Developing a Peer Advocate Intervention for Rural LGBT Populations

描述（由申请人提供）：十年的研究证实，与异性恋者相比，女同性恋、男同性恋、双性恋和变性人（LGBT）遭受的精神健康和物质使用问题不成比例。这一人群中较高的疾病患病率最合理的解释是少数民族压力，这里指的是对社会弱势群体的耻辱、偏见、歧视和暴力。我们之前在农村和多民族的新墨西哥州进行的形成性研究表明，专业提供者经常无法认识到少数民族压力的经历对农村LGBT人群的影响，并且通常没有准备好为这一人群提供高质量的服务。农村的LGBT人群，特别是那些被孤立于支持性社会网络之外的人，在精神健康和药物使用问题上需要帮助时，很少有针对LGBT的资源可以利用。我们建议使用训练有素的同伴倡导者作为对这种情况的创造性回应。倡导者将在农村地区发挥几个重要作用：减少与少数民族压力相关的社会背景因素，这些因素可能对LGBT人群的福祉和服务利用产生不利影响；与专业提供者和其他人的联系；培养对LGBT群体的社会支持。倡导者的日常工作将根据授权协议进行，该协议规定了他们将参与的社区活动的总体范围，以向农村的LGBT寻求帮助者提供援助。为了获得有效实施该协议所需的知识和技能，同伴倡导者将参加教学和互动培训练习，这些练习将在本研究过程中进行评估和改进。本研究有三个目的：(1)建立授权协议、辅导手册和同伴倡导支持系统；(2)设计和实施培训课程，使个人做好担任同伴倡导者的准备；(3)对授权协议进行试点测试，获得初步的定性和定量数据，包括可行性、可接受性以及对LGBT求助者治疗获取和利用以及社会支持的影响。为了实现这三个目标，我们将评估在干预研究中招募和留住同伴倡导者和LGBT寻求帮助者的程序，他们都是广泛分布的农村人口。从这个多方法研究中产生的数据也将用于提高协议的效用和完善培训课程。最重要的是，这些基本数据将为一项有希望的干预措施在服务不足和研究不足的人群中进行更大规模的有效性试验奠定基础。据我们所知，没有针对农村性和性别少数群体的类似干预措施，尽管这些人面临着严重的心理健康差异。

DESCRIPTION (provided by applicant): A decade of studies confirm that lesbian, gay, bisexual, and transgender (LGBT) people suffer disproportionately from mental health and substance use problems in comparison to their heterosexual counterparts. The higher prevalence of disorders within this population is most reasonably explained by minority stress, referring here to stigma, prejudice, discrimination, and violence toward socially disadvantaged groups. Our previous formative research in the rural and multi-ethnic state of New Mexico suggests that professional providers frequently fail to recognize how the experience of minority stress affects rural LGBT people and are often ill-prepared to provide quality services to this population. Rural LGBT people, particularly those who are isolated from supportive social networks, have few LGBT-specific resources to draw from when in need of assistance for mental health and substance use problems. We propose the use of well-trained peer advocates as a creative response to this situation. The advocates will perform several vital functions in rural areas: reduction of social contextual factors associated with minority stress that can adversely affect wellbeing and service utilization among LGBT people; outreach to professional providers and others; and cultivation of LGBT social support. The day-to-day work of the advocates will be informed by an empowerment protocol that specifies the general range of community-based activities they will engage in to provide assistance to rural LGBT help seekers. To obtain the knowledge and skills needed to effectively implement this protocol, peer advocates will take part in didactic and interactive training exercises that are to be evaluated and refined in the course of this research. This study has three aims: (1) Develop the empowerment protocol, coaching manual, and peer advocate support system; (2) Design and implement a training curriculum to prepare individuals to serve as peer advocates; (3) Conduct a pilot test of the empowerment protocol that will yield preliminary qualitative and quantitative data on feasibility, acceptability, and impacts on treatment access and utilization and social support for LGBT help seekers. In pursuit of all three aims, we will evaluate procedures to recruit and retain peer advocates and LGBT help seekers both members of a widely dispersed, rural population in intervention research. Data generated from this multi-method study will also be used to improve utility of the protocol and refine the training curriculum. Most importantly, these essential data will comprise the groundwork for a broader scale effectiveness trial of a promising intervention for an underserved and understudied population. To our knowledge, there are no similar interventions tailored for rural sexual and gender minorities, even though such individuals face significant mental health disparities. PUBLIC HEALTH RELEVANCE: Lesbian, gay, bisexual, and transgender (LGBT) persons living in rural areas of the U.S. face tremendous challenges in accessing appropriate treatment and social support for mental illness and substance use disorders. Building upon our formative research, we will design, implement, and evaluate a data- and theory driven intervention that will address these challenges within the predominantly rural state of New Mexico. This will be accomplished by developing an educational curriculum to educate peer advocates in LGBT mental health and substance use issues, who will then help empower LGBT people in rural communities to proactively address social contextual factors that affect their use of LGBT-affirmative treatment and social support.