Design and evaluation of a mobile-based intervention for Maya adults during the COVID-19 pandemic
Diseño y evaluación de una intervención basada en dispositivos móviles para adultos mayas durante la pandemia COVID-19
Alejandro Dominguez-Rodriguez
,
Karla Dzul-Rosado
,
Rosa Olimpia Castellanos-Vargas
,
Sergio Sanz Gómez
,
Paulina Erika Herdoiza-Arroyo
,
Yolanda de Jesús Hernández Delgado
,
Juan Ancona-Manzanilla
,
Juan Jose Arias-León
,
Cessia Esther Chuc Uc
,
Margarita Gabriela Albán-Terán
,
Emilia Gabriela Nieto Ramos
,
Emilia Nicole Villavicencio Calderón
,
Carlos Armando Arzola-Sánchez
,
Anabel de la Rosa-Gómez
,
Flor Rocío Ramírez-Martínez
,
Victoria Acosta Guzmán
,
Felipe Castillo Tzec
Revista Latinoamericana de Psicología, (2023), 55, pp. 202-211.
Received 20 October 2022
Accepted 12 June 2023
Introducción: La pandemia de COVID-19 tuvo impacto directo en la salud mental. Organizaciones internacionales han enfatizado la vulnerabilidad de los pueblos indígenas. Los enfoques de salud mental digital brindan terapia en línea como una opción de tratamiento basada en evidencia, efectiva y accesible; sin embargo, los datos son limitados en población indígena. El objetivo de este estudio fue describir el diseño, desarrollo y evaluación de la eficacia de una intervención en línea autoaplicada sobre síntomas psicológicos de depresión, ansiedad y miedo al COVID-19 en una muestra de población maya. Método: Se diseñó un estudio cuantitativo longitudinal prospectivo, donde se midió a un solo grupo antes y después de recibir la intervención en línea, implementada de abril a septiembre de 2021, que constó de seis sesiones impartidas vía WhatsApp, en español y maya. Resultados: La evaluación inicial se implementó con 82 participantes que fueron evaluados mediante el Cuestionario de Salud del Paciente, Escala para el Trastorno de Ansiedad Generalizada y Escala de Miedo al COVID-19; 18 participantes permanecieron para la evaluación posterior. Se observaron diferencias estadísticas en las medidas pre- y post- de depresión y ansiedad, pero no miedo al COVID-19. Conclusiones: Este estudio arrojó resultados positivos de la primera intervención de salud mental en línea implementada en la población indígena latinoamericana. Estudios futuros podrían considerar el desarrollo de intervenciones similares para otras comunidades indígenas en América Latina.
Palabras clave:
Población Maya, COVID-19, ansiedad, depresión, miedo al COVID-19, intervención en línea
Introduction: The COVID-19 pandemic has had a direct impact on mental health. International organisations have emphasised the vulnerability of indigenous people. Digital Mental Health approaches deliver online therapy as an evidence-based, effective, and accessible treatment option for common mental health problems. However, the evidence regarding these approaches is limited in indigenous populations. The objective of this study is to describe the design, development, and evaluation of the efficacy of a self-applied online intervention regarding the psychological symptoms of depression, anxiety, and fear of COVID-19 in a sample of the Maya population. Method: A prospective longitudinal quantitative study was designed, where a single group was measured before and after receiving the online intervention. This study took place from April to September 2021 and consisted of six sessions delivered via WhatsApp in Spanish and Mayan. Results: The initial assessment was implemented with 82 participants who were evaluated using the Patient Health Questionnaire, Scale for Generalised Anxiety Disorder and the Fear of COVID-19 Scale; 18 participants remained in the intervention for the post-assessment. Statistical differences were observed in PRE and POST measures of depression and anxiety, but not in fear of COVID-19. Conclusions: This study produced positive results for the first online mental health intervention implemented in the Latin American indigenous population. Future studies might consider developing similar interventions for other indigenous communities in Latin America.
Keywords:
Maya population, COVID-19, anxiety, depression, fear of COVID-19, online intervention
Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2022). The Fear of COVID-19 Scale: Development and Initial Validation. International Journal of Mental Health and Addiction, 20, 1537-1545. https://doi.org/10.1007/s11469-020-00270-8
Arrieta, J., Aguerrebere, M., Raviola, G., Flores, H., Elliott, P., Espinosa, A., Reyes, A., Ortiz-Panozo, E., Rodriguez-Gutierrez, E. G., Mukherjee, J., Palazuelos, D., & Franke, M. F. (2017). Validity and Utility of the Patient Health Questionnaire (PHQ)-2 and PHQ-9 for Screening and Diagnosis of Depression in Rural Chiapas, Mexico: A Cross-Sectional Study. Journal of Clinical Psychology, 73(9), 1076-1090. https://doi.org/10.1002/jclp.22390
Banco Interamericano de Desarrollo. (2022, July 12). COVID-19: Actualización de la situación en América Latina y el Caribe [COVID-19: Update on the situation in Latin America and the Caribbean].
Bernal, G., & Sáez-Santiago, E. (2006). Culturally centered psychosocial interventions. Journal of Community Psychology, 34(2), 121-132. https://doi.org/10.1002/JCOP.20096
Comisión Económica para América Latina y el Caribe. (2020). El impacto del COVID-19 en los pueblos indígenas de América Latina-Abya Yala: entre la invisibilización y la resistencia colectiva [Impact of COVID-19 on the indigenous peoples of Latin America-Abya Yala: Between invisibility and collective resistance]. Documentos de Proyectos, Estudios e Investigaciones. https://www.cepal.org/es/publicaciones/46543-impacto-covid-19-pueblos-indigenas-america-latina-abya-yala-la-invisibilizacion
Dominguez-Rodriguez, A., Sanz-Gomez, S., González Ramírez, L. P., Herdoiza-Arroyo, P. E., Trevino Garcia, L. E., de la Rosa-Gómez, A., González-Cantero, J. O., Macias-Aguinaga, V., & Miaja, M. (2023). The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial. Journal of Medical Internet Research, 25, e43839. https://doi.org/10.2196/43839
Dzul-Rosado, K.R., Dominguez-Rodriguez, A., Hernández Delgado, Castellanos Vargas, R.O., Arzola-Sánchez, C.A., Chuc Uc, C.,… Arias-León, J.J. (2023). Impact on Mental Health and Coping Strategies Among a Mayan Sample During the Covid-19 Pandemic: an Exploratory Qualitative Study. [Manuscript submitted for publication]
García-Campayo, J., Zamorano, E., Ruiz, M. A., Pardo, A., Pérez-Páramo, M., López-Gómez, V., Freire, O., & Rejas, J. (2010). Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health and Quality of Life Outcomes, 8(8). https://doi.org/10.1186/1477-7525-8-8
Hirschtritt, M. E., & Insel, T. R. (2018). Digital Technologies in Psychiatry: Present and Future. Focus The Journal of Lifelong Learning in Psychiatry, 16(3), 251–258. https://doi.org/10.1176/appi.focus.20180001
Horbath, J. E. (2022). Análisis de supervivencia de pacientes indígenas mexicanos contagiados con COVID-19 iniciando la pandemia [Survival analysis of Mexican indigenous patients infected with COVID-19 at the beginning of the pandemic]. Revista Latinoamericana de Población, 16, e202111. https://doi.org/10.31406/RELAP2021.V16.E202111
Huarcaya-Victoria, J., Villarreal-Zegarra, D., Podestà, A., & Luna-Cuadros, M. A. (2022). Psychometric Properties of a Spanish Version of the Fear of COVID-19 Scale in General Population of Lima, Peru. International Journal of Mental Health and Addiction, 20(1), 249-262. https://doi.org/10.1007/s11469-020-00354-5
Instituto Nacional de Estadística, Geografía e Informática [INEGI]. (2021). Censo de población y vivienda 2020 [Population and housing census 2020]. https://www.inegi.org.mx/programas/ccpv/2020/
Jouault, S., Enseñat-Soberanis, F. & Balladares-Soberano, C. (2018) The Mayan milpa in Yucatán: A transition between patrimonialization and turistification? Revista Gremium, 5(10), 9-24
Mak, W. W., Tong, A. C., Yip, S. Y., Lui, W. W., Chio, F. H., Chan, A. T., & Wong, C. C. (2018). Efficacy and moderation of mobile app-based programs for mindfulness-based training, self-compassion training, and cognitive behavioral psychoeducation on mental health: Randomized controlled noninferiority trial. JMIR Mental Health, 5(4), e60. https://doi.org/10.2196/mental.8597
Martínez, I. V., Larrea, S., Romero, F., & Cicolella, L. (2020). Conocimientos, actitudes y prácticas relacionadas a la pandemia del COVID-19 en comunidades indígenas de Yucatán y Chiapas [Knowledge, attitudes and practices related to the COVID-19 pandemic in indigenous communities of Yucatan and Chiapas]. Population Council. https://doi.org/10.31899/pgy16.1013
Meyerowitz-Katz, G., Ravi, S., Arnolda, L., Feng, X., Maberly, G., & Astell-Burt, T. (2020). Rates of attrition and dropout in app-based interventions for chronic disease: Systematic review and meta-analysis. Journal of Medical Internet Research, 22(9), e20283. https://doi.org/10.2196/20283
Pinzón-Pérez, H., & Vásquez Santos, L. (2021). Comunidades indígenas de Oaxaca, México. Problemas, oportunidades y retos en salud pública con atención especial en salud mental [Indigenous communities from Oaxaca, Mexico. Health problems, opportunities and challenges in public health with special attention in mental health]. Revista de la Facultad de Medicina Humana, 21(3), 691-698. https://doi.org/10.25176/RFMH.V21I3.3929
Povey, J., Mills, P. P. J. R., Dingwall, K. M., Lowell, A., Singer, J., Rotumah, D., Bennett-Levy, J., & Nagel, T. (2016). Acceptability of mental health apps for aboriginal and torres Atrait Islander Australians: A Qualitative Study. Journal of Medical Internet Research, 18(3). https://doi.org/10.2196/JMIR.5314
Richards, D., & Richardson, T. (2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32(4), 329-342. https://doi.org/10.1016/j.cpr.2012.02.004
Shepherd, M., Fleming, T., Lucassen, M., Stasiak, K., Lambie, I., & Merry, S. N. (2015). The design and relevance of a computerized gamified depression therapy program for indigenous Māori adolescents. JMIR Serious Games, 3(1), e3804. https://doi.org/10.2196/GAMES.3804
Şimşir, Z., Koç, H., Seki, T., & Griffiths, M. D. (2021). The relationship between fear of COVID-19 and mental health problems: A meta-analysis. Death Studies, 46(3), 515-523. https://doi.org/10.1080/07481187.2021.1889097
Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. The Journal of the American Medical Association, 282(18), 1737-1744. https://doi.org/10.1001/jama.282.18.1737
Tighe, J., Shand, F., Ridani, R., Mackinnon, A., De La Mata, N., & Christensen, H. (2017). Ibobbly mobile health intervention for suicide prevention in Australian Indigenous youth: A pilot randomised controlled trial. BMJ Open, 7(1), e013518. https://doi.org/10.1136/bmjopen-2016-013518
Torous, J., Lipschitz, J., Ng, M., & Firth, J. (2020). Dropout rates in clinical trials of smartphone apps for depressive symptoms: A systematic review and meta-analysis. Journal of Affective Disorders, 263, 413-419. https://doi.org/10.1016/j.jad.2019.11.167.
Vallejo, I. R., & Álvarez, K. (2020). A pandemia do coronavírus e a Amazônia Equatoriana: vulnerabilidades e esquecimento do Estado [The coronavirus pandemic and the Ecuadorian Amazon: Vulnerabilities and forgetfulness of the State]. Cadernos de Campo (São Paulo – 1991), 29(1), 94-110. https://doi.org/10.11606/ISSN.2316-9133.V29I1P94-110
Williams, A., Farhall, J., Fossey, E., & Thomas, N. (2019). Internet-based interventions to support recovery and self-management: A scoping review of their use by mental health service users and providers together. BMC Psychiatry, 19(1), 191. https://doi.org/10.1186/s12888-019-2153-0
Xiong, J., Lipsitz, O., Nasri, F., Lui, L. M. W., Gill, H., Phan, L., Chen-Li, D., Iacobucci, M., Ho, R., Majeed, A., & McIntyre, R. S. (2020). Impact of COVID-19 pandemic on mental health in the general population: A systematic review. Journal of Affective Disorders, 277(1), 55-64. https://doi.org/10.1016/J.JAD.2020.08.001
Yeshua-Katz, D., Shapira, S., Aharonson-Daniel, L., Clarfield, A. M., & Sarid, O. (2021). Matching digital intervention affordances with tasks: The case of a Zoom and WhatsApp mental health intervention for seniors during the COVID-19 pandemic. Health Communication, 38(3), 499-511. https://doi.org/10.1080/10410236.2021.1956071