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

项目总结/摘要 本研究的目的是测试一种跨学科的生态学方法来减少心理健康的差异 通过调整和整合以社区为基础的多层次宣传，学习， 将社会支助干预（移民福利项目）纳入三个社区伙伴现有努力 这些组织关注墨西哥移民的心理健康、教育、法律的和民权问题。这 研究是创新和重要的，因为它采用了尖端战略，以解决社会结构 心理健康的决定因素，并审查社区参与的适应和测试过程， 最初为难民设计的多层次干预措施的影响。国际工作方案的干预强调， 社区组织与大学之间可持续和可复制的伙伴关系模式， 涉及墨西哥移民和本科生倡导者共同努力：a）增加移民的 （b）提高移民利用社区资源的能力;（B）加强移民利用社区资源的能力;（c）加强移民利用社区资源的能力;（d）加强移民利用社区资源的能力。 通过重视移民的文化，经验和知识来发挥有意义的社会作用; d）减少移民的 社会隔离; e）通过改变政策和 实践IWP由参加服务学习课程的大学生管理， 要素：1）学习圈，包括文化交流和一对一的学习机会，以及; 2） 宣传，包括协同努力，调动与保健、住房、 就业、教育和法律的问题。对难民干预模式的研究表明， 可行性，适当性，可接受性，以及干预降低参与者 心理困扰和保护因素增加，并影响到全系统政策的变化， 实践在完成了对24名墨西哥成年移民的深入民族志采访后， 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 社区参与和干预措施调整过程，一个收集数据的混合方法战略 在14个月的时间里，在4个时间点从90名参与者中收集的数据将用于测试6- 一个月的干预，减少心理困扰，增加保护因素（获得资源， 英语能力、环境掌握和社会支持），并实现系统层面的变革， 组织，地方和国家的政策和做法，影响墨西哥移民的福祉。机制 将通过测试保护因素和 心理困扰定性数据将探讨干预的可行性和可接受性，参与者的 干预的经验和意外的影响;记录多层次的变化和背景 在每个地点执行;并对定量数据进行知情解释。数量和质量数据 还将审查CBPR伙伴关系的质量及其与多层面成果的关系。

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.