Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness

Safety net care system clinical trial results

Kathleen Ell, María P. Aranda, Shinyi Wu, Hyunsung Oh, Pey Jiuan Lee, Jeffrey Guterman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score ≥ 10) were enrolled, randomized to AHH (n = 178) or UC (n = 170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12 months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12 months was 30% (AHH 31%, UC 28%, P = 0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12 months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalContemporary Clinical Trials
Volume61
DOIs
StatePublished - Oct 1 2017

Fingerprint

Self Care
Hispanic Americans
Chronic Disease
Clinical Trials
Los Angeles
Depression
Safety
Hand
Health Services
Heart Diseases
Patient Care Management
Interviews
Delivery of Health Care
Mental Health
Referral and Consultation
Research
Therapeutics

Keywords

  • Chronic disease management
  • Community health worker
  • Depression
  • Latino
  • Promotora
  • Safety net care system

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology (medical)

Cite this

Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness : Safety net care system clinical trial results. / Ell, Kathleen; Aranda, María P.; Wu, Shinyi; Oh, Hyunsung; Lee, Pey Jiuan; Guterman, Jeffrey.

In: Contemporary Clinical Trials, Vol. 61, 01.10.2017, p. 1-9.

Research output: Contribution to journalArticle

@article{5b6919f1c5a84e8b980148dfcf05a07c,
title = "Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness: Safety net care system clinical trial results",
abstract = "The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score ≥ 10) were enrolled, randomized to AHH (n = 178) or UC (n = 170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12 months by an independent interviewer blind to the study group. Patients (85{\%} diabetes, 4{\%} heart disease, 11{\%} both) were predominantly female (85{\%}), Latino (99{\%}), born outside of the US (91{\%}). Study attrition at 12 months was 30{\%} (AHH 31{\%}, UC 28{\%}, P = 0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12 months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.",
keywords = "Chronic disease management, Community health worker, Depression, Latino, Promotora, Safety net care system",
author = "Kathleen Ell and Aranda, {Mar{\'i}a P.} and Shinyi Wu and Hyunsung Oh and Lee, {Pey Jiuan} and Jeffrey Guterman",
year = "2017",
month = "10",
day = "1",
doi = "10.1016/j.cct.2017.07.001",
language = "English (US)",
volume = "61",
pages = "1--9",
journal = "Contemporary Clinical Trials",
issn = "1551-7144",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Promotora assisted depression and self-care management among predominantly Latinos with concurrent chronic illness

T2 - Safety net care system clinical trial results

AU - Ell, Kathleen

AU - Aranda, María P.

AU - Wu, Shinyi

AU - Oh, Hyunsung

AU - Lee, Pey Jiuan

AU - Guterman, Jeffrey

PY - 2017/10/1

Y1 - 2017/10/1

N2 - The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score ≥ 10) were enrolled, randomized to AHH (n = 178) or UC (n = 170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12 months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12 months was 30% (AHH 31%, UC 28%, P = 0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12 months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.

AB - The study evaluated depression and self-care management among patients with diabetes and/or heart disease in a 12-month randomized trial conducted in Los Angeles County Department of Health Services (LAC-DHS) community clinics. We compared LAC-DHS clinic usual care (UC) versus A-Helping-Hand (AHH) intervention in which bilingual promotoras, hired and supervised by the research project, provided 6 weekly psychoeducational sessions followed by boosters. Of 1957 screened, 348 depressed patients (PHQ-9 score ≥ 10) were enrolled, randomized to AHH (n = 178) or UC (n = 170) after baseline interview assessing mental health, treatment receipt, co-morbid illness, self-care management, and environmental stressors. Comprehensive assessments were repeated at 6 and 12 months by an independent interviewer blind to the study group. Patients (85% diabetes, 4% heart disease, 11% both) were predominantly female (85%), Latino (99%), born outside of the US (91%). Study attrition at 12 months was 30% (AHH 31%, UC 28%, P = 0.51). No baseline characteristics were associated with attrition. Half of AHH patients received 4 or more sessions. Intend-to-treat analysis found study groups did not vary significantly at 6 and 12 months. Before-after paired t-tests showed significant improvements in most measures in each group. During the trial, LAC-DHS activated healthcare improvements including depression screening, referral to clinic staff including community health workers (with the same role as the promotoras) to improve patient care management. Both patient groups performed equally well which may be a function of the enhanced healthcare model. Future research should replicate the promotora-integrated care model with other groups and care settings with similar comorbid conditions.

KW - Chronic disease management

KW - Community health worker

KW - Depression

KW - Latino

KW - Promotora

KW - Safety net care system

UR - http://www.scopus.com/inward/record.url?scp=85024391567&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85024391567&partnerID=8YFLogxK

U2 - 10.1016/j.cct.2017.07.001

DO - 10.1016/j.cct.2017.07.001

M3 - Article

VL - 61

SP - 1

EP - 9

JO - Contemporary Clinical Trials

JF - Contemporary Clinical Trials

SN - 1551-7144

ER -