Addressing the Social-Structural Determinants of Mental Health through Adaptation of a Transdisciplinary Ecological Intervention Model for Mexican Immigrants

项目摘要/摘要 这项研究的目标是测试一种跨学科的生态方法来减少心理健康差距。 通过适应和整合多层次的基于社区的倡导、学习和 社会支持干预(移民福祉项目，IWP)对三个社区合作伙伴的现有努力 关注墨西哥移民的心理健康、教育、法律和民权问题的组织。这 研究具有创新性和重要意义，因为它采用了尖端战略来解决社会结构 心理健康的决定因素，并检查社区参与的适应和测试 最初为难民设计的多级干预的影响。国际水资源综合计划的干预强调 社区组织和大学之间可持续和可复制的伙伴关系模式 墨西哥移民和本科生倡导者共同努力：a)增加移民的 社区导航能力；b)改善移民获得社区资源的机会；c)加强 通过重视移民的文化、经验和知识，发挥有意义的社会作用；d)减少移民的 社会孤立；以及e)通过改变政策和提高社区对移民的反应能力 练习一下。IWP由参加服务学习课程的大学生管理，有两个 要素：1)学习圈，包括文化交流和一对一的学习机会；2) 倡导，这涉及到合作努力，以调动与卫生、住房、 就业、教育和法律问题。对难民干预模式的研究表明 可行性、适当性、可接受性和干预降低参与者 心理痛苦和更多的保护因素，并影响到全系统政策和 练习。在完成了对24名墨西哥移民成年人的深入人种学采访后，以澄清 他们的心理健康需求、压力源、当前的政治/经济/社会背景和当地解决方案，以及 社区参与和干预适应的过程，收集数据的混合方法策略 来自四个时间点的90名参与者将在14个月的时间内被用来测试6- 一个月的干预，以减少心理痛苦，增加保护性因素(获得资源， 英语熟练程度、环境掌握和社会支持)，并实现系统级别的变化 影响墨西哥移民福祉的组织、地方和国家政策和做法。机制 通过测试保护因素和保护因素之间的中介关系来探索干预效果 心理上的痛苦。定性数据将探索干预的可行性和可接受性，参与者的 干预中的经验和意外影响；记录多层次的变化和 在每个地点实施；并为量化数据的解释提供信息。关于的定量和定性数据 还将审查CBPR伙伴关系的质量及其与多层次成果的关系。

PROJECT SUMMARY / ABSTRACT The goal of this study is to test a transdisciplinary ecological approach to reducing mental health disparities among Mexican immigrants by adapting and integrating a multilevel community-based advocacy, learning, and social support intervention (Immigrant Well-being Project, IWP) into existing efforts at three community partner organizations that focus on mental health, education, legal, and civil rights issues for Mexican immigrants. This research is innovative and significant because it employs cutting edge strategies to address social-structural determinants of mental health and examines the community-engaged process of adapting and testing the impact of a multilevel intervention originally designed for refugees. The IWP intervention emphasizes a sustainable and replicable partnership model between community-based organizations and universities that involves Mexican immigrants and undergraduate advocates working together to: a) increase immigrants’ abilities to navigate their communities; b) improve immigrants' access to community resources; c) enhance meaningful social roles by valuing immigrants' culture, experiences, and knowledge; d) reduce immigrants' social isolation; and e) increase communities’ responsiveness to immigrants through changes in policy and practice. The IWP is administered by university students enrolled in a service learning course, and has two elements: 1) Learning Circles, which involve cultural exchange and one-on-one learning opportunities, and; 2) Advocacy, which involves collaborative efforts to mobilize community resources related to health, housing, employment, education, and legal issues. Studies of the intervention model with refugees demonstrated feasibility, appropriateness, acceptability, and evidence that the intervention decreased participants’ psychological distress and increased protective factors, and impacted changes in system-wide policies and practices. After completing in-depth ethnographic interviews with 24 Mexican immigrant adults to elucidate their mental health needs, stressors, current political/economic/social context, and local solutions, and a process of community engagement and intervention adaptation, a mixed methods strategy with data collected from 90 participants at four time points over a period of 14 months will be used to test the impact of the 6- month intervention on reducing psychological distress, increasing protective factors (access to resources, English proficiency, environmental mastery, and social support), and achieving system-level changes in organizational, local, and state policies and practices that impact Mexican immigrants’ well-being. Mechanisms of intervention effectiveness will be explored by testing mediating relationships between protective factors and psychological distress. Qualitative data will explore feasibility and acceptability of the intervention, participants’ experiences in the intervention, and unexpected impacts; document multilevel changes and the context of implementation at each site; and inform interpretation of quantitative data. Quantitative and qualitative data on the quality of the CBPR partnerships and their relationship to multilevel outcomes will also be examined.