title: Promotora assisted depression care among predominately Hispanic patients with concurrent chronic illness: Public care system clinical trial design.
abstract: Depression frequently negatively affects patient overall self-care and social stress management within United States safety net care systems. Rates of major depression are significantly high among low-income predominantly Hispanic/Latino with chronic illness, such as diabetes and heart disease. The study design of the A Helping Hand to Activate Patient-Centered Depression Care among Low-income Patients (AHH) randomized clinical trial aims to enhance patient depression care receipt and overall bio-psychosocial self-care management. The AHH trial is conducted in collaboration with three Los Angeles County Department of Health Services (DHS) safety net clinics that provide Patient-Centered Medical Home (PCMH) care. The study compares AHH intervention (AHH) in which community-based bilingual promotoras provide in-person or telephone patient engagement and intervention aimed to reduce the burden and strain on patients, families, and care providers by assessing, enhancing, and facilitating patient depression and co-morbid illness self-care management skill, and activating patient communication with clinic medical providers versus DHS PCMH team usual care (PCMHUC). AHH independent bilingual recruiters screened 1957 and enrolled 348 predominantly Hispanic/Latino patients, of whom 296 (85%) had diabetes, 14 (4%) with heart disease, and 38 (11%) with both diseases. Recruiters identified depressed patients by baseline Patient Health Questionnaire-9 scores of 10 or more, completed baseline assessments, and randomized patients to either AHH or PCMHUC study group. The comprehensive assessments will be repeated at 6 and 12months by an independent bilingual follow-up interviewer. Baseline and outcome data include mental health assessment and treatment receipt, co-morbid illness self-care, social relationships, and environmental stressor assessments.
authors.affiliation: School of Social Work, University of Southern California, United States. Electronic address: ell@usc.edu.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ell
authors.affiliation: School of Social Work, University of Southern California, United States. Electronic address: aranda@usc.edu.
authors.forename: María P
authors.initials: MP
authors.lastname: Aranda
authors.affiliation: School of Social Work, University of Southern California, United States; Edward R. Roybal Institute on Aging, University of Southern California, United States; Daniel J. Epstein Department of Industrial and Systems Engineering, University of Southern California, United States. Electronic address: shinyi@usc.edu.
authors.forename: Shinyi
authors.initials: S
authors.lastname: Wu
authors.affiliation: School of Social Work, Arizona State University, United States. Electronic address: hyunsung@asu.edu.
authors.forename: Hyunsung
authors.initials: H
authors.lastname: Oh
authors.affiliation: School of Social Work, University of Southern California, United States. Electronic address: peylee@usc.edu.
authors.forename: Pey-Jiuan
authors.initials: PJ
authors.lastname: Lee
authors.affiliation: Los Angeles County Department of Health Services, Research and Innovation, David Geffen School of Medicine, University of California Los Angeles, United States. Electronic address: jguterman@dhs.lacounty.gov.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Guterman
mesh_terms: D000368:Aged; D002140:California / Q000453:epidemiology; D002908:Chronic Disease; D003150:Community Health Workers; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000523:psychology; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty; D064876:Safety-net Providers; D012648:Self Care / Q000523:psychology; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology
keywords: Depression; Diabetes; Heart disease; Low-income Hispanics; Promotora; Safety net care system