study”
    • Efficacy of an mHealth Intervention: BRAVE
  • Engagement Paper: Accepted
    • JMIR Formative Research
    • Title: “Patterns of User SMS Engagement in the BRAVE Study with American Indian and Alaska Native Teens and Young Adults”.

Collectively, the TAM project substantially improved the mental wellness resources available on We R Native’s website and supported the evaluation of an evidence-based mHealth health intervention for AI/AN youth. BRAVE builds on traditional community values and connects AI/AN teens and young adults to people, stories, resources, and teachings that demonstrate what it means to be strong and resilient.

Year 2, Quarter 3

Briefly restate the specific aims or objectives associated with this project. 

Year 2, Aim 1. During the first year of the project, we were able to identify gaps in We R Native’s mental health (MH) and wellness messaging. The second year of the project we are working to fill these gaps by creating youth-designed campaigns (at a 3-day Mental Health Springboard Lab) – bringing together Native youth, filmmakers, technologists, and We R Native’s communication team. We are working with an analytics firm (Marketcast) to assess the campaign’s uptake, reach, and impact on youth’s social media conversations.  

Year 2, Aim 2. The final wave of BRAVE study participants completed their 8-month surveys in August 2020. Now that data collection is complete, we are preparing to disseminate the intervention to tribal health educators and teachers, the second half of Year 2. The BRAVE Facilitator’s Guide is available on the www.HealthyNativeYouth.org website – a one-stop-shop for tribal health educators, teachers, and parents – providing the training and tools needed to access and deliver effective, age-appropriate health programs in AI/AN communities.  

Briefly summarize what was accomplished with regard to these aims in the present quarter.

Last quarter we built a new “My Mind” hub for mental health topics and wellness skills on We R Native’s website. The wellness pages include the youth-designed #IndigiLOVE Campaign, with articles and videos that role-model reaching out for help, combatting stress, self-care, and managing anxiety. The complete #IndigiLOVE series is also featured on WRN’s YouTube channel. 

The new “My Mind” section also features a caring text message service designed by THRIVE (the NPAIHB’s suicide prevention team) to increase protective factors.

We also contracted with MarketCastto learn more about Native youth’s conversations on social platforms related to mental health and wellness skills. Their Phase #1 Reportand their Phase #2 Reportidentified positive trends in relation to #IndigiLOVE, #WeNeedYouHere, and self-care mentions as a result of We R Native’s social media messaging. 

 The MarketCast reports have been particularly informative, for our team – offering a new perspective on the topics (and events) that drive conversations about mental health on social media channels for Native youth.   

The MarketCast reports are now available on Healthy Native Youth’s website: Phase #1 Report and Phase #2 Report

Our BRAVE Efficacy Paper was also revised and re-submitted this quarter.

  1. Submitted to: JMIR Mental Health
    1. Title: “Efficacy of an mHealth Intervention to promote Mental Wellness for American Indian and Alaska Native Teens and Young Adults: A Randomized Controlled Trial of the BRAVE Intervention”
      Is now available at http://preprints.jmir.org/preprint/26158and has been assigned the following DOI: 10.2196/preprints.26158.

The final quarter of our work in Year 2 will focus on recruiting youth to enroll in the BRAVE intervention. 

Year 2, Quarter 2

Briefly summarize what was accomplished with regard to these aims in the present quarter.

To promote mental health and wellness skills among AI/AN teens and young adults this Quarter, we posted the #IndigiLOVE campaign poems, videos, and art across We R Native’s social media channels.

  • Altogether, the campaign reached approximately 150k viewers via Facebook, Instagram, Twitter, YouTube and text message.
  • The team partnered with Center for Native American Youth and Native Wellness Institute to help amplify the campaign themes.
  • Our staff contributed to NWI Power Hours focusing on self-care, reaching an additional 5k viewers.
  • The partners developed and shared resources to support self-care.

BRAVE study participants reported improvements in mental health, reductions in A&D misuse, improvements in resilience and coping skills, and better self-esteem (despite delivery in the midst of a pandemic). These findings suggest that mHealth interventions can be feasibly used to improve health behavior, reaching at-risk youth. We are now in the early stages of developing and implementing a dissemination plan for the BRAVE intervention. Youth can text BRAVE to 97779 to receive the text message sequence ontheir own. The facilitator’s manual can also be accessed on the Healthy Native Youth website. So far, the BRAVE curriculum has been viewed 191 times on the Healthy Native Youth website since its release in August 2020.

Year 2, Quarter 1, part 2

Briefly summarize what was accomplished with regard to these aims in the present quarter.

We R Native hosted a 5-day virtual Springboard Lab in July to design and produce new wellness messages -filling gaps in We R Native’s mental health content. In addition, mHealth is now in the process of preparing the BRAVE study dataset and conducting analyses to determine to what extent the BRAVE intervention impacted youth’s mental health, cultural resilience, and help-seeking behaviors. Both teams are preparing publications to report outcomes and impact on the study. To share the intervention more broadly, We R Native designed a User’s Guide that is available on the Healthy Native Youth website.

Tell us what excites you about the funded project.

The need for mental health interventions and wellness campaigns is critical right now, as is the need for programs that can be delivered virtually. The BRAVE intervention is coming out at the right time to address both needs.

Year 2, Quarter 1, part 1

Building off the research carried out in Year 1, our teams will:

With regard to Year 2 Quarter 1 progress, We R Native described the following:

  • The Native Youth Springboard Lab has been transformed into a virtual format. The travel budget for the 20 youth participants have been repurposed as youth stipends!
  • We R Native is setting up contracts with Fizziology (now MarketCast) to help gauge the reach and impact of the mental wellness campaigns that emerge from the Springboard Lab process. MarketCast will apply their network analysis capabilities to asses the campaign’s uptake, reach, and impact on youth’s social media conversations.

Quarter 4

Briefly restate the specific aims or objectives associated with this project.

Aim 1. Carry out formative research to evaluate the quality and usability of the mental health messages delivered by We R Native through its multimedia messaging channels (including the http://www.weRnative.org website, the Ask Auntie Q&A service, our text messaging service, and our social media platforms) with 45+ AI/AN youth 15-24 years old.

Aim 2. Rigorously test whether We R Native’s messages impact youth norms, intentions, self-efficacy and behaviors related to mental health, resilience, and cultural pride; as well as the relative impact of each communication channel (including its website, Ask Auntie Q&A service, text messaging service, and social media channels) and user engagement.

Briefly summarize (3-5 sentences) what was accomplished with regard to these aims in the present quarter.

In the last quarter, youth who enrolled in the BRAVE study have been exposed to the first arm of the study, either:

  • 8 weeks of BRAVE text messages + role model videos designed to improve mental health, help-seeking skills, and promote cultural pride and resilience; or
  • 8 weeks of STEM text messages + role model videos designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine.

In the last month, the two groups switched study arms and are now receiving the second set of text messages. See:  http://www.npaihb.org/brave/

Quarter 3

Tell us about key learnings you’ve uncovered over the course of your project, including advice you might give to investigators conducting similar work.

The first aim of our study has given us the opportunity to investigate and better understand the quality and utilization of We R Native’s current mental health messages. Here is a summary of our findings:

Top Mental Health pages viewed on We R Native

In 2019, our mental health pages on www.weRnative.org received 2.8K pageviews, up 17% from the year before. On average, users viewed 4 pages per session and visited the site for over 7 minutes (far longer than when visiting other sections of the website). The most viewed pages focused on wellness and healing, tips for becoming resilient, ways to improve your mood, and spiritual wellbeing.

Preferred Messaging Channels

We conducted a pre-survey with AI/AN teens and young adults interested in being interviewed about their experience using We R Native’s communication channels. Users ranked the channels they’d prefer to get messages on, ranking text messaging and Instagram most favorably.

Quality, Trust and Impact of We R Native’s Mental Health Messages:

Interview participants shared numerous ways We R Native’s messages have improved their own mental health, cultural connectedness, sense of self-worth, and access to health resources – both for themselves and their loved ones:

“I used to believe that mental illness was something to be ashamed about and the way that people look at it on the website – they look at it as a story, and that story can help so many other people – knowing that they’re not alone, knowing that there are other people to talk to.”

Priority Mental Health Concerns

When asked to reflect on their own mental health concerns, teens 15-17 years-old identified stress, depression, and anxiety. The young adults 18-24 years-old discussed suicide prevention, depression, and unhealthy relationships. Overall, grief and depression were the most common mental health topics discussed by participants, followed by stress and mental wellness skills (e.g. coping mechanisms).

Quarter 2

Tell us about the anticipated or real-time impact of this project.

Research investigating the effectiveness of social media- and text-based interventions has yet to focus on mental health outcomes for AI/AN youth. As a result, there are no rigorously evaluated interventions using these ubiquitous messaging platforms and technologies. The BRAVE study will focus on widely-available communication platforms that have not been widely studied in relation to adolescent mental health. Our intervention will reach 1,500 AI/AN Native teens and young adults nationwide.

Tell us about problems encountered, changes to your approach, and reasons behind these changes.

We anticipated interviewing 45 AI/AN teens and young adults (10+ who have used the website, 10+ who’ve used our Ask Auntie Q&A service, 10+ who have used our text messaging service, and 10+ who have used our social media platforms). Through the interest form and first 9 interviews, we are finding that most youth report using more than one channel and revised our interview guide to cover all (applicable) channels during the interview.

Quarter 1

What excites you about the funded project?

We are so incredibly grateful for the opportunity to do this work. It is generating new analytic tools we will use to monitor our messaging’s uptake and impact, and it’s creating new opportunities for us to hear first-hand from our users about ways we can better support their mental health and wellness. This work will inform the development of innovative tools to support resilience and help-seeking run across We R Native’s messaging channels.

Tell us more about your team!

· Stephanie Craig Rushing, PhD, MPH, is the daughter of a teacher and a coffee salesman, mother of two mischief-makers, and a PI at the Northwest Portland Area Indian Health Board.

· Morgan Thomas, MFA, is a short-story writer from the Gulf Coast.

· Jackie Johnson is a Makah Tribal member, NPAIHB Research Assistant, and interview extraordinaire for the TAM study.

· David Stephens, BSN, RN, is a Haida descendant, son of a tribal health director and school bus driver, father of a lively 2-year-old, and a nurse with a passion for improving the lives of Native youth.

· Sheana Bull, PhD, MPH is native to Thunder Bay, Ontario Canada, but raised in the U.S., and has lived the past 22 years in Denver, Colorado, where she and her husband have raised two kids.

· Isaac Alawobu: A Ghanaian and currently the Business Manager for the mHealth Impact Lab.

· Kira Elsbernd: Originally from northern California, Kira Elsbernd, MPH is a graduate research assistant at the mHealth Impact Lab in the Colorado School of Public Health.

· Kelsey Ford MPH DrPH(c) is a project manager and research assistant at the mHealth Impact Lab.

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