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种新的基于文化的墨西哥裔美国人家庭干预(CFIMA)。家庭参与对精神分裂症患者的服务干预一直显示出对患者及其家人的强烈积极结果。尽管众所周知，与以西方为基础的文化相比，拉丁裔文化更以家庭为中心，但只有一种基于家庭的受控精神分裂症模型(针对非少数族裔进行了经验验证)在墨西哥裔美国人中进行了研究，结果喜忧参半。在这一领域非常需要更多的家庭工作，因为研究一直发现，与非少数族裔相比，大多数拉丁裔患者更有可能与家人生活在一起。家庭干预需要与拉丁裔文化的照顾意识形态在社会文化上同步，并在文化上与这一在很大程度上服务不足、研究不足的不断增长的人口的需求、偏好和文化学习方式相一致。我们对拉丁裔的广泛临床经验、关于保护因素的文献，以及我们最近对讲西班牙语的墨西哥裔拉丁裔进行的深入人种学研究，都为干预发展提供了信息。这一数据表明，这一庞大的拉丁裔群体的文化与现有的服务干预措施之间缺乏文化契合度。墨西哥裔美国人在应对疾病对家庭的影响时所使用的显著文化资源，在很大程度上没有被现有的干预措施所利用。CFIMA采用家庭小组形式，遵循我们开发的家庭提供者文化交流的启发式模式。它在三个连续的治疗阶段：文化评估、文化适应和文化融合，培养能够在改善家庭和患者结果方面发挥重要作用的文化资源。基于文化一致性服务发展的干预发展阶段模型和干预文献，我们建议(1)进一步开发、标准化和手册精神分裂症亲属家庭的CFIMA，并(2)在实际环境中对60个西班牙语家庭(N=30个条件)进行为期6个月(基线、6个月、9个月的随访)的对照试验(CFIMA与常规护理)评估其初步有效性。在这两种情况下，都将评估广泛的家庭和患者结果以及消费者衍生的数据。这一结果将提供初步证据，证明机械化的CFIMA对墨西哥裔美国人是否有效。这项工作将提供一个模式，说明如何将文化因素融入其他干预服务，并在现实世界中为文化多样性群体加强这些服务。结果将作为R01的基础，将这项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.