The proposed Mentored Patient-Oriented Research Career Development Award (K23) is a four-year plan that will enable the candidate to develop as an intervention development, services researcher with an independent program of research. The goal of this research program is to improve the treatment engagement of underserved racial and ethnic minority populations in mental health settings by developing a cross-cultural communication engagement aid that ascertains relevant cultural views in starting, continuing, and participating in treatment. We will test the intervention's effects on medical communication and patient outcomes. The training objectives are to: 1) train in intervention development;2) study how to overcome cultural barriers to engagement, focusing on treatment entry, continuation, and participation;3) acquire methodological skills to assess how cross-cultural miscommunication leads to treatment disengagement and health disparities;4) train in clinical trials methodology and longitudinal data analysis. The application integrates formal course work, mentorship from established investigators, and mentored research activities. Three studies, supported by the candidate's training plan, are proposed that move from intervention development to pilot testing. Project 1 consists of three separate focus groups with patients, clinicians, and administrators to define program objectives, methods, and strategies to promote treatment entry, participation, and continuation of minorities with mental illness. The candidate will present these diverse stakeholders with results from a literature review on these topics to translate theoretical methods into practical strategies. The goals of this 12-month program are to design the intervention, write the first instruction manual for clinicians, and to develop cliniian adherence and competence measures for the intervention. Project 2 is a small, pre-pilot, open study in which trained clinicians will deliver the intervention. Debriefing interviews with patient and clinicians will identify factors affecting feasibility and acceptability with subsequent revisin of the intervention's instruction manual. An implementation plan will then be revised for clinicians based on the adapted intervention with fidelity indicators. Project 3 is a small pilot RCT to examine the feasibility and acceptability of the adapted intervention and explore its initia efficacy versus usual care at a public outpatient mental health clinic. Drawing from implementation mapping, a Scientific Advisory Board (SAB) consisting of patients, clinicians, administrators, mentors, and consultants will be used to incorporate the perspectives of multiple stakeholders in all projects. Results from these projects will serve as pilot data to apply for subsequent grants.
This K23 prepares the candidate to initiate an independent research program on developing cross-cultural communication interventions to engage minorities in mental health treatment. This project responds to Objectives 3 and 4 of the NIMH Strategic Plan calling for the development of interventions that address the needs of diverse people with mental illness and that translate research findings into clinical practice to enhance the NIMH's public health mission.