This mixed methods study will identify individual and interpersonal factors that are associated with utilization of primary care services among a diverse sample of people with serious mental illness who are receiving mental health care at urban community mental health centers. Background: People with serious mental illnesses face enormous health disparities and are at risk of premature mortality due to medical conditions. Ethnic and racial minorities and women with serious mental illness may encounter even greater health risks. Increasing the utilization of primary care services is a promising way to reduce health disparities among disadvantaged populations. Broad systems-level changes like the Affordable Care Act and the implementation of integrated models of mental health-primary care will make primary care services more accessible to people with serious mental illness. In the context of these systems-level changes, it will be important to understand how individual and interpersonal factors may limit the adequate utilization of available services. The objective of th present study is to identify social factors underlying primary care utilization among people with serious mental illness, thereby providing knowledge regarding specific factors that can be addressed to improve primary care utilization and ultimately reduce the substantial health disparities and premature mortality in this population. This objective is consistent with the goal of the National Institute on Minority Health and Health Disparities (NIMHD) to support research on factors underlying health disparities. Accordingly, the proposed study has the following specific aims:
Aim 1. To prospectively assess the contributions of health literacy, health insurance literacy, mental health stigma, discrimination, and mistrust in the health system on primary care utilization over the course of six months among a racially diverse sample of urban community mental health center patients with SMI.
Aim 2 To assess primary care experiences and preferences of a racially diverse sample of urban community mental health center patients with SMI as a function of whether or not patients received primary care in the prior six months. An exploratory aim related to Specific Aim 2 is to examine potential gender and racial/ethnic differences related to primary care experiences and preferences. Methods: The study will employ a sequential mixed-methods design. First, a prospective survey study will be conducted to address Aim 1. Second, using a subsample of participants from the prospective study, focus groups will be conducted to better understand patients' preferences for primary care, and their personal experiences of the social factors assessed in the prospective study. The focus groups will yield critical information as to how the intersection of multiple social identities (e.g., race/ethnicity, gender, having a mental illness) influences patients' primary care experiences and preferences. Student involvement: Consistent with NIMHD's goal to enhance research capacity to create a culturally sensitive workforce, the research team for the proposed study includes undergraduate and graduate students who will receive training health disparities research through their involvement in the study.
This study will provide critical information as to how individual and interpersonal factors serve as barriers to adequate use of primary care services among diverse persons with serious mental illness who are receiving mental health care at urban community mental health centers. Findings will provide new knowledge that can be applied to increase the use of primary care services, and thus potentially reduce significant health disparities and premature mortality in the vulnerable population of people with serious mental illness.
