Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Two-way interactive text messaging between patient and community health workers through mobile phone short message service (SMS) is a form of digital health that can be used cost-effectively to enhance patient engagement. Objective: We developed a two-way interactive communication SMS tool to enhance child/adolescent patient engagement between patients and/or caregivers and community health workers. Methods: We applied a design thinking methodology for development of the SMS tool. We collected qualitative data from 127 patients/caregivers and 13 community health workers, healthcare professionals, and experts. Four iterative phases were used to design the final prototype. Results: Outcomes from the design thinking process led to the final SMS tool that integrated multi-user feedback. The SMS tool was transformed from a one-dimensional, template-driven prototype (phases 1 and 2) into a dynamic interactive and individually tailored tool (phases 3 and 4). The individualized components consider social factors that influence patients’ ability to engage such as transportation issues and appointment reminders. SMS tool components also include operational factors to support staff such as patient contact lists, SMS templates, and technology chat support. Conclusions: Our SMS tool may be useful to patients who are unable, due to lack of resources such as time, data and Wi-Fi, to interact face-to-face with their healthcare team. We recommend that developers use hybrid computer-human interactions that utilize existing low cost and easy to use technology, such as SMS text messaging, in order to optimize personalized experience and the likelihood of enhanced patient engagement.

The high prevalence of major depressive disorder in adolescents and the low rate of successful treatment highlight a pressing need for accessible, affordable adolescent depression prevention programs. The Internet offers opportunities to provide adolescents with high quality, evidence-based programs without burdening or creating new care delivery systems. Internet-based interventions hold promise, but further research is needed to explore the efficacy of these approaches and ways of integrating emerging technologies for behavioral health into the primary care system. We developed a primary care Internet-based depression prevention intervention, Competent Adulthood Transition with Cognitive Behavioral Humanistic and Interpersonal Training (CATCH-IT), to evaluate a self-guided, online approach to depression prevention and are conducting a randomized clinical trial comparing CATCH-IT to a general health education Internet intervention. This article documents the research framework and randomized clinical trial design used to evaluate CATCH-IT for adolescents, in order to inform future work in Internet-based adolescent prevention programs. The rationale for this trial is introduced, the current status of the study is reviewed, and potential implications and future directions are discussed. The current protocol represents the only current, systematic approach to connecting at-risk youth with self-directed depression prevention programs in a medical setting. This trial undertakes the complex public health task of identifying at-risk individuals through mass screening of the general primary care population, rather than solely relying on volunteers recruited over the Internet, and the trial design provides measures of both symptomatic and diagnostic clinical outcomes. At the present time, we have enrolled N = 234 adolescents/expected 400 and N = 186 parents/expected 400 in this trial, from N = 6 major health systems. The protocol described here provides a model for a new generation of interventions that blend substantial computer-based instruction with human contact to intervene to prevent mental disorders such as depression. Because of the potential for broad generalizability of this model, the results of this study are important, as they will help develop the guidelines for preventive interventions with youth at-risk for the development of depressive and other mental disorders. Clinical Trial Registry: NCT01893749 date 6 May 2012.

Approximately 13% to 20% of adolescents experience minor depressive episodes (mDE) or major depressive episodes (MDE) annually.¹ These adolescents have a higher incidence of medical illness² than those without mDE and MDE, and are at higher risk for suicide and recurrent depression.^3-5 Effective depression prevention programs are essential.⁶