Comparison of Patient Versus Trained Observer Assessments of Healthcare Providers' Use of Motivational Interviewing Techniques for Patients Experiencing Depression and Anxiety in the Dominican Republic.

In settings with limited mental health system capacity, integrated care and the improvement of patient-provider communication surrounding common mental disorders is critical to advancing treatment outcomes. We trained primary care providers in the Dominican Republic in motivational interviewing (MI) to improve communication with patients experiencing depression and anxiety. Providers were randomized to an intervention group, which received MI training, or a control group. To evaluate the training's effectiveness, patients assessed their clinical encounters using the Motivational Interviewing Measure of Staff Interaction (MIMSI). Trained research assistants (RAs) rated a sub-set of those interactions using an adapted MIMSI instrument. Overall, patients (n = 36) perceived their interactions with providers (n = 10) very positively; however, the RAs' ratings strongly indicated that providers' application of MI behaviors was insufficient. Patients generally could not distinguish between intervention and control providers. Findings underscore the need to carefully consider optimal training delivery and cultural influences surrounding the implementation of MI mental health interventions in settings where directive communication is highly valued.

A Mobile App to Prevent Depression Among Low-Income Primary Care Patients in the Dominican Republic: Sociocultural Adaptations.

Introduction: Mental health mobile apps (MHapps) can provide depression treatment to people worldwide who do not have access to care, but few apps are culturally targeted to the population. In this series of studies, we described sociocultural considerations of MHapp development, and we explored participants' perceptions of acceptability, usability, and cultural relevance of the MHapp. Method: Individual interviews were conducted in three separate primary care sites in the Dominican Republic among convenience samples of staff and patients (n = 23, 18, and 21, respectively), using mixed methods of data collection. Results: Modifications were made during the iterative design process to reflect user preferences, which included a female gendered voice, the addition of animations, and changes to the psychoeducational content. Discussion: Primary care patients reported strong interest in MHapps due to its convenience, privacy, and affordability. Our findings support the necessity of detailed examination of user preferences to develop culturally congruent MHapp psychoeducation.

Mental health services in the Dominican Republic from the perspective of health care providers.

This study examines mental health services in five different regions of the Dominican Republic (DR) from the perspectives of health care providers. The purpose of this research was to (1) examine existing mental health care services; (2) identify barriers to treatment and mental health services delivery; and (3) explore potential strategies to improve mental health services delivery. Thirty-seven health care workers including physicians, nurses, psychologists, governmental administrators, and non-governmental community health workers were part of five focus groups and subsequent follow-up interviews. Transcripts were coded and analysed to obtain the most parsimonious categories of themes. Results indicated that there is insufficient funding allocated to mental health. The unreliable distribution of psychiatric medications precludes care for patients with severe chronic mental illness. Stigmatising attitudes among health care providers influences the quality of care. The prevalence of domestic violence is a significant public health problem contributing to mental illness. In conclusion, our study findings call for a re-examination of priority public health foci, with special attention to mental health and domestic violence in the DR. From a policy perspective, mental health care should be integrated into primary care and coupled with provider and patient education to reduce stigma. A social determinants approach could ameliorate systemic factors contributing to mental illness.

Depression, Help-Seeking and Self-Recognition of Depression among Dominican, Ecuadorian and Colombian Immigrant Primary Care Patients in the Northeastern United States.

Latinos, the largest minority group in the United States, experience mental health disparities, which include decreased access to care, lower quality of care and diminished treatment engagement. The purpose of this cross-sectional study of 177 Latino immigrants in primary care is to identify demographic factors, attitudes and beliefs, such as stigma, perceived stress, and ethnic identity that are associated with depression, help-seeking and self-recognition of depression. Results indicated that 45 participants (25%) had depression by Patient Health Questionnaire (PHQ-9) criteria. Factors most likely to be associated with depression were: poverty; difficulty in functioning; greater somatic symptoms, perceived stress and stigma; number of chronic illnesses; and poor or fair self-rated mental health. Fifty-four people endorsed help-seeking. Factors associated with help-seeking were: female gender, difficulty in functioning, greater somatic symptoms, severity of depression, having someone else tell you that you have an emotional problem, and poor or fair self-rated mental health. Factors most likely to be associated with self-recognition were the same, but also included greater perceived stress. This manuscript contributes to the literature by examining attitudinal factors that may be associated with depression, help-seeking and self-recognition among subethnic groups of Latinos that are underrepresented in research studies.

Cultural influences on causal beliefs about depression among Latino immigrants.

PURPOSE: This study describes causal beliefs about depression among Dominican, Colombian, and Ecuadorian immigrants. The authors describe participants' narratives about how particular supernatural or religious beliefs may contribute to or alleviate depression. METHOD: Latino primary care patients (n = 177) were interviewed with the Beliefs About Causes of Depression Scale, a list of 35 items rated from not at all important to extremely important. Participants had the option of expanding on responses using an informal conversational approach. Underlying themes of these explanatory comments were derived from narrative and content analysis. RESULTS: Major themes that emerged were Psychosocial and Religious and Supernatural causal beliefs. A third theme emerged that represented the integration of these categories in the context of the immigrant experience. DISCUSSION AND CONCLUSIONS: This article adds to the understanding of cross-cultural beliefs about depression. Psychosocial stressors related to the immigrant experience and adverse life events were highly endorsed, but the meaning of these stressors was construed in terms of religious and cultural values. To provide culturally appropriate services, nurses should be aware of and discuss the patient's belief systems, illness interpretations, and expectations of treatment.