Culturally Informed Digital Behavioral Intervention Development for Inflammatory Bowel Disease: A Qualitative Study

Recognition of the bidirectional effects between psychological distress (ie, anxiety, depression, perceived stress) and inflammatory bowel disease (IBD) activity has led to efforts to integrate behavioral medicine in the management of IBD. As part of a broader project focused on testing the feasibility and acceptability of digital mind-body interventions among a greater diversity of people with IBD, we collected qualitative data on the lived experience of patients from Black and/or Hispanic backgrounds in an outpatient gastroenterology setting. We aimed to understand how racial and ethnic background influences patients' illness perceptions and receptivity to a digital mind-body intervention for psychological distress in IBD.

Data were collected (2022-2023) via semi-structured interviews among IBD patients (n = 25) attending an outpatient gastroenterology practice. All data collection occurred virtually and was audio recorded. Transcripts were thematically analyzed and coded via NVivo software.

We identified 3 core themes regarding the influence of racial and ethnic background on IBD experience with relevance to intervention design and content: broad impact of racial and cultural identity on IBD; resonance of gut-brain interaction with personal experience notwithstanding barriers to mental healthcare; and acceptance of digital technology in everyday life and health. For most, digital technology was part of their everyday life, and a digitally delivered self-management resource would be welcome.

Racial and ethnic background influences IBD patients' illness perception, coping, and desires for support. Findings can directly inform the design and content of digital behavioral interventions in IBD towards increased applicability and equitable engagement.