title: Clinician descriptions of communication strategies to improve treatment engagement by racial/ethnic minorities in mental health services: A systematic review.
abstract: OBJECTIVE
  To describe studies on clinician communication and the engagement of racial/ethnic minority patients in mental health treatment.
  
  
  METHODS
  Authors conducted electronic searches of published and grey literature databases from inception to November 2014, forward citation analyses, and backward bibliographic sampling of included articles. Included studies reported original data on clinician communication strategies to improve minority treatment engagement, defined as initiating, participating, and continuing services.
  
  
  RESULTS
  Twenty-three studies met inclusion criteria. Low treatment initiation and high treatment discontinuation were related to patient views that the mental health system did not address their understandings of illness, care or stigma. Treatment participation was based more on clinician language use, communication style, and discussions of patient-clinician differences.
  
  
  CONCLUSIONS
  Clinicians may improve treatment initiation and continuation by incorporating patient views of illness into treatment and targeting stigma. Clinicians may improve treatment participation by using simple language, tailoring communication to patient preferences, discussing differences, and demonstrating positive affect.
  
  
  CONCLUSIONS
  Lack of knowledge about the mental health system and somatic symptoms may delay treatment initiation. Discussions of clinician backgrounds, power, and communication style may improve treatment participation. Treatment continuation may improve if clinicians tailor communication and treatment plans congruent with patient expectations.
authors.affiliation: Columbia University Department of Psychiatry and The Center of Excellence for Cultural Competence at The New York State Psychiatric Institute, New York, USA. Electronic address: aggarwa@nyspi.columbia.edu.
authors.forename: Neil Krishan
authors.initials: NK
authors.lastname: Aggarwal
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Pieh
authors.affiliation: Columbia University Department of Psychiatry and The New York State Psychiatric Institute, New York, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Dixon
authors.affiliation: Institute for Health. Health Care Policy & Aging Research. Rutgers,The State University of New Jersey, New Brunswick, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Guarnaccia
authors.affiliation: Center for Multicultural Mental Health Research and Harvard Medical School, Somerville, USA.
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegría
authors.affiliation: Columbia University Department of Psychiatry and The Center of Excellence for Cultural Competence at The New York State Psychiatric Institute, New York, USA.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lewis-Fernández
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D003266:Continuity of Patient Care; D054521:Cultural Competency; D018864:Cultural Diversity; D005006:Ethnicity / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011369:Professional-Patient Relations; D044469:Racial Groups / Q000523:psychology
keywords: Cross-cultural communication; Cultural psychiatry; Medical communication; Systematic review; Treatment engagement