Insights About Cannabis and Psychosis Using Video Games for Young People With a First Episode of Psychosis, Particularly Those From Black Racialized Communities: Protocol for a Mixed Methods Study

Background Cannabis use disorder among young people with a first episode of psychosis contributes to relapse, hospitalization, and impaired functioning. However, few studies have examined what young people with early phase psychosis, particularly those from Black racialized communities, understand or appreciate about this relationship, even though they may be at risk. There are no formally tested knowledge translation strategies that disseminate these research findings for young people with emerging psychosis from Black racialized communities. Objective This study aims to conceptualize what young people with early phase psychosis/cannabis use disorder understand about the relationship between cannabis and psychosis, focusing on people from racialized backgrounds. This study also aims to assess whether the knowledge translation product, the “Back to Reality Series,” increases awareness of the impact of cannabis use on psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Methods Qualitative analysis will reveal themes from qualitative interviews about cannabis and psychosis from the perspectives of young people with emerging psychosis and cannabis use disorder from Black African and Caribbean communities. Perceptions before and after exposure to the Back to Reality Series will be qualitatively analyzed. A control game will be used for comparison, and scores on a quiz after playing the Back to Reality Series will be quantitatively analyzed to establish whether the Back to Reality Series raises awareness of the effects of cannabis on psychosis. An advisory council involving young people from Black communities, family members, and clinicians will bring community perspectives to this research. Results We began recruiting participants for this study in September 2021. We will complete data collection on demographic and clinical factors, qualitative interviews, and quantitative assessments of the Back to Reality Series. Conclusions The voices of young people from racialized backgrounds will generate preliminary data to inform early psychosis programs, addressing cannabis use in this population. The findings may advance the use of a new knowledge translation product that deals with gaps in knowledge about cannabis use for people experiencing early phase psychosis, particularly those from racialized communities. International Registered Report Identifier (IRRID) DERR1-10.2196/36758


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The study aims to evaluate the use of a new video game (SERIES) focusing on black youth as a hero with psychosis. To be included in the study, a participant needs to have had a first episode of psychotic disorder and a cannabis use disorder. The standard clinical interview for DSM-V will be used to diagnose participants to be included in the study.
-Three sets of data will be collected; a) qualitative interview before the game, quantitative interviewwhich is meant to explore experiences and perspectives of cannabis and psychosis b) quantitative test using PCT quiz, a validated tool to measure the knowledge change on the connection between cannabis and psychosis and; c) qualitative interview focusing on experiences playing the game. -It is not clear why the researchers opted for a pre-game qualitative interview instead of a pre-game quantitative quiz, given that they intend to use a t-test to measure the change in knowledge ( pre and postintervention change). -The explicit role that the advisory council will play to respond to research objective three-i.e., to develop a strong participatory and community engagement component is not fully developed. - The research is well supported by the community based on the letters of support from the partner agencies -There is a strong mentorship component judging by the students both in graduate and undergraduate program involved in the study -This research builds on previous work with the community that led to the development and validation of the measurement tools and the video series. - The PI and her team have a track record of engaging in research with the community. - The team is well-positioned to conduct the study - The budget is justified well. A mixed methods study will be used and conducted virtually. Youth will be Black immigrants experiencing psychosis (new cases) and CUD. They will collect quant/qual baseline datathis is well described. The next visit will give youth a link to the videogames and collect data related to key outcomes. These procedures are well described, and well thought out. There will then be another qualitative interview. Figure 2 was helpful to visualize the key components of the study and their timing. The advisory council they will create is also well described and clearly well thought out. The team has organized and provided the questions they will use in the interviews, and it is clear that much work has been done to plan and get ready to launch the study.

Applicant(s)
The PI is Co-Chair of the Anti-Black Racism Task (2020)(2021)(2022) for $25,000, and has been a co-applicant or Co-I on a number of other recent grants on these topics. Her publication record is modest with 11 publications between 2015-2020, and only a few as first or last author. The team includes Co-Is, collaborators and a knowledge user that are experienced in the field, interdisciplinary and strong.

Impact of the Research
The team seeks to find out how racial identity, gender, psychosis and CUD intersect to impact the lives of youth people. Based on my review, I agree that the team has put together a project that can achieve this aim.

Research Approach
The proposed application falls within the scope of the CIHR Catalyst Grant: Cannabis and Mental Health to generate lived experience-based knowledge on potential benefits/harms of cannabis use and mental health implications, support community-based/population-specific research, facilitate the development of new evidence to inform policies, and connect existing knowledge translation (KT) efforts across Canada.
The overall goal of this mixed-methods project is to explore perceptions about cannabis and psychosis from Black and racialized people, develop KT products to compare before and after exposure, and foster community engagement of stakeholders to create a referral strategy to boost young people from Black and racialized communities.
The literature review is comprehensive, timely, and relevant to the proposed research design, which is thorough and appropriate. This research will be guided by an Advisory Council of Black and Racialized peoples with lived experiences that ensure relevance and the cultural appropriateness of the study. However, it is not clear, how all research participants will have access to the virtual platform given their diverse socioeconomic backgrounds. It is also not clear, how the data collection and knowledge translation processes will address and mitigate the potential barriers if the COVID-19 pandemic continues to prevail.
The proposed project considers SGBA+ to ensure that data collection and analysis are sensitive to gender and identify factors such as race, language, age or disability. As the proposal describes, specific consideration will be given to self-assigned identify factors (such as man, woman, transgender, fluid, twospirit). Equal numbers of men (including transmen) and women (including transwomen) will be enrolled for each racialized group).
The proposal builds on strong participatory research, co-creation concept, capacity building, and community engagement components, which increases the proejct's community relevance.

Applicants:
The applicants form a multidisciplinary team of researchers and collaborators and well-positioned to undertake this research. The research team including NPI, co-applicants, knowledge users, and collaborators has several years of experience, expertise, and proven track record in the area of mental health and addiction research and related community-based work. The NPI has significant experience in the field of addiction and mental health research with successful research funding history, peer-reviewed publications (n=13), presentations (n=4), and knowledge translation and mentorship experiences.
The participants received strong letters of support or collaboration from a range of stakeholders that demonstrate their significant contribution to this field of research. Impact of Research: The proposed study will be the first of its kind in Canada to reveal how racial identity, gender, psychosis, and cannabis use intersect and uniquely impact the lives of young people with FEP and CUD from Black racialized communities. This project intends to give voice to the people from racialized Black and other communities to generate new knowledge about the meaning of race, cannabis use, and psychosis to inform a new KT product to address knowledge gaps about early phases of psychosis from cannabis use. The emerging KT product will likely provide new recruitment strategies that EPI clinicians could use to engage more young people from marginalized communities into care.

Open Science & Knowledge Translation Plan:
The study's research protocol will be published in an Open Access journal. Additionally, the research findings will be presented at conferences, workshops, and online. The research project aims to share codeveloped knowledge via monthly sharing circles and co-production of KT products in the end.
Budget: the funding ask seems appropriate. Surprisingly, the project proposal has no funding allocation for KT activities. e) Viability of proposed approach to mitigate potential conflict of interests and/or impact of industry relationships (if applicable) on research project. No concerns f) Quality and appropriateness of Sex-and Gender-Based analysis Plus (SGBA+) is appropriately integrated throughout the proposal, including study rationale, experimental design, methods, analysis, as well as data interpretation and reporting. SGBA+ is of high quality and well-addressed throughout the proposal. g) Quality of the proposed plan to include consideration of specific populations (e.g., ethnicity, socioeconomic, sex, gender, minorities such as official language minority populations) and health equity. Same, and fully addressed as an inherent part of the proposal. h) Anticipation of difficulties that may be encountered in the research and plans for management. Recruitment is raised a potential issue, but community outreach activities of the researchers, as well as the involvement of those with lived experience, alleviate these concerns to a significant extent.

2) Applicant(s)
a) Qualifications of the applicant(s), including training, experience and independence (relative to career stage)/ Experience of the applicant(s) in the proposed area of research and with the proposed methodology.

Strengths:
The study aims to evaluate the use of a video game (SERIES) focusing on a black youth hero with psychosis and a cannabis use disorder to examine perceptions of effects of cannabis on mental health in black immigrant youth who have a new diagnosis of psychosis. The study aims to use the video game to communicate how cannabis use might be impacting on psychosis and evaluate the impact of the intervention in enhancing youth understanding of the link between cannabis and psychosis. Do they come to a better understanding of how cannabis could be impacting their psychosis through the intervention. The study includes an elegant control condition, which was considered a strength. Participatory action nature of the research to assure engagement and solid knowledge translation of this research with the target community was also considered a strength. Perceived effects of cannabis on mental health is not well studied in black youth with immigrant backgrounds therefore considered important research. The game has been used with a number of high risk populations already as a way to communicate balanced information on cannabis and psychosis risk, which speaks to feasibility. The proposal is well written and the protocol well-presented. The role and level of engagement of advisory council was well described. Feasibility was evaluated as being very high.
Team membership seemed appropriate for the proposed research and covered all three components of this research (psychosis, cannabis and black community engagement). Publication record of the PI was modest. But all team members appeared to fit well in the application.
The team seemed well positioned to conduct the study, and community-based letters of support were strong.
Impact was considered to be potentially high and knowledge translation plan was strong.

Weaknesses:
It was not clear why the researchers opted for qualitative pre-post game evaluation but did not incorporate a quantitative pre-post assessment.
The PI has low number of publications, which raised concerns about the likelihood that this research will result in published scientific report.