Suggested citation: Nicolaidis, C., Wahab, S., Trimble, J., Mejia, A., Mitchell, S., Raymaker, D., et al. The Interconnections Project: Development and Evaluation of a Community-Based Depression Program for African American Violence Survivors. Journal of General Internal Medicine, 1-9., Nov 2012
Multi-faceted depression care programs based within the healthcare system have been found to be e... more Multi-faceted depression care programs based within the healthcare system have been found to be effective, but may not fully address the needs of African American Intimate Partner Violence (IPV) survivors, many of whom are not seeking depression care in healthcare settings.
OBJECTIVES
To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV.
METHODS
We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data.
RESULTS
Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants’ unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value.
CONCLUSION
Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.
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Papers by Angie Mejia
• Participation in diabetes self-management education was associated with increases in fruit and vegetable intake, weight loss, and a decrease in blood sugar levels among low-income adults with Type 2 diabetes.
• Integrating a fruit and vegetable purchase assistance incentive with diabetes self- management education is a cost-effective way to increase low-income patient participation in diabetes self-management education and improve self-management knowledge and behaviors.
do; these words encapsulate the overall message of this chapter, which is the need to check the many ways our methods rectify the very same social, political, economic, and cultural hierarchies that we as action researchers seek to challenge and effect.
Latino children are diagnosed with autism spectrum disorders (ASDs) at older ages and at the point of more severe symptoms. We sought to qualitatively describe community, family, and health care system barriers to ASD diagnosis in Latino children.
Methods
Five focus groups and 4 qualitative interviews were conducted with 33 parents of Latino children previously diagnosed with an ASD. Participants described Latino community perceptions of autism and barriers they experienced during the diagnostic process. Sessions were audiorecorded and transcribed. Transcripts were coded by 2 researchers, and data were analyzed using thematic analysis.
Results
Parents reported low levels of ASD information and high levels of mental health and disability stigma in the Latino community. Parents had poor access to care as a result of poverty, limited English proficiency, and lack of empowerment to take advantage of services. Providers sometimes dismissed parents' concerns. The ASD diagnostic process itself was slow, inconvenient, confusing, and uncomfortable for the child. These factors led many parents to normalize their child's early behaviors, deny that a problem existed, and lose trust in the medical system.
Conclusions
Additional educational outreach to Latino families, destigmatization of ASD, streamlining the ASD diagnostic process, and providing additional support to Latino parents of at-risk children may decrease delays in ASD diagnosis among Latino children.
Keywords autism spectrum disorder; delayed diagnosis; health services accessibility; Hispanic Americans; qualitative research
OBJECTIVES
To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV.
METHODS
We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data.
RESULTS
Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants’ unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value.
CONCLUSION
Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.
Objective To understand Latina women's beliefs, attitudes, and recommendations regarding depression and depression care, with a special focus on the impact of gender, ethnicity, violence, and social stressors.
Design Focus group study. Participants Spanish-speaking Latina women with a lifetime history of IPV and moderate to severe depressive symptoms.
Approach We used a community-based participatory research (CBPR) approach to conduct a thematic analysis using an inductive approach.
Results Thirty-one women participated in five focus groups. Women felt depression is caused by keeping things inside . They also felt that keeping things inside could lead to physical illness or an inability to function. Their inability to talk was fueled by issues such as stigma, fear, isolation, cultural norms, or simply not having the words . They felt that the key to treating depression was finding a way to talk about the things that they had kept inside. They greatly valued information about depression and appreciated learning from providers that their physical symptoms were caused by depression. They wanted confidential depression care programs that not only helped them deal with their depression, but also addressed the violence in their lives, gave them practical skills, and attended to practical issues such as childcare. They had negative attitudes toward antidepressants, primarily due to experiences with side effects. Negative experiences with the health care system were primarily attributed to lack of good healthcare insurance.
Conclusions The concept of "keeping things inside" was key to participants' understanding of the cause of depression and other health problems. Clinicians and depression care programs can potentially use such information to provide culturally-appropriate depression care to Latina women.
"
• Participation in diabetes self-management education was associated with increases in fruit and vegetable intake, weight loss, and a decrease in blood sugar levels among low-income adults with Type 2 diabetes.
• Integrating a fruit and vegetable purchase assistance incentive with diabetes self- management education is a cost-effective way to increase low-income patient participation in diabetes self-management education and improve self-management knowledge and behaviors.
do; these words encapsulate the overall message of this chapter, which is the need to check the many ways our methods rectify the very same social, political, economic, and cultural hierarchies that we as action researchers seek to challenge and effect.
Latino children are diagnosed with autism spectrum disorders (ASDs) at older ages and at the point of more severe symptoms. We sought to qualitatively describe community, family, and health care system barriers to ASD diagnosis in Latino children.
Methods
Five focus groups and 4 qualitative interviews were conducted with 33 parents of Latino children previously diagnosed with an ASD. Participants described Latino community perceptions of autism and barriers they experienced during the diagnostic process. Sessions were audiorecorded and transcribed. Transcripts were coded by 2 researchers, and data were analyzed using thematic analysis.
Results
Parents reported low levels of ASD information and high levels of mental health and disability stigma in the Latino community. Parents had poor access to care as a result of poverty, limited English proficiency, and lack of empowerment to take advantage of services. Providers sometimes dismissed parents' concerns. The ASD diagnostic process itself was slow, inconvenient, confusing, and uncomfortable for the child. These factors led many parents to normalize their child's early behaviors, deny that a problem existed, and lose trust in the medical system.
Conclusions
Additional educational outreach to Latino families, destigmatization of ASD, streamlining the ASD diagnostic process, and providing additional support to Latino parents of at-risk children may decrease delays in ASD diagnosis among Latino children.
Keywords autism spectrum disorder; delayed diagnosis; health services accessibility; Hispanic Americans; qualitative research
OBJECTIVES
To develop and evaluate a multifaceted, community-based depression care program (the Interconnections Project) for African American women with a history of IPV.
METHODS
We used a community-based participatory research (CBPR) approach to develop, implement, and evaluate the intervention. Participants were African American women who had current depressive symptoms and a lifetime history of IPV. They participated in a 6-month intervention where a peer advocate provided education, skills training, and case management services, and used Motivational Interviewing to support self-management behaviors. We conducted pre-intervention and post-intervention assessments using quantitative and qualitative data.
RESULTS
Fifty-nine women participated, with 92 % attending any sessions and 51 % attending at least 6 h of intervention activities. Intervention changes made to better accommodate participants’ unpredictable schedules improved participation rates. Participants noted high levels of satisfaction with the program. There were significant improvements in depression severity (PHQ-9 13.9 to 7.9, p < 0.001), self-efficacy, self-management behaviors, and self-esteem (all p < 0.001), but no increase in use of antidepressants. Common themes related to why the program was helpful included that the program was by and for African American women, that it fostered trust, and that it taught self-management strategies with practical, lasting value.
CONCLUSION
Culturally specific, community-based interventions led by peer advocates may be a promising way to help African American IPV survivors effectively address depression.
Objective To understand Latina women's beliefs, attitudes, and recommendations regarding depression and depression care, with a special focus on the impact of gender, ethnicity, violence, and social stressors.
Design Focus group study. Participants Spanish-speaking Latina women with a lifetime history of IPV and moderate to severe depressive symptoms.
Approach We used a community-based participatory research (CBPR) approach to conduct a thematic analysis using an inductive approach.
Results Thirty-one women participated in five focus groups. Women felt depression is caused by keeping things inside . They also felt that keeping things inside could lead to physical illness or an inability to function. Their inability to talk was fueled by issues such as stigma, fear, isolation, cultural norms, or simply not having the words . They felt that the key to treating depression was finding a way to talk about the things that they had kept inside. They greatly valued information about depression and appreciated learning from providers that their physical symptoms were caused by depression. They wanted confidential depression care programs that not only helped them deal with their depression, but also addressed the violence in their lives, gave them practical skills, and attended to practical issues such as childcare. They had negative attitudes toward antidepressants, primarily due to experiences with side effects. Negative experiences with the health care system were primarily attributed to lack of good healthcare insurance.
Conclusions The concept of "keeping things inside" was key to participants' understanding of the cause of depression and other health problems. Clinicians and depression care programs can potentially use such information to provide culturally-appropriate depression care to Latina women.
"