SUPERA: Supporting Peer Interactions to Expand Access to Digital Cognitive Behavioral Therapy for Spanish-speaking Safety-Net Patients in Primary Care

SUPERA：支持同伴互动，以扩大初级保健中西班牙语安全网患者获得数字认知行为治疗的机会

• 批准号: 10686980
• 负责人: Adrian Aguilera
• 金额: $ 92.88万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686980
• 关键词: Address; Anxiety; Attitude; Behavioral; Caring; Climate; Clinic; Cognitive Therapy; Country; Data; Disparity; Effectiveness; Eligibility Determination; Equity; Evaluation; Evidence based intervention; Evidence based practice; Focus Groups; Future; General Hospitals; Goals; Hand; Health; Health Personnel; Health Resources; Health system; Healthcare Systems; Human; Internet; Intervention; Interview; Knowledge; Language; Latinx; Leadership; Limited English Proficiency; Linguistics; Measures; Mediator; Medicaid; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modality; Modeling; Outcome; Patient Care; Patients; Population; Population Heterogeneity; Primary Care; Process; Provider; Public Health; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Registries; Research; Resource-limited setting; Resources; San Francisco; Site; Surveys; Symptoms; System; Technology; Testing; Therapeutic Intervention; Time; Underserved Population; Uninsured; United States; Work; behavioral health; burden of illness; clinic ready; common treatment; cost comparison; cost effective; design; digital; digital delivery; digital health; digital intervention; digital mental health; digital treatment; effectiveness evaluation; effectiveness/implementation trial; efficacious treatment; evidence base; experience; health care settings; health equity promotion; implementation evaluation; implementation strategy; improved; innovation; medical specialties; mobile computing; outreach; patient engagement; patient registry; peer; peer support; primary care clinic; primary care provider; primary outcome; psychologic; relative cost; safety net; secondary outcome; skills; social; standard of care; trial comparing; uptake

Project Summary Limited English Proficiency (LEP) Latinxs experience longer duration of untreated mental health disorders. In the case of depression and anxiety, Latinxs are half as likely as whites to receive quality, evidence-based care despite primary care providers recommending treatment at equivalent rates. There are known barriers for LEP Latinx patients with depression and anxiety, especially at the healthcare setting level. Because these patients are more likely to receive care in public healthcare settings which disproportionately care for patients on Medicaid or who are uninsured, there are often language and culturally concordant care models in these systems yet an overall deficiency of Spanish-speaking behavioral/mental health clinicians. In addition, these under-resourced healthcare systems also are less likely to be the site for implementation of innovations that might increase access to mental health care for their population. Digital interventions, i.e., those that leverage Internet and mobile technologies, can provide an effective option for overcoming these barriers. In many countries, digital treatments are frontline treatments for mental health issues such as depression and anxiety, creating a standard of care that can overcome disparities and promote health equity. In the United States, few patients have access to evidence-based digital treatments, and even when available, uptake and engagement is often low. This proposal aims to implement and evaluate an evidence-based digital cognitive-behavioral therapy intervention in safety-net primary care clinics for LEP Latinx patients with depression and/or anxiety. Primary care is the de facto treatment setting for the treatment of common mental health problems such as depression and anxiety and Latinx patients tend to prefer to remain treated in primary care rather than being referred to other specialty mental health services. We will conduct an effectiveness-implementation hybrid trial (Type 2) design with both provider- and patient-level randomization. This will generate data on effectiveness of digital peer support for mental health outcomes for LEP Latinx patients while simultaneously generating rigorous data on the implementation strategies with the highest chance of dissemination in future work. At the provider-level we will compare outreach (using our clinic patient registry) with inreach (traditional provider referral), at the patient-level we will compare two modes of delivery of the dCBT platform (peer-supported vs. unsupported). The long-term goal of this research is to aid in the implementation of digital mental health interventions that can be sustainable implemented in low-resourced settings, while reducing the reliance on professionals, overcoming workforce deficits, and increasing relevance for diverse populations. Such interventions could be provided at scale and address the substantial burden of disease resulting from common mental disorders while making resources more available to those traditionally underserved by our health system.

项目摘要 有限的英语能力（LEP）拉丁裔经历更长的未经治疗心理健康的持续时间 疾病。在抑郁症和焦虑症的情况下，拉丁裔的可能性是白人的一半，获得质量， 尽管初级保健提供者建议以同等的速度治疗，但循证护理。有 LEP Latinx患者患有抑郁和焦虑症的已知障碍，尤其是在医疗保健设置水平上。 因为这些患者更有可能在公共医疗保健环境中获得护理 照顾医疗补助或没有保险的患者，通常会有语言和文化一致的护理 这些系统中的模型却是讲西班牙语的行为/心理健康临床医生的总体缺陷。在 此外，这些资源不足的医疗保健系统也不太可能成为实施的地点 可能会增加人口获得精神保健的创新。 数字干预措施，即那些利用互联网和移动技术的干预措施，可以提供有效的 克服这些障碍的选项。在许多国家，数字治疗是精神上的一线治疗 抑郁症和焦虑等健康问题，创建一个可以克服差异和的护理标准 促进健康公平。在美国，很少有患者获得基于证据的数字治疗， 即使在可用的情况下，吸收和参与度通常也很低。 该建议旨在实施和评估基于证据的数字认知行为疗法 抑郁症和/或焦虑的LEP Latinx患者的安全网络初级保健诊所的干预。基本的 护理是治疗常见心理健康问题（例如抑郁）的事实治疗环境 焦虑和拉丁人患者倾向于在初级保健中保持治疗，而不是被提及 其他专业心理健康服务。我们将进行有效实施混合试验（2型） 使用提供者和患者级随机化设计。这将生成有关数字有效性的数据 同时支持LEP Latinx患者的心理健康成果的同伴支持，同时产生严格的数据 关于在未来工作中传播最高机会的实施策略。在提供商级别 我们将在 患者级别我们将比较DCBT平台的两种传递模式（同伴支持与无支撑）。 这项研究的长期目标是帮助实施数字心理健康干预措施 这可以在低资源环境中实施可持续性，同时减少了对专业人士的依赖， 克服劳动力赤字，并增加与不同人群的相关性。这样的干预措施可能是 按大规模提供并解决由常见精神障碍引起的疾病负担 使我们的卫生系统传统上服务不足的人更加可用。