Although minority elders represent the fastest growing segment of an aging US population, they have less access to mental health care and prevention of disability, lagging well behind non-Latino whites, and suffering significant disparities. Research suggests that a contributing factor may be an insufficient supply of professional providers and the inability of evidence based treatments to reach and be acceptable to minority elders. We have obtained promising results from a novel model of disability prevention, the Positive Minds Strong Bodies (E-PMSB) intervention, embedded in the client?s neighborhood and culture to improve access, quality of mental health outcomes and reduce disability. The proposed renewal tests whether an enhanced PMSB intervention is acceptable in community-based organizations and community clinics, and allows effectiveness to be strengthened through added maintenance components. We identified areas to strengthen the intervention, to facilitate easier adoption at the organizational level, to increase mental health symptom reduction beyond 6 months, and augment dosage of the exercise component.
In Aim 2 we will assess implementation readiness of the E-PMSB, to ensure that its package of interventions is feasible and can be easily adopted, with reduced barriers to its sustainability. Informed by the Consolidated Framework for Implementation Research (CFIR), we will assess facilitators and barriers to implementation. A learning community consisting of community-based organizations (CBOs), clinical sites and academic partners will share elements that have contributed to initial success and can strengthen the collaboration.
For Aim 3, we will create and evaluate a toolkit to disseminate the program, with a focus on developing cultural and age appropriate evidence-based messaging, packaging, and an overview of the implementation process and financing. This dynamic toolkit will be designed for use by community organizations, community health workers (CHWs), exercise trainers, and program participants, targeting strategies for capacity building as well as implementation. Drawing on the feedback from participating sites, we envision refining materials in the last 6 months of the project to have a lasting product that can be disseminated, and that not only facilitates positive intervention outcomes but additionally support organizations to optimize implementation success, fidelity, and sustainability.
The rapid expansion of the aging ethnic/racial and linguistic minority population is outstripping the capacity to offer disability prevention services necessary to respond to their needs. The proposed renewal project aims to test the effectiveness and implementation readiness of an enhanced mental health and physical disability prevention intervention, delivered by community- based staff in four languages. If proven effective, we will develop a dynamic toolkit to accelerate its dissemination and implementation.
| Alegría, Margarita; Alvarez, Kiara; Falgas-Bague, Irene (2017) Clinical Care Across Cultures: What Helps, What Hinders, What to Do. JAMA Psychiatry 74:865-866 |
| Alegría, Margarita; Alvarez, Kiara; Ishikawa, Rachel Zack et al. (2016) Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 35:991-9 |
