- A culturally-sensitive care intervention that addresses the social determinants of health can reduce the care disparities that often arise between sociocultural groups accessing mental health treatment, according to a group of researchers from Washington University in St. Louis.
Minority patients often report difficulty engaging in the healthcare system, previous research has indicated. These patients often face language barriers that impede meaningful patient-provider communication. Likewise, providers tend to struggle delivering care that meets the cultural expectations of a different racial demographic.
The research team from the Brown School at Washington University sought to close that care gap by designing a care delivery model that specifically addresses medical needs and expectations of non-white Hispanic patients managing serious mental illness (SMI).
The intervention, called “Bridges to Better Health and Wellness” worked off an already-existing framework, PCARE. Although the researchers did not state how they specifically adapted PCARE, they did explain that they made changes with Hispanic patient culture in mind, and created all patient engagement and education materials in both English and Spanish.
The redesigned intervention also included masters-level social workers because they represent a growing provider population in the US.
The research team, led by Leopoldo Cabassa, associate professor at the Brown School, introduced the new targeted care intervention to 34 Hispanic patients with SMI and at risk for cardiovascular disease. Cabassa chose patients with cardiovascular comorbidities because research indicates that Hispanic patients with SMI suffer from cardiovascular disease at higher rates than other races.
The team tested for changes in patient activation, self-efficacy, patient-rated quality of care, receipt of preventive primary care, and quality of life.
Most of the patients (85 percent) completed the intervention reporting high levels of patient satisfaction. The researchers also found notable improvement in patient activation, self-efficacy, patient ratings of quality of care, and receipt of preventive primary care.
“‘Bridges to Better Health and Wellness’ is a promising intervention that can help to address some of the health care disparities faced by Hispanics with serious mental illness (SMI), a population that is often overlooked in the literature and in the system of care,” said Cabassa, who is also the report’s lead author and an expert in racial and ethnic disparities in mental health care.
Creating culture-specific patient engagement and care delivery strategies is essential, according to Cabassa. While most cultures have their distinct experiences with the healthcare industry, he knows that Hispanic patients specifically grapple with both structural and cultural barriers.
For example, Hispanic patients often struggle to obtain access to mental healthcare, Cabassa pointed out.
“On top of the structural barriers that people with SMI face in accessing and using primary care services, Hispanics with SMI have to contend with additional obstacles to care related to their minority status, including language barriers and mistrust of the health care system due to discrimination toward minorities and immigrants in the US,” Cabassa added.
These cultural factors can also impact how patients interact with their own health and symptoms. Patients from different cultures usually perceive certain health situations differently, making it difficult to assess when they should access certain healthcare providers, Cabassa said.
These efforts are part of an industry-wide push to address the social determinants of health. Race and culture are two of the most common social determinants of health, having a significant impact on patient health. For example, the Hispanic culture may alter how a patient interacts with her healthcare providers, thus having in impact on how she experiences treatments and yields health outcomes.
A downstream intervention that accounts for that patient’s culture can eventually help improve health, despite that patient’s genetic and medical makeup.
Making these downstream considerations is essential, especially for what Cabassa says is a vastly underrepresented patient population.
“Our study is one of the few studies to date to have adapted and tested a health-care manager intervention delivered by social workers that focuses on the Hispanic population,” Cabassa concluded. “There is a stark underrepresentation of Latinos in these types of intervention studies, so up to now there was little to no evidence indicating that these interventions could benefit this population.”