Sandra L Bloom

Background : Sexual risk-taking behavior in underserved minority urban youth is an important factor in prevalence of sexually-transmitted diseases, mental health issues, and other risks and disease burden. Modern technological developments with cell phones or other mobile devices, which are widely and skillfully used in this population, have potential to transform these behaviors using gaming approaches to education.
Objective : The study objective was creation of a user-centered participatory design mHealth app development approach: An approach necessary for the success of these interventions.
Methods : Researchers conducted a descriptive study of the creation of an interactive story app developed with at-risk teens to better manage risky behavior. The site was a HIV/STI/pregnancy prevention program. The participatory design youth group was a moderator-led focus group whose discussions about the app were recorded for researcher access. With the site’s project manager, the remotely-located researchers planned the app development, identified the story’s decision points (e.g. would partner use condom?), designed the graphics, reviewed the recordings, and iteratively programmed the app, eliciting feedback from the focus groups.
Results : For the interactive story about selecting romantic partners, the focus group created the app plot line and advice-providing avatars at decision points, and role-played the scenario dialog. The advice was drawn for the well-accepted trauma-informed care intervention, SELF. To make certain that at-risk teens are compelled to use the app and find that its content and ‘voice’ are credible; the group was framed as experts regarding challenges app users face.
Discussion : Patient centered care including trauma-informed psychoeducational interventions could be delivered through mHealth interventions that are less resource intensive for the mental health delivery system. Despite promise, these approaches can only succeed if teens themselves accept them. Inclusion of teens as expert app users in a user-centered participatory design approach is necessary for mHealth app development for this population.
Learning Areas: Communication and informatics Diversity and culture Planning of health education strategies, interventions, and programs
Learning Objectives: Discuss the importance of patient-driven participation in mHealth development. Define elements of a participatory design approach to mHealth development. Identify components of an mHealth interactive story application.

After a century-long detour, psychiatry is finding its way back to a vision of psychiatric dysfunction as originating in normal reactions to abnormal stress (Van der Kolk, 1987; Van der Kolk et al, 1989). The study of psychological trauma and its effects as the major factor in the origin of a significant amount of psychiatric illness is creating a paradigm shift with profound consequences to the treatment of the mentally ill and to society at large.

The innate defense against the overwhelming nature of psychological stress is dissociation - the ability to segregate certain mental processes from the rest of the psychic apparatus. This mechanism allows the traumatized individual to split off the overwhelming affect from the experience itself, thus permitting the person to continue to function and defend himself without being paralyzed by emotion. [1st paragraph]