Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research.
Partnering with community-based organizations to improve equitable access to depression care for underserved older adults in the U.S.: Qualitative formative research.
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与社区组织合作，以改善美国服务不足的老年人的公平抑郁症护理：定性形成性研究。
DOI：
10.3389/fpubh.2022.1079082
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发表时间：
2022
影响因子：
5.2
通讯作者：
Snowden, Mark B.
中科院分区：
文献类型：
--
作者：
Steinman, Lesley E.;Parrish, Amanda T.;Kohn, Marlana J.;Wu, Sherry;Hara-Hubbard, KeliAnne K.;Brown, Lori;Imam, Syed;Baquero, Barbara;Hannon, Peggy A.;Snowden, Mark B.
在临床环境之外嵌入珍珠等循证项目（ebp）有助于减少获得抑郁症治疗方面的不公平现象。值得信赖的社区组织（cbo）为得不到充分服务的老年人提供服务；然而，珍珠的采用是有限的。实施科学试图缩小这种知识差距，但需要更有意识地关注公平，以吸引首席执行官。我们与社区组织合作，以更好地了解他们的资源和需求，以便设计更公平的传播和实施（D&I）战略，以支持珍珠的采用。2020年2月至9月，我们对24个现有和潜在的采用者组织和其他合作伙伴进行了39次访谈。cbo有目的地对地区、类型和优先级的老年贫困人口（有色人种社区、语言多样化社区、农村）进行抽样。利用社会营销框架，我们的指南探讨了采用珍珠的障碍、好处和过程；CBO的能力和需要；珍珠的可接受性和适应性；以及首选的沟通渠道。在2019冠状病毒病期间，访谈还涉及远程珍珠资源交付和优先事项的变化。我们使用快速框架方法对转录本进行了主题分析，以描述服务不足的老年人和参与他们的cbo的需求和优先事项，以及在这些情况下整合抑郁症治疗的策略、合作和适应。在2019冠状病毒病期间，老年人依靠国会预算办公室的支持来满足食品和住房等基本需求。孤立和抑郁也是社区内的紧迫问题，但在晚年抑郁症和抑郁症护理方面仍然存在耻辱。cbo希望ebp具有文化灵活性、稳定的资金、可获得的培训、员工投资，并符合员工和社区的需求和优先事项。研究结果指导了新的传播策略，以更好地传达珍珠计划如何适用于那些与得不到充分服务的老年人接触的组织，以及哪些项目组成部分是核心，哪些是可调整的，以更好地与组织和社区保持一致。新的实施战略将通过培训和技术援助以及为筹资和临床支助牵线搭线来支持组织能力建设。研究结果支持cbo作为服务不足的老年人抑郁症护理提供者，并建议改变沟通和资源，使ebp更好地适应组织和老年人的资源和需求。我们目前正在与加利福尼亚和华盛顿的组织合作，评估这些D&I战略是否以及如何增加服务不足的老年人公平获得珍珠的机会。
Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February–September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.
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