Culturally-Based Family Intervention for Mexican Americans(CFIMA)

描述（由申请人提供）：我们建议利用R34机制的资源进一步开发和测试一个新的基于文化的墨西哥裔美国人家庭干预（cima）。家庭参与精神分裂症患者的服务干预一直显示出对患者及其家庭的强烈积极结果。尽管与以西方文化为基础的文化相比，拉丁美洲文化更以家庭为中心，但只有一种对照的以家庭为基础的精神分裂症模型（对非少数民族进行了经验验证）在墨西哥裔美国人中进行了研究，结果好坏参半。这方面非常需要更多的家庭工作，因为研究一直发现，与非少数民族患者相比，大多数拉丁裔患者更有可能与家人住在一起。家庭干预需要在社会文化上与拉丁文化的照料意识形态保持同步，并在文化上与这一服务不足、研究不足的不断增长的人口的需求、偏好和文化学习风格保持一致。我们对拉丁美洲人的丰富临床经验、有关保护因素的文献以及我们最近对讲西班牙语的墨西哥裔拉丁美洲人进行的深入人种学研究为干预措施的发展提供了信息。这些数据表明，这个庞大的拉丁裔亚群体的文化与现有的服务干预之间缺乏文化契合。墨西哥裔美国人在处理家庭内部疾病影响时所使用的重要文化资源在很大程度上未被现有的干预措施所利用。CFIMA采用家庭小组形式，以我们开发的启发式家庭提供者文化交流模型为指导。培养文化资源，在文化评估、文化适应和文化融合三个顺序治疗阶段中，对改善家庭和患者预后发挥重要作用。基于干预发展的阶段模型和文化一致性服务发展的干预文献，我们建议：(1)进一步发展、标准化和手工化有精神分裂症亲属的家庭的CFIMA；(2)在一项对照试验（CFIMA与常规护理）中评估其初步有效性，该试验包括60个西班牙语家庭（每种情况N=30），持续6个月（基线、6个月、9个月的随访）。在这两种情况下，将评估广泛的家庭和患者结果以及消费者来源的数据。结果将提供初步证据，说明手动CFIMA是否对墨西哥裔美国人有效。这项工作将为如何将文化因素整合到其他干预服务中提供一个模型，并在现实环境中为文化多样化的群体增强这些服务。结果将作为R01的基础，将本研究扩展到更大的样本，跨越文化适应水平，其他拉丁裔亚群体和社区环境中的种族群体。

DESCRIPTION (provided by applicant): We propose to further develop and test a new Culturally-based Family Intervention for Mexican Americans (CFIMA) using the resources of the R34 mechanism. Family involvement in service interventions for persons with schizophrenia has consistently shown strong positive outcomes for patients and their families. Despite that Latino cultures are known to be more family-centered in comparison to Western-based cultures, only one controlled family-based schizophrenia model (empirically-validated for non-minorities) has been studied with Mexican Americans, and the results were mixed. There is a great need for more family work in this area because studies have consistently found that most Latino patients are more likely to live with family compared to non-minorities. Family interventions need to be developed that are socioculturally synchronous with the caregiving ideology of Latino culture and that are culturally congruent with the needs, preferences, and cultural learning styles of this largely under-served, under-researched growing population. Intervention development has been informed by both our extensive clinical experience with Latinos, the literature on protective factors, and our recent in-depth ethnographic research with Spanish-speaking Mexican origin Latinos. This data showed a lack of cultural fit between the culture of this large Latino subgroup and existing service interventions. The salient cultural resources used by Mexican Americans in coping with the impact of the illness within the family are largely untapped by existing interventions. The CFIMA employs a family group format guided by the heuristic model of family-provider cultural exchange we have developed. It cultivates cultural resources that can play an influential role in improving family and patient outcomes within 3 sequential treatment stages: cultural assessment, cultural accommodation, and cultural integration. Based on a stage model for intervention development and intervention literature on the development of culturally congruent services, we propose to (1) further develop, standardize, and manualize the CFIMA for families with a relative with schizophrenia and to (2) evaluate its preliminary effectiveness in a controlled trial (CFIMA vs. usual care) with 60 Spanish-speaking families (N=30 each condition) lasting 6 months (with baseline, 6-months, 9-month follow-ups) in real-world settings. A wide range of family and patient outcomes and consumer-derived data will be assessed in both conditions. The results will provide preliminary evidence on whether the manualized CFIMA is effective for Mexican Americans. This work will provide a model for how to integrate cultural factors into other intervention services and enhance these in real-world settings for culturally diverse groups. Results will serve as the basis for an R01 to extend this research to larger samples, across acculturation levels, other Latino subgroups and ethnic groups in community settings.