Culturally-Based Family Intervention for Mexican Americans(CFIMA)

描述（由申请人提供）：我们建议使用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）。家庭参与服务干预精神分裂症患者的人一直表现出强烈的积极成果，为患者及其家属。尽管与西方文化相比，拉丁美洲文化被认为更以家庭为中心，但只有一个受控的以家庭为基础的精神分裂症模型（对非少数民族进行了验证）已经在墨西哥裔美国人中进行了研究，结果喜忧参半。在这方面需要更多的家庭工作，因为研究一直发现，与非少数民族相比，大多数拉丁裔患者更有可能与家人住在一起。家庭干预措施需要开发，是社会文化同步与拉丁美洲文化的意识形态，这是文化上的需求，偏好和文化学习风格的一致，这在很大程度上是服务不足，研究不足的不断增长的人口。 我们对拉丁美洲人的广泛临床经验、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美洲人进行的深入人种学研究都为干预措施的制定提供了信息。这些数据表明，这个大型拉丁裔亚组的文化和现有的服务干预措施之间缺乏文化契合。墨西哥裔美国人在应对家庭内部疾病影响时所使用的突出文化资源在很大程度上未被现有的干预措施所利用。CFIMA采用了一种家庭团体形式，由我们开发的家庭供应商文化交流的启发式模型指导。它培养文化资源，可以在3个连续的治疗阶段中发挥影响作用，改善家庭和患者的结局：文化评估，文化适应和文化融合。 基于干预发展的阶段模型和关于发展文化一致性服务的干预文献，我们建议（1）进一步发展，标准化，并为有精神分裂症亲属的家庭制定CFIMA手册，（2）在对照试验中评估其初步有效性（CFIMA与常规护理），60个讲西班牙语的家庭（每种情况N=30）在现实世界中持续6个月（基线，6个月，9个月随访）。在这两种情况下，将评估广泛的家庭和患者结局以及消费者来源的数据。研究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纳入其他干预服务提供一个模式，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，跨文化适应水平，其他拉丁裔亚组和社区环境中的族裔群体。

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.