Targeted Stories Help Users Help Themselves

Can an involving, targeted story motivate a person to take action to help themselves? Dr. MarySue Heilemann, UCLA School of Nursing professor, predicts it can. Heilemann has created an intervention designed to help Latinas overcome barriers to seeking mental health treatment. Catalina: Confronting My Emotions/ Enfrentando Mis Emociones is a choice-driven, professionally produced web-based app users can interact with across multiple digital platforms. Pilot studies showed the app generated more sustained interest and engagement among users after six weeks than those participants who watched videos about another topic. 

Now, the National Institute of Mental Health has awarded Heilemann and her six co-investigators a $3.68 million, five-year grant to conduct a randomized controlled trial exploring whether the app motivates users to take action at a higher rate than for control group participants. Examples of actions include identifying a place to obtain therapy, making an appointment, keeping the appointment, continuing with therapy, or obtaining and filling a prescription for medication.

“NIH grants are extremely competitive, and they are looking for studies that will move the needle,” Heilemann says. She believes the grant award recognizes the strong investigative team and the groundbreaking nature of the study. “Many studies have looked at how stories change attitudes, but few have tested whether stories can change behavior,” Heilemann says. “If this works, it could be easily scalable.” She notes that story-based apps could potentially address a range of health topics such as managing diabetes or high blood pressure, or boosting vaccine compliance. 

The study will begin in early 2025 and enroll 876 Latina women who scored on validated scales as having untreated depression or anxiety. Participants will answer questionnaires before starting the study, and at one, five, and nine months afterward. 

“Research shows Latina women are not just undertreated, but underdiagnosed due to factors including stigma, cultural concerns, distrust of professionals, and lack of insurance,” Heilemann says. “They often don’t even know they’re struggling with depression and anxiety; they’re just struggling. They don’t seek services or resources because they think their situation is normal. That’s unacceptable. I wanted to create something to show the women it doesn’t have to be this way and they can get help tailored to their needs.” 

Heilemann understands the power of a good story to capture the listener. When a story features a character people relate to, she says, they find it irresistible. Movies such as Star Wars demonstrate the enthusiasm for interacting with a story as much as possible, such as through comic books, fan fiction, and merchandise. 

The phenomenon of expanding and telling a story across multiple platforms is called transmedia, and Heilemann has pioneered its use for mental health interventions. She presented on the topic as a delegate to the 2018 United Nations Commission on the Status of Women. 

Heilemann linked the need for a Latina mental health intervention with the idea of transmedia to create the free app. Using the information gleaned from her studies on Latina mental health, she worked with a Latinx scriptwriter (who also served as the director) and therapists to create a script. Heilemann, the director, his production staff, Latinx actors, a composer, and a sound editor collaborated to create videos and tools accessible by smartphone, tablet, and computer. 

Catalina: Confronting My Emotions includes six videos and a blog with a story centering on a 28-year-old Latina single mother of a young child. Participants see Catalina interact with her parents, child, and friends. She encounters setbacks and becomes increasingly aware that she is sad and anxious. Catalina decides to visit a nurse therapist. She later tells her friend what therapy is like and how her therapist helped her. 

Participants have the option to view a video of a character portraying Catalina’s nurse therapist, Veronica, who talks about the prevalence of depression and anxiety and assures participants, “It doesn’t have to be that way.” Participants have another option to click on a module Veronica recommends, which explores the obstacles to getting help and what might be needed to overcome those obstacles. They also have access to Veronica’s blog, which includes an array of links to resources including local clinics, hotlines, and mental health information. A Pinterest page for Veronica is in the works. The app collects encrypted and HIPAA-protected data for analysis. 

In addition to looking at the actions participants take, the study will examine levels of stigma and attitudes about seeking mental health help and whether participants’ levels of depression and anxiety show a decrease.