Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care

Abstract

BackgroundPsychological therapy is effective for symptoms of mental distress, but many groups with high levels of mental distress face significant barriers in terms of access to care, as current interventions may not be sensitive to their needs or their understanding of mental health. There is a need to develop forms of psychological therapy that are acceptable to these groups, feasible to deliver in routine settings, and clinically and cost effective.MethodsWe developed a culturally sensitive wellbeing intervention with individual, group and sign-posting elements, and tested its feasibility and acceptability for patients from ethnic minorities and older people in an exploratory randomised trial.ResultsWe recruited 57 patients (57% of our target) from 4 disadvantaged localities in the NW of England. The results of the exploratory trial suggest that the group receiving the wellbeing interventions improved compared to the group receiving usual care. For elders, the largest effects were on CORE-OM and PHQ-9. For ethnic minority patients, the largest effect was on PHQ-9. Qualitative data suggested that patients found the intervention acceptable, both in terms of content and delivery.ConclusionsThis exploratory trial provides some evidence of the efficacy and acceptability of a wellbeing intervention for older and ethnic minority groups experiencing anxiety and depression, although challenges in recruitment and engagement remain. Evidence from our exploratory study of wellbeing interventions should inform new substantive trial designs.Trial registrationCurrent controlled trials ISRCTN68572159

Recruitment strategies for British South Asians in 5 depression trials: A mixed method study

“…(c) Working with the media: Local ethnic TV, radio and print media have invited us to participate in their activities where they have highlighted our research projects. These activities have also been reported in local newspapers (Gater et al, 2009;Lovell et al, 2014;Husain et al, in preparation). (d) Collaborating with key persons: We have managed to invite key individuals and community elders to our academic department and present to them our future research plans.…”

“…Literature review (Table 2) (a) We listed all randomised controlled trials of psychosocial interventions for depression the University of Manchester research group has been involved with. (b) Published papers from the SITARA Pilot study , SITARA trial (Gater et al, 2009), AMP trial (Lovell et al, 2014) and unpublished manuscripts for the COINCIDE (Coventry et al, 2015) and ROSHNI-D trials (Husain et al, in preparation) were sourced. Brown et al (2014).…”

“…A very important link with the community has been through developing working relationships with local imams and religious leaders. We have been given opportunities to speak to congregations and respond to queries raised by the audience (Gater et al, 2009;Lovell et al, 2014;Coventry et al, 2015;Husain et al, in preparation). (e) Patient and public involvement: The interventions in our SI-TARA, AMP and ROSHNI studies have been developed with direct input from lay voluntary sector members.…”

“…When launching the SITARA study, we ran community engagement events in collaboration with ethnic minority charities where (along with local politicians) we raised the importance of dealing with mental health issues (Gater et al, 2009). In the AMP study, we worked with The Roby Centre in Longsight, Manchester (a multi-faith organisation) in running our recruitment drive (Lovell et al, 2014). We developed and distributed a multilingual calendar as part of this study.…”

“…There is limited literature on depression trials for British South Asians (Jacob et al, 2002;Chaudhry et al, 2009;Gater et al, 2010;Lovell et al, 2014). There is an emerging literature on barriers to ethnic recruitment in mental health trials, but evidence on strategies to overcome them (particularly from outside US) are scarce (Brown et al, 2014).…”