title: Activation, self-management, engagement, and retention in behavioral health care: a randomized clinical trial of the DECIDE intervention.
abstract: OBJECTIVE
  Given minority patients' unequal access to quality care, patient activation and self-management strategies have been suggested as a promising approach to improving mental health care.
  
  
  OBJECTIVE
  To determine whether the DECIDE (Decide the problem; Explore the questions; Closed or open-ended questions; Identify the who, why, or how of the problem; Direct questions to your health care professional; Enjoy a shared solution) intervention, an educational strategy that teaches patients to ask questions and make collaborative decisions with their health care professional, improves patient activation and self-management, as well as engagement and retention in behavioral health care.
  
  
  METHODS
  In this multisite randomized clinical trial performed from February 1, 2009, through October 9, 2011 (date of last follow-up interview), we recruited 647 English- or Spanish-speaking patients 18 to 70 years old from 13 outpatient community mental health clinics across 5 states and 1 US territory. A total of 722 patients were included in analyses of secondary outcomes.
  
  
  METHODS
  Three DECIDE training sessions delivered by a care manager vs giving patients a brochure on management of behavioral health.
  
  
  METHODS
  Primary outcomes were patient assessment of activation (Patient Activation Scale) and self-management (Perceived Efficacy in Patient-Physician Interactions). Secondary outcomes included patient engagement (proportion of visits attended of those scheduled) and retention (attending at least 4 visits in the 6 months after the baseline research assessment), collected through medical record review or electronic records.
  
  
  RESULTS
  Patients assigned to DECIDE reported significant increases in activation (mean β = 1.74, SD = 0.58; P = .003) and self-management (mean β = 2.42, SD = 0.90; P = .008) relative to control patients, but there was no evidence of an effect on engagement or retention in care.
  
  
  CONCLUSIONS
  The DECIDE intervention appears to help patients learn to effectively ask questions and participate in decisions about their behavioral health care, but a health care professional component might be needed to augment engagement in care. DECIDE appears to have promise as a strategy for changing the role of minority patients in behavioral health care.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01226329
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegría
authors.forename: Nicholas
authors.initials: N
authors.lastname: Carson
authors.forename: Michael
authors.initials: M
authors.lastname: Flores
authors.forename: Xinliang
authors.initials: X
authors.lastname: Li
authors.forename: Ping
authors.initials: P
authors.lastname: Shi
authors.forename: Anna Sophia
authors.initials: AS
authors.lastname: Lessios
authors.forename: Antonio
authors.initials: A
authors.lastname: Polo
authors.forename: Michele
authors.initials: M
authors.lastname: Allen
authors.forename: Mary
authors.initials: M
authors.lastname: Fierro
authors.forename: Alejandro
authors.initials: A
authors.lastname: Interian
authors.forename: Aida
authors.initials: A
authors.lastname: Jimenez
authors.forename: Martin
authors.initials: M
authors.lastname: La Roche
authors.forename: Catherine
authors.initials: C
authors.lastname: Lee
authors.forename: Roberto
authors.initials: R
authors.lastname: Lewis-Fernández
authors.forename: Gabriela
authors.initials: G
authors.lastname: Livas-Stein
authors.forename: Laura
authors.initials: L
authors.lastname: Safar
authors.forename: Catherine
authors.initials: C
authors.lastname: Schuman
authors.forename: Joan
authors.initials: J
authors.lastname: Storey
authors.forename: Patrick E
authors.initials: PE
authors.lastname: Shrout
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001364:Awareness; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000193:education* / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D009042:Motivation; D010174:Pamphlets; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000523:psychology*; D010817:Physician-Patient Relations; D011788:Quality of Life / Q000523:psychology; D012648:Self Care; D020377:Self Efficacy; D014481:United States; D044465:White People / Q000193:education* / Q000523:psychology; D055815:Young Adult