The Acceptability of Text Messaging to Help African American Women Manage Anxiety and Depression: Cross-Sectional Survey Study (Preprint)

Abstract

BACKGROUND The rates of mental illness among African American women are comparable with the general population; however, they significantly underutilize mental health services compared with their white counterparts. Previous studies revealed that interventions delivered via text messaging are effective and can be used to increase access to services and resources. More insight into whether or not this modality is acceptable for use to deliver mental health care to help African American women manage anxiety and depression is needed. OBJECTIVE This exploratory study aimed to gain insight into the acceptability of using text messaging to help African American women manage anxiety and depression. METHODS A self-administered Web-based survey was launched in June 2018 and closed in August 2018. Eligible participants were African American women (18 years or older) who reside in the United States. Participants were recruited through convenience sampling (eg, email sent via listservs and social media posts). Respondents were provided an anonymous link to the questionnaire. The survey consisted of 53 questions on the following subjects: sociodemographic characteristics, attitudes toward seeking professional psychological help, mobile phone use, and acceptability of using a mobile phone to receive mental health care. RESULTS The results of this exploratory study (N=101) showed that fewer than half of respondents endorsed the use of text messaging to communicate with a professional to receive help to manage anxiety (49/101, 48.5%) and depression (43/101, 42.6%). Approximately 51.4% (52/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with anxiety would be helpful. Similarly, 48.5% (49/101) agreed that having the option to use text messaging to communicate with a professional if they are dealing with depression would be helpful. Among participants who agreed that text messaging would be helpful, more than 80% noted being comfortable with its use to receive help for managing anxiety (approximately 86%, 45/52) and depression (approximately 82%, 40/49; highly significant positive association, all <i>P</i><.001). More than 50% of respondents (56/101, 55.4%) indicated having concerns about using text messaging. No statistically significant associations were found between age and agreement with the use of text messaging to communicate with a professional to receive help for managing anxiety (<i>P</i>=.26) or depression (<i>P</i>=.27). CONCLUSIONS The use of text messaging was not highly endorsed by African American women as an acceptable mode of communication with a professional to help them manage anxiety or depression. Concerns around privacy, confidentiality, and the impersonal feel of communicating about sensitive issues via text messages must be addressed for this modality to be a viable option. The findings of this study demonstrated the need for further research into the use of mobile technology to provide this population with more accessible and convenient options for mental health care.

Attitudes Toward Seeking Mental Health Services and Mobile Technology to Support the Management of Depression Among Black American Women: Cross-Sectional Survey Study

“…Respondents were most comfortable with the use of voice call or video call to communicate with a professional to receive help for managing depression. The results supported the findings of the preliminary study that showed that Black American women were more comfortable with the use of video call than SMS text messaging to communicate with a professional to receive help for managing depression [34,36]. Furthermore, most respondents agreed that having the option to use voice call or video call to communicate with a professional if they are dealing with depression would be helpful.…”

“…Sample proportions from the preliminary study exploring the acceptability of telemedicine to support the management of anxiety and depression among Black American women were considered for use in nQuery (Statsols) statistical software to determine the necessary sample size to obtain a specified level of precision via a half-width of 0.05 for a 2-sided 95% CI [34,36]. On the basis of a conservative scenario with an expected proportion of 0.50, the sample size required to obtain this level of precision was determined to be 385.…”

“…Demographic variables also included race (Black or African American or multiracial-defined as Black or African American and another race), ethnicity (Hispanic or non-Hispanic), education (high school diploma or General Educational Development tests; some college, <4-year degree; or bachelor's degree or higher), income (≤US $10,000, US $10,000-US $24,999, US $25,000-US $49,999, US $50,000-US $100,000, or ≥US $100,000), health insurance (yes or no), and the region in the United States in which the respondent currently lives (Midwest, Northeast, West, or South). For additional context, age was dichotomized into 2 groups (<50 years and ≥50 years) and education was categorized into 2 levels (less than a bachelor's degree and a bachelor's degree or higher) to be consistent with the preliminary study [34,36].…”

“…Black women have high rates of smartphone ownership (80%) and, in general, are comfortable with participating in mobile health (mHealth) research and interventions [34,35]. Moreover, they are more willing to participate in mHealth research "if they were interested in the topic, if they had an opportunity to become more educated about the topic, and to contribute to the greater good" [35].…”

“…Building upon prior work [34,36], the purpose of this study was to gauge the attitudes and perceptions of Black American women toward using mental health services and determine the acceptability of using mobile technology (eg, mobile app, video call, voice call, or SMS text messaging) to support the management of depression. The study was guided by two theoretical frameworks: (1) the Theory of Planned Behavior (TPB) model [37] and (2) the Technology Acceptance Model (TAM) [38].…”