Effectiveness and Implementation of a Text Messaging Intervention to Reduce Depression and Anxiety Symptoms Among Latinx and White Adults During the COVID-19 Pandemic
Bibliographic record
Abstract
Background SMS text messaging interventions are increasingly being used to help people manage mental health symptoms due to the COVID-19 pandemic. Despite the widespread adoption of SMS text messaging interventions, little is known about racial and ethnic differences in effectiveness, feasibility, and implementation factors. Objective A hybrid type 1 mixed-methods study was conducted to compare the effectiveness and implementation of the StayWell intervention for Latinx and non-Latinx White (White) adults using elements of the RE-AIM framework. Methods Adults using the StayWell intervention received daily mood inquiries and skills–based text messages for 60 days and reported symptoms via online surveys and the HealthySMS portal. Reach was assessed by the share of adults reached via distinct recruitment methods, and effectiveness was evaluated using the Personal Health Questionnaire (PHQ-8) depression scale and General Anxiety Disorder (GAD-7) scale. Adoption was assessed with user engagement, defined as the share of responses to the (60) daily mood inquiries. Implementation was evaluated based on user feedback on the number/timing of messages, the difficulty of using the program, and the System Usability Scale. Maintenance was assessed with user reports of the likelihood of continuing and recommending the program. Quantitative RE-AIM indicators were assessed using a t test for continuous outcomes and a chi-square test for categorical outcomes. Mixed-effects linear regressions examined heterogeneity among Latinx and White users in the outcomes’ (ie, PHQ-8 and GAD-7) changes over time. A thematic text analysis of responses to an open-ended question about participant experiences of the program was conducted to help contextualize differences in the effectiveness and implementation of StayWell between Latinx and White users. Results Among 398 users, 262 (65.8%) responded to the postintervention assessment. Upon completion, depressive (–1.48; P=.001) and anxiety (–1.38; P=.001) symptoms decreased among all users. Compared to White adults, Latinx adults reported an additional –1.45 (P<.05) decline in PHQ-8 scores, adjusting for demographics, recruitment sample, and engagement. Among Latinx adults, StayWell resulted in a greater improvement of depression symptoms (25.8% vs 13.8% reduction; P=.02) but not in anxiety symptoms (21.2% vs 15.9% reduction; P=.23). Despite Latinx adults reporting lower usability (76.8 vs 83.9; P=.001) than White adults, they were more likely to report interest in continuing the program (7.5 vs 6.2; P=.001) and recommend StayWell to a family member or friend (7.8 vs 7.0; P=.013). Repetitive content was a critical barrier to engaging Latinx adults in StayWell; among Latinx adults, support groups and bidirectional messages were considered important program modifications. Conclusions Although anxiety and depressive symptoms decreased among all StayWell users after receiving 2 messages daily for 60 days, Latinx users experienced greater reductions in depression symptoms compared to White users. Bidirectional text messaging using contextual information and ecological momentary analysis of mood data are promising adaptations to enable the tailoring of messages and improved usability of StayWell, which may be especially effective in improving Latinx user engagement. Trial Registration ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 Conflicts of Interest None declared.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".