Dr. Ariel Smith-Malonga is exploring how a social media simulation game can help reduce dating violence and suicidality among young LGBT identifying individuals.
Ariel Smith-Malonga, RN, PhD
Assistant Professor
Department of Population Health Nursing Science
College of Nursing
University of Illinois Chicago
0:00 Ariel Smith-Malonga
Because you can have an intervention, you can have content, but what's the difference between taking that same concept and putting it in a pamphlet versus incorporating it into a digital tool that someone can take home with them and physically engage in to facilitate learning? And that's something that I've had to really chew on and digest and learn and apply in my thought process of how I'm building this out.
0:22 Voice Over (VO), Lauren:
Welcome to Collaborative Endeavors, a podcast about how experts from different areas of research come together to tackle big health challenges, leading to better therapies and healthier communities.
In this episode, we meet Dr. Ariel Smith-Malonga, an assistant professor within UIC College of Nursing. She is also one of the newest affiliate scholars under the Clinical and Translational Science Scholar’s program, focusing on her project, “Reducing Adverse Dating Outcomes,” or RADOS. RADOS is a social media simulation game focused on reducing dating violence among young LGBT identifying individuals. According to a 2021 brief from The Trevor Project, 11% of LGBTQ youth who reported dating someone in the past year experienced physical dating violence. This same study found that physical dating violence was associated with a greater likelihood of a suicide attempt within the previous year across age ranges as well as gender, racial and ethnic identities. In our conversation, Dr. Smith-Malonga described her experience with suicidal youth and how this has shaped her career ambition to become a leader in the creation of digital tools to reduce adverse mental health outcomes within this population.
1:34 Smith-Malonga:
I did all of my formal training down at the University of Miami and Coral Gables. Initially, when I went down, I was interested in pursuing an accelerated medical program, but I did a little bit of shadowing, and I realized I wanted more one-on-one interaction. I wanted to be more directly involved with patients throughout the trajectory of their care. Talked to a few nurses, I'm like, hey, that sounds like it's the career path for me. Just because I can be in a patient's room, I get to see them from start to finish, and I feel like I had more of a direct impact. But even as I was getting my BSN in nursing, I worked as a psych mental health nurse for a bit, you realize there's limitations at every single level. As a psych mental health nurse, I had patients coming in- mostly kids because I was child psych- where I felt so limited in my ability to actually help them. I would have kids coming in for suicide ideation, I will have kids coming in for cutting, and there's only very few interventions that they would qualify for, or that them and their parents would actually be willing to invest in long term. When I had the opportunity to pursue a PhD, I didn't even know what it was. I'm like- What is a doctor nurse? What is a PhD in nursing? But I found that I would be able to develop new knowledge, develop new tools to fill in gaps that I saw within my current practice, and I absolutely love that. And it made me fall in love with research. I feel like a lot of times people hear the word research, and they think you're in a white coat and a lab behind the screen. And yes, that's all important, but research is also getting out there in a community, identifying needs, and saying- how can I, within my current skill set but also partnering with other people, fill the gaps that I see in my current practice? I absolutely fell in love with knowledge, acquisition, and translational science, and putting work to practice and collaborating within multi-disciplinary teams.
3:18 VO:
While CATS affiliates are not funded through the NIH KL2 grant, their home departments still agree to protect their time to focus on research interests. This allows affiliates to participate in the rest of the CATS program curriculum, including crafting and implementing Individual Development Plans, attending monthly development activities and more. Dr. Smith-Malonga described her project supported by the CATS affiliate program.
3:34 Smith-Malonga:
A lot of my dissertation work focused on examining differences in violence, but also suicidality among different populations. So prevalence rates within heterosexual groups, specifically heterosexual youth, and also the sexual minority subgroups. When you look at a lot of literature, they combine LGBT individuals into one cluster when they have extremely unique experiences. What I was extremely interested in is dissecting that cluster and seeing how lived experience varied between individuals who were identified as lesbian, gay versus bisexual versus those that were unsure. And what I found is that individuals that identified as LGBT in general had significantly higher rates as compared to the heterosexual counterparts. However, bisexual individuals specifically, they were the group that were driving those prevalence rates up because they represented the highest rates. It just all stems from stigma. You know, when you are bisexual, the individuals that may be heterosexual, identify as straight, they may not view you as a part of their community if you're not just completely straight. If you don't identify as lesbian and gay, the individuals within that community may not particularly invite you or consider you a part of their community. So, you're kind of in this isolated space, where there's a complete lack of understanding, but also extreme microaggressions where people have these negative perceptions of who you are as a person based on how you identify.
During my postdoc at University of Illinois Chicago, which is how I ended up at UIC, there are incredible scholars doing incredible sexual minority health research. And I want to be a part of that to see how I can fill that gap. There are very few evidence-based interventions that address dating violence and suicidality among sexual minority youth, and there is a need for all youth, indeed. However, sexual minority individuals, they have very unique lived experiences that need to be accounted for when developing interventions. So, my intervention it's called RADOS, “Reducing Adverse Dating Outcomes and Suicidality.” It's a social media simulation game. I've conducted some focus groups, I interviewed some 15 to 18 year olds. I had interviewed some 18 to 24 year olds, and 18 to 24 year old sexual minority individuals are more likely to have been in and encountered relationships. They also found the game to be extremely intriguing and extremely inviting, and they were like, this is something that I can actually see myself engaging in. I decided to go with a social media platform because social media is just well embedded within our culture and society today, over 95% of young adults and adults in general have access to a mobile device at all times. So, when thinking about creating an intervention that's easily accessible, that was my biggest thing. One the gold standard interventions for suicidality is called dialectical behavioral therapy. It's a 12 month intervention, and sometimes we don't have 12 months to intervene in somebody's life. So it's thinking about, how can we take core components and emotional regulation, you know interpersonal relationships, and infuse that within an intervention platform that we can get out to someone right away. That was kind of the mindset that I had when developing this intervention, which focuses specifically on dating violence, but also navigating stress and stigma and maintaining healthy relationships.
It's helping people to identify- hey, if you're dating this guy or this girl or this individual, and they're calling and texting you all night, even while you're out with your friends, it is not necessarily because they love you. That can be a sign of a controlling tendency. Are you actually able to identify that? And then how will you respond once you are able to pinpoint? It's equipping young adults, and participants in general, with the skills to identify the behavior, name the experience, but then how do you respond? Because I feel like in a lot of situations, you get to step one or step two like I can identify it, I can name it, but when it comes to responding or intervening on my own behalf, advocating for myself, I just feel ill equipped. And that was the story that I was getting from so many of the young adults that I interviewed: I stayed in that situation because I wasn't quite sure, a fear of being alone, a fear of being outed, a fear of being casted out. So equipping them with also resources- when you're taking these necessary steps, what are environments? What are communities or individuals that you can reach out for support when you're undergoing these situations? And I wanted to package this intervention where it felt real, it felt raw, but it was also a safe space where people can navigate through these different situations in the environment where they can make mistakes. They can receive critiques and feedback and correction and justification as to why another mechanism of action, another pathway, another response, would be more appropriate. It's actually been a lot of fun. And my vision for this intervention is that it's a tool that's accessible to any individual regardless of identity, however, I'm going to have culturally targeted segments that address unique cultural elements for each identity type. That's my vision for it, that it's a resource that we can get out to all young adults, because, you know, it doesn't matter what your background is, doesn't matter what your sexual identity, gender identity is- maintaining healthy relationships is hard. Especially in a society where we don't interact and communicate face to face like we used to. However, we cannot deny that there are unique stigmas. There are unique experiences that certain individuals encounter that need to be incorporated into the science and the mindset behind creating these tools.
We've incorporated a lot of technology as well. It looks like social media. The platform where they'll get an icon that glares up like, “you just received a direct message from Brandy,” one of the characters within the game, and you're actually tasked to communicate and respond to this bot that has been trained to kind of navigate you through the system of processing and learning throughout the targeted scenario. I’ve used the behavioral theory of dating violence to guide every single scenario included within the game, and I'm excited because I'm submitting an NIH R34 grant to help refine the gaming component, but allow me to test it in a more widespread manner prior to moving on to full out efficacy testing. So, it's been a journey. It's been a new space. I've had to learn a lot about collaborating with individuals from different disciplines, because as a nurse, I'm not a coder. You know, I'm not familiar with all the tech behind it. But I think to do good science, it takes pulling multiple minds together.
10:29 VO:
Dr. Smith-Malonga went on to describe her mentor team and how they are helping to round out her expertise and grow as a translational scientist.
10:39 Smith-Malonga:
One of the main drivers that brought me to UIC was the strong mentorship system and infrastructure that they have built in for new investigators. Phoenix Matthews, they are actually out in Columbia University in their School of Nursing. Phoenix has an incredible background when it comes to intervention implementation. They've done a lot of work with smoking cessation among LGBTQ population, wide scale efficacy testing. And they've been giving me a lot of perspective on what it looks like to actually build and develop an intervention and then move it forward from it being a thought in my mind to acceptability testing, feasibility testing and connecting with community partners. Wendy Bostwick is also an associate professor here at UIC within the College of Nursing, who has been my main point person- considering that she is local, she's here in person- when it comes to the content and making sure that I'm involving the population- 18 to 24 year olds identifying within an LGBT community- in every single stage of developmental process. I was fortunate enough to get connected to Rebecca Schnall, who is also out at Columbia. She's done a lot of HIV prevention work among LGBT youth, however, she's used a ton of mHealth technology and that was huge for me. I wanted an individual on my mentorship team that has paired the nursing mindset, the social behavioral research, with technology. I also have my mentor, Rohan Jeremiah. When it comes to dating violence, he is a dating violence and intimate partner violence expert and has done work globally. And I can't not shout out my game development company, Denovo Studios, who I've been partnered with since, I believe, 2021/2022 when I first thought of this concept. And we've been building out the platform. It's been expensive, but it's been so worth it having a professional gaming company come in to make sure, from a technological standpoint, this intervention will stand the test of time when it comes to implementing updates, implementing the content, training, the artificial intelligence bot to function the way that I want. So, I could not have done this work at all without such a diverse and experienced team.
13:03 VO:
Dr. Smith-Malongo talked about the future potential of mobile technology-based interventions to reduce dating violence, drive meaningful behavior change and – ideally- reduce suicidality in the process.
13:16 Smith-Malonga:
The translational piece for me has been taking the science and merging it at the intersection of technology. Because you can have an intervention, you can have content, but what's the difference between taking that same concept and putting it in a pamphlet versus incorporating it into a digital tool that someone can take home with them and physically engage in to facilitate learning? And that's something that I've had to really chew on and digest and learn and apply in my thought process of how I'm building this out. Like, what's the change mechanism? What's the feedback loop. What's the lever that I'm trying to push in order to see a change in the actual behavioral outcome? And then presenting that in a way that's appealing to my target population. Because the thing is, I could think that this is an amazing idea, but if I get this to college age students and they're like- this is not anything that I would want to engage in at all or this isn't what our lived experience looks like- then I just developed a very expensive tool that doesn't get to the root of the problem and it doesn't change anything. So, I think for me, it's translating the knowledge of what we know to be true, based on theory, based on facts, incorporating it into the actual lived experiences of these individuals, and then feeding that into a tool that can facilitate behavioral change and learning. I've done a lot of research recently looking at dating violence interventions for sexual and gender minority individuals, and there are very, very few that are evidence based and actually facilitate change. But what we found is that a lot of times we think that by changing knowledge, immediately we will change behavior. And that's not the case. People need the opportunity to develop skills. So how do we do that? It's thinking of, how can we develop an intervention taking that knowledge and applying it so individuals, participants feel that- I have the tools I need. I have the skills to actually go out and live my life a different way to promote my overall health.
In a lot of my work, I've looked at the relationship between dating violence and suicidality, and there is a very strong relationship there, especially among 18 to 24 year olds. I want to kind of pivot into leaning more into suicide prevention with my same application, but of course adjusting it a little bit. There are a ton of people that come into the emergency department for suicide related behaviors, or just self-injurious behavior, whether it's with suicidal intent or not suicidal intent. But not all of those individuals are admitted. A lot of times they come into the ER, they get stabilized, and if they're not an immediate threat to themselves or others, they get sent home. And what we found a lot of times, those readmission rates for individuals that get sent home are still relatively high, especially if they're within an intimate partner relationship. Meaning they're probably still having issues within their relationships, but they also don't have the tools to regulate their emotions. Coupled with that, the infrastructure of mental health in our nation in general is just not that great. You may get discharged and say, “Go see your mental health provider within 7 days”, but if that person's not available, an individual can go two weeks to a month without being connected to mental health care. What I'm interested in doing is creating an intervention that bridges that wait time gap. So if you're not able to get connected to your healthcare provider for a week, I would love to have an intervention that I can send home with a person when they're discharged from the hospital that starts touching on skills of emotional regulation, interpersonal relationships, right? Different tools and skills that they can use to regulate their emotions, have important dialogue, and communicate in a healthy way with individuals within their sphere of influence, until they're able to get that large boost of care when they get connected to their healthcare provider. And that's why I really want to develop this intervention in an app form, because then it can get taken with that individual wherever they go. So that's also something that's really high on my priority list right now.
17:16 VO:
Dr. Smith-Malongo concluded with thoughts on the critical role mentorship has played in her career and her aspirations to one day become a mentor and leader herself, driving translational science within the field of nursing.
17:30 Smith-Malonga:
I see myself being a leader when it comes to dating violence prevention, but also leveraging digital tools to elicit change specifically among minority youth and young adults. I see myself being having my own center, partnering on a larger scale to leverage technology to really impact dating violence and suicide prevention among minority individuals. I'm very grateful for the NIH KL2, just because mentorship is everything. And I think that we can't talk about it enough; like it can't be overstated. I feel like it's very unique to UIC, especially within the College of Nursing, but everything I've seen within the CCTS program where you have so many people willing to help. Mentorship was the reason I came to UIC as a postdoc. Mentorship was the reason the grants that I have received that I've received them, because I've had the experiences of other people as a guide instead of me having to make the mistakes on my own, and having the KL2, having so much support from people that are genuinely invested in what you desire your next steps to be. Someone can have a goal or a vision of where they want you to be in five to ten years, but having people that say, “Hey, here's your individual development plan that is completely targeted to where you see yourself,” and then being held accountable in that as an early stage investigator. Especially being a mom with multiple small children, it can be very easy to get distracted, but it can also be very easy to make excuses as to why we can't right. So, having individuals in my corner that understand the phase of life that I'm in, but also empower me to overcome and realize that I can still do all the things while being a mom. My path and my journey, my trajectory may look a little bit different, but that's the beautiful thing about it. I love doing this work. I love being able to represent individuals that look and sound like me. I always appreciate programs that invest into their early stage investigators, realizing that we're early stage right now, but it won't be like that forever. So now I have the tools and the resources to make sure that I do good science. And that's one thing that I really value: doing the work and doing it really, really, really well, so that when it comes to diversifying the nursing workforce and developing the next generation of nurse leaders, that I can be a part of that as well. And I do see myself in one of those leadership positions one day.
20:05 Voice Over:
Collaborative Endeavors is written and produced by me, Lauren Rieger, on behalf of the Center for Clinical and Translational Science (AKA the CCTS) at the University of Illinois Chicago.
To learn more about Dr. Ariel Smith Malonga and the CCTS’s KL2 CATS and CATS affiliate program, visit the links in our show notes.
The CCTS is supported by the National Institutes of Health’s National Center for Advancing Translational Science through their Clinical and Translational Science Award. Opinions expressed by guests of the show are their own and do not necessarily represent the views of myself, the CCTS or our funding agencies.
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