TY - JOUR
KW - Adult
KW - Community Health Aides
KW - Community Health Centers/organization & administration
KW - Community Mental Health Services/organization & administration
KW - Depression/etiology/therapy
KW - Employment/psychology
KW - Female
KW - Food Supply/statistics & numerical data
KW - Housing/statistics & numerical data
KW - Humans
KW - Interprofessional Relations
KW - Male
KW - Medically Underserved Area
KW - Middle Aged
KW - New Mexico
KW - Poverty
KW - Primary Health Care/organization & administration
KW - Professional Role
KW - Treatment Outcome
KW - Violence/psychology
AU - H. Waitzkin
AU - C. Getrich
AU - S. Heying
AU - L. Rodriguez
AU - A. Parmar
AU - C. Willging
AU - J. Yager
AU - R. Santos
A1 - 
AB - We assessed the role of promotoras--briefly trained community health workers--in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention's impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention's implementation, involving infrastructure at the health centers, boundaries of the promotoras' roles, and "turf" issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers.
BT - Journal of community health
C5 - Education & Workforce; Healthcare Disparities
CP - 2
CY - Netherlands
DO - 10.1007/s10900-010-9313-y
IS - 2
JF - Journal of community health
N2 - We assessed the role of promotoras--briefly trained community health workers--in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention's impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p < .05); logistic regression revealed housing and food insecurity as the most important predictors (odds ratios both 2.40, p < .05). Unexpected challenges arose in the intervention's implementation, involving infrastructure at the health centers, boundaries of the promotoras' roles, and "turf" issues with medical assistants. In the quantitative assessment, the intervention did not lead to statistically significant improvements in depression (odds ratio 4.33, confidence interval overlapping 1). Ethnographic research demonstrated a predominantly positive response to the intervention among stakeholders, including patients, promotoras, PCPs, non-professional staff workers, administrators, and community advisory board members. Due to continuing unmet mental health needs, we favor further assessment of innovative roles for community health workers.
PP - Netherlands
PY - 2011
SN - 1573-3610; 0094-5145
SP - 316
EP - 331
EP - 
T1 - Promotoras as mental health practitioners in primary care: A multi-method study of an intervention to address contextual sources of depression
T2 - Journal of community health
TI - Promotoras as mental health practitioners in primary care: A multi-method study of an intervention to address contextual sources of depression
U1 - Education & Workforce; Healthcare Disparities
U2 - 20882400
U3 - 10.1007/s10900-010-9313-y
VL - 36
VO - 1573-3610; 0094-5145
Y1 - 2011
ER -