Culturally adapted motivational interviewing for Latino heavy drinkers: results from a randomized clinical trial

Racial and ethnic disparities in receipt of specialty treatment across risk profiles of adults with heavy alcohol use

BACKGROUND

Variation in specialty treatment utilization for alcohol use disorder (AUD) by patient subgroups is poorly understood. This study examined whether and how patient risk profiles predict receipt of specialty treatment and whether there are disparities by race and ethnicity.

METHODS

This cohort study included 206,956 adults with heavy alcohol use (that which exceeded National Institute on Alcohol Abuse and Alcoholism guidelines) between June 1, 2013 and December 31, 2014, using electronic health record data from Kaiser Permanente Northern California. Five risk profiles (characterized by daily or weekly heavy drinking and level of health risks) were identified in latent class analysis. Logistic regression models were fit to examine associations between risk profiles, race, ethnicity, and receipt of specialty treatment (including addiction medicine, psychiatry, or integrated behavioral health visits, and AUD pharmacotherapy), adjusting for other patient characteristics. Variation in the association between risk profiles and receipt of specialty treatment by race/ethnicity was also examined.

RESULTS

Overall, 4.0% of patients received specialty treatment. Latino/Hispanic and Asian/Pacific Islander patients had lower odds of receiving specialty treatment than White patients (adjusted odds ratio [aOR] [95% CI] = 0.80 [0.75, 0.85], and 0.64 [0.59, 0.70], respectively). The substance use disorder and mental health disorder (SUD/MH) risk profile had the highest odds of receiving specialty treatment (10.46 [9.65, 11.34]). Associations between risk profiles and receipt of specialty treatment significantly differed by race/ethnicity. Black patients in the SUD/MH risk profile, and Hispanic/Latino patients in the risk profile with heavy daily drinking and more health risks, had lower odds of receiving specialty treatment than their White counterparts (adjusted ratio of odds ratios [aROR] [95% CI] = 0.69 [0.50, 0.94], and 0.79 [0.67, 0.92], respectively).

CONCLUSIONS

This study provides new insights into racial/ethnic disparities in specialty treatment utilization for alcohol problems. Findings may help inform strategies for tailoring interventions to address heavy alcohol use.

A clinical science guide for reviewing the cross-cultural rigor of assessments in an alcohol training clinic

A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Improving patient-centred counselling skills among lay healthcare workers in South Africa using the Thusa-Thuso motivational interviewing training and support program

We developed a motivational interviewing (MI) counselling training and support program for lay counsellors in South Africa-branded "Thusa-Thuso-helping you help", commonly referred to as Thusa-Thuso. We present the results of a pilot study to determine the program's impact on MI technical skills and qualitatively assess the feasibility of a training-of-trainers (TOT) scale-up strategy among counselling staff of non-governmental (NGO) support partners of the human immunodeficiency virus (HIV) treatment program in South Africa. We enrolled adult (≥ 18 years) lay counsellors from ten primary healthcare clinics in Johannesburg (South Africa) selected to participate in the Thusa-Thuso training and support program. Counsellors attended the ten-day baseline and quarterly refresher training over 12 months (October 2018-October 2019). Each counsellor submitted two audio recordings of mock counselling sessions held during the ten-day baseline training and two additional recordings of sessions with consenting patients after each quarterly contact session. We reviewed the recordings using the MI treatment integrity (MITI) coding system to determine MI technical (cultivating change talk and softening sustain talk) and relational (empathy and partnership) competency scores before and after training. After 12 months of support with pilot site counsellors, we were asked to scale up the training to NGO partner team trainers in a once-off five-day Training of trainers (TOT) format (n = 127 trainees from November 2020 to January 2021). We report TOT training experiences from focus group discussions (n = 42) conducted six months after the TOT sessions. Of the 25 enrolled lay counsellors from participating facilities, 10 completed the 12-month Thusa-Thuso program. Attrition over the 12 months was caused by death (n = 3), site exclusion/resignations (n = 10), and absence (n = 2). MI competencies improved as follows: the technical skills score increased from a mean of 2.5 (standard deviation (SD): 0.8) to 3.1 (SD: 0.5), with a mean difference of 0.6 (95% confidence interval (CI): 0.04, 0.9). The MI relational skills score improved from a mean of 3.20 (SD: 0.7) to 3.5 (SD: 0.6), with a mean difference of 0.3 (95% CI: -0.3, 8.5). End-point qualitative data from the counsellors highlighted the value of identifying and addressing specific skill deficiencies and the importance of counsellors being able to self-monitor skill development using the MITI review process. Participants appreciated the ongoing support to clarify practical MI applications. The TOT program tools were valuable for ongoing on-the-job development and monitoring of quality counselling skills. However, the MITI review process was perceived to be too involved for large-scale application and was adapted into a scoring form to document sit-in mentoring sessions. The Thusa-Thuso MI intervention can improve counsellor motivation and skills over time. In addition, the program can be scaled up using an adapted TOT process supplemented with fidelity assessment tools, which are valuable for skills development and ongoing maintenance. However, further studies are needed to determine the effect of the Thusa-Thuso program on patient ART adherence and retention in care. Trial registration: Pan African Clinical Trials Registry No: PACTR202212796722256 (12 December 2022).

Processes for culturally adapting behavioral health interventions for people with refugee backgrounds: A scoping review

Academic literature supports cultural adaptation (CA) of evidence-informed interventions to increase accessibility and effectiveness of behavioral health treatment to meet the needs of a culturally diverse society. While several meta-analyses have shown positive outcomes of CA mental health interventions, there is a need for more information about how theoretical CA models have been applied in practice to meet the cultural and contextual needs of specific groups. This scoping review was conducted to understand how CA models have been applied to adapt evidence-informed behavioral health interventions for people with refugee backgrounds in resettlement. Eighteen manuscripts were identified and analyzed, resulting in five categories: Reasons for Engaging in CA, Processes of CA, Types of CAs, Resources Needed to Support CA, and Evaluating Adaptation Choices. Only four studies utilized any existing model to guide their adaptation efforts, three of which used CA models. Level of detail regarding CA processes and justification for choices varied considerably among articles. Significant gaps were identified, posing challenges for replication. Although articles reported that adapted interventions were effective, it is unclear which, if any, CA choices contributed to the successful outcomes. Findings indicate a need for emphasis on clear and thorough documentation of CA processes and more rigorous assessment of the impact of adaptation choices.

Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

Risk profiles of adults with heavy alcohol use: Drinking patterns, behavioral and metabolic factors, health problems, and racial and ethnic disparities

BACKGROUND

Heavy alcohol use is a growing risk factor for chronic disease, yet little is known about its co-occurrence with other risk factors and health problems. This study aimed to identify risk profiles of adults with heavy alcohol use and examined potential disparities by race and ethnicity.

METHODS

This cross-sectional study included 211,333 adults with heavy alcohol use (in excess of daily or weekly limits recommended by National Institute on Alcohol Abuse and Alcoholism) between June 1, 2013 and December 31, 2014 in Kaiser Permanente Northern California. Latent class analysis was used to examine how heavy drinking patterns clustered with other behavioral and metabolic risk factors and health problems to form risk profiles. Multinomial logistic regression models were fit to examine associations between race, ethnicity, and risk profiles.

RESULTS

A 5-class model was selected as best fitting the data and representing clinically meaningful risk profiles: (1) "heavy daily drinking and lower health risks" (DAILY, 44.3%); (2) "substance use disorder and mental health disorder" (SUD/MH, 2.3%); (3) "heavy weekly drinking and lower health risks" (WEEKLY, 19.6%); (4) "heavy daily drinking and more health risks" (DAILY-R, 18.5%); (5) "heavy weekly drinking and more health risks" (WEEKLY-R, 15.3%). American Indian or Alaska Native (AIAN) and Black patients had higher odds than White patients of being in the SUD/MH, DAILY-R, and WEEKLY-R profiles than the DAILY profile. AIAN, Black, and Latino/Hispanic patients had higher odds than White patients of being in the SUD/MH, DAILY-R, and WEEKLY-R profiles rather than the WEEKLY profile.

CONCLUSIONS

AIAN, Black, and Latino/Hispanic patients with self-reported heavy drinking were more likely to be in risk profiles with greater alcohol consumption, more health risks, and higher morbidity. Targeted, culturally appropriate interventions for heavy alcohol use that may address other modifiable risk factors are needed to work towards health equity.

Development and Evaluation of a Measure of Drinking Behavior in Response to Acculturation Stressors for Latinx Adults Entering Alcohol Treatment

Introduction

The current study presents the development of a scale to assess drinking behavior in response to acculturation and immigration stress.

Methods

The 19-item Measure of Immigration and Acculturation Stressors (MIAS) and a parallel assessment, a Measure of Drinking in Response to Immigration and Acculturation Stressors (MDRIAS), were administered at baseline, 6 months, and 12 months in a completed randomized controlled trial testing culturally adapted motivational interviewing to reduce heavy drinking and related problems in Latinx individuals who met criteria for heavy drinking (n=149).

Results

Exploratory factor analysis of the MIAS showed best fit for a four-factor solution (Relational Stress, Perceived Ethnic Discrimination, Attenuated Aspirations, and Sense of Alienation) with 15 items. The MIAS subscales and the four corresponding MDRIAS subscales were shown to have good reliability (i.e., internal consistency, intercorrelations, and test-retest) and criterion-related validity (i.e., concurrent, convergent, and predictive).

Conclusions

These findings suggest that the MIAS can be used to assess different types of immigration and acculturation stressors for Latinx adults and the MDRIAS can be used to assess drinking in response to those experiences. The MIAS and MDRIAS could be used in the future to adapt alcohol interventions to relevant stressors that contribute to Latinx adults' alcohol use.

Promoting alcohol treatment engagement post-hospitalization with brief intervention, medications and CBT4CBT: protocol for a randomized clinical trial in a diverse patient population

BACKGROUND

Alcohol use disorder (AUD) commonly causes hospitalization, particularly for individuals disproportionately impacted by structural racism and other forms of marginalization. The optimal approach for engaging hospitalized patients with AUD in treatment post-hospital discharge is unknown. We describe the rationale, aims, and protocol for Project ENHANCE (ENhancing Hospital-initiated Alcohol TreatmeNt to InCrease Engagement), a clinical trial testing increasingly intensive approaches using a hybrid type 1 effectiveness-implementation approach.

METHODS

We are randomizing English and/or Spanish-speaking individuals with untreated AUD (n = 450) from a large, urban, academic hospital in New Haven, CT to: (1) Brief Negotiation Interview (with referral and telephone booster) alone (BNI), (2) BNI plus facilitated initiation of medications for alcohol use disorder (BNI + MAUD), or (3) BNI + MAUD + initiation of computer-based training for cognitive behavioral therapy (CBT4CBT, BNI + MAUD + CBT4CBT). Interventions are delivered by Health Promotion Advocates. The primary outcome is AUD treatment engagement 34 days post-hospital discharge. Secondary outcomes include AUD treatment engagement 90 days post-discharge and changes in self-reported alcohol use and phosphatidylethanol. Exploratory outcomes include health care utilization. We will explore whether the effectiveness of the interventions on AUD treatment engagement and alcohol use outcomes differ across and within racialized and ethnic groups, consistent with disproportionate impacts of AUD. Lastly, we will conduct an implementation-focused process evaluation, including individual-level collection and statistical comparisons between the three conditions of costs to providers and to patients, cost-effectiveness indices (effectiveness/cost ratios), and cost-benefit indices (benefit/cost ratios, net benefit [benefits minus costs). Graphs of individual- and group-level effectiveness x cost, and benefits x costs, will portray relationships between costs and effectiveness and between costs and benefits for the three conditions, in a manner that community representatives also should be able to understand and use.

CONCLUSIONS

Project ENHANCE is expected to generate novel findings to inform future hospital-based efforts to promote AUD treatment engagement among diverse patient populations, including those most impacted by AUD.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT05338151.

Needs and Attitudes Related to the Adoption of Evidence-Based Practices Among Latinx Mental Health Professionals

Empirically supported interventions are warranted to achieve desired clinical outcomes and improve service delivery. Thus, efforts to identify, adopt, and implement Evidence-Based Practices (EBPs) are underway across various Latinx communities, including Puerto Ricans, where there is a growing recognition and prevalence of mental health and substance use disorders. This study investigated the needs and attitudes toward EBPs among an interdisciplinary sample of mental health professionals in Puerto Rico. An anonymous survey was distributed to social workers, psychologists, and professional counselors (N = 237). Using structural equation modeling, four dimensions of attitudes towards EBPs (openness, divergence, appeal, and requirement) were regressed on various individual and organizational factors. Some socio-demographic characteristics, educational opportunities, and organizational factors significantly contributed to specific attitudes related to the adoption of EBPs. Female participants and those working in rural settings scored higher in the openness to innovation dimension. Greater organizational support and graduating from a private institution were associated with more divergence from research, while married individuals and those trained on EBPs scored lower on this dimension. The lack of exposure to EBPs in college and younger age predicted greater interest in the appeal of adopting an EBP intervention (i.e., would adopt an EBP if it made sense). No differences in attitudes toward EBPs were found by professional discipline or work setting (i.e., clinical, community, and schools). Recommendations to increase openness and interest in the appeal of EBPs among Spanish-speaking professional communities in Latin America are highlighted.

Culturally adapted motivational interviewing's effects on drinking in response to immigration and acculturation stressors among Latinx adults with heavy drinking problems

INTRODUCTION

Culturally adapted motivational interviewing (CAMI) is a form of motivational interviewing that was adapted to address immigration- and acculturation-related stressors among Latinx adults who met criteria for hazardous drinking. This study hypothesized that (1) receiving CAMI was associated with reduced immigration/acculturation stress and related drinking and that (2) these associations differed by participants' acculturation and perceived discrimination levels.

METHODS

This study employed a single group pre-post study design using data from a randomized controlled trial. Participants were Latinx adults who received CAMI (N = 149). The study assessed immigration/acculturation stress with the Measure of Immigration and Acculturation Stressors (MIAS) and measured related drinking with the Measure of Drinking Related to Immigration and Acculturation Stressors (MDRIAS). The study team conducted linear mixed modeling for repeated measures to examine outcome changes between the baseline and the 6-month and 12-month follow-ups and moderation effects.

RESULTS

Compared to baseline, the study found significant decreases in the total MIAS and MDRIAS scores and subscale scores at 6- and 12-month follow-ups. Moderation analysis results showed that lower acculturation levels and higher levels of perceived discrimination were significantly associated with larger decreases at follow-up in total MIAS and MDRIAS scores and several subscale scores.

CONCLUSIONS

Findings provide preliminary support for CAMI's efficacy in reducing immigration and acculturation stress and related drinking among Latinx adults with heavy drinking problems. The study observed more improvements among the less acculturated and more discriminated participants. Larger studies with more rigorous designs are needed.

Intersectional forms of racism and sexual minority stress are associated with alcohol use among Latinx sexual minority men with greater Hispanic/Latinx cultural orientation

Background: Latinx sexual minorities with increased levels of acculturation report higher rates of alcohol use, and discrimination may impact this association. Yet, there is little research examining the concomitant impact of racism and sexual minority stress (i.e. intersectional discrimination) and the additive effect of acculturation on Latinx sexual minority men's risk for hazardous alcohol consumption.Objectives: This study investigated the role of perceived stressfulness of intersectional discrimination in the relation between acculturation (US cultural orientation/Hispanic cultural orientation) and alcohol use among Latinx sexual minority men.Methods: A structural equation model was utilized to test the indirect effect of discrimination between acculturation and alcohol use with a sample of 357 Latinx sexual minority men (M_age = 28.39) recruited via Amazon MTurk.Results: The indirect effect between the Hispanic cultural orientation to alcohol use through intersectional forms of discrimination was significant and positive (b = .19, SE = .03, p < .01). The indirect effect for the US cultural orientation to alcohol use through intersectional forms of discrimination was significant and negative (b = -.10, SE = .03, p < .01).Conclusion: Contrary to previous literature, Latinx sexual minority men with a higher Hispanic cultural orientation reported higher levels of intersectional forms of discrimination, which in turn was associated with increased alcohol use. Those with a higher US cultural orientation reported lower levels of intersectional forms of discrimination, which in turn was associated with decreased alcohol use. These findings may help identify mechanisms that exacerbate health disparities for Latinx sexual minority men.

Vales+Tú: a cluster-randomized pilot study to reduce workplace injuries among US Latino day laborers

Latino day laborers (LDL) are a vulnerable population of workers facing considerable risk for occupational injury. Under the guidance of our Community Advisory Board, we developed and tested the feasibility, acceptability and preliminary effects of Vales+Tú (You Are Worth More), a workplace injury risk-reduction program implemented by promotores on street-corners where LDL seek employment. The program was informed by theoretical perspectives emphasizing individual and group agency and self-determination. A pilot three-arm cluster-randomized community trial was conducted among 75 LDL. The intervention arms consisted of an individualized Brief Motivational Interview, a Group Problem Solving activity and a standard of care control (OSHA safety cards). We met our study goal of 25 LDL per intervention arm, and contacted 88% of participants post intervention. Participants evaluated the interventions favorably. At post-test, the Brief Motivational Interview group reported significant reductions in exposure to workplace hazards and increases in risk-reduction practices. The Group Problem Solving participants showed significant reductions in exposure to hazards (t-test −4.16, p &lt; 0.001). Both intervention groups increased their reliance on corner peers, a measure of social support. Standard of care participants increased in self-efficacy to work safely. Overall, the only significant different between the three study conditions was in self-efficacy. These findings provide evidence of the feasibility and acceptability of Vales+Tú and show preliminary program efficacy. A large-scale replication trial will permit a more formal modeling of the study findings. Clinical Trial Registration (ClinicalTrials.gov): NCT04378348.

Racial and ethnic differences in alcohol, cannabis, and illicit substance use treatment: a systematic review and narrative synthesis of studies done in the USA

Reports from uncontrolled trials and surveys suggest that there are disparities in substance-use outcomes for minoritised racial and ethnic populations, yet few of these disparities have emerged from randomised clinical trials (RCTs). We conducted a systematic review of RCTs published in English of Black or Latinx adults with any non-nicotine substance use disorder that reported rates of treatment initiation, engagement, or substance-use outcome by race or ethnicity. Study quality was assessed by the Joanna Briggs Institute appraisal tool and a Yale internally validated quality assessment. Of the 5204 studies, 50 RCTs met the inclusion criteria, all done in the USA, 24 compared treatment initiation, engagement, or outcome across races or ethnicities and 26 compared these same factors within a race. Few RCTs have reported outcomes specifically for Black or Latinx populations, with nine reporting significant differences by race or ethnicity. Significant differences were found in all studies that evaluated the baseline differences in social determinants. This Review explains the need for optimisation of RCTs to inform the design, delivery, and dissemination of treatment to historically excluded communities.

Cultural adaptations of motivational interviewing: A systematic review

Motivational interviewing (MI; Miller & Rollnick, 2012) has expanded from treating substance use disorders to other health concerns across a range of racial-ethnic groups and ages. The spirit of MI lends itself well to working with culturally diverse populations by eliciting the client's values and goals in a collaborative and client-centered approach in pursuit of behavior change. Additionally, MI has been further adapted for use with racial-ethnic minority groups to enhance its effectiveness with specific populations. The aim of this review was to investigate existing cultural adaptations of MI (CAMI), their effectiveness, and to provide directions for future cultural adaptations in both research and clinical settings. This systematic review identified studies of CAMI over the past 20 years using MEDLINE/Pubmed and Embase. The final dataset consisted of 25 peer review studies. In the randomized controlled trial (RCT) studies that utilized a control condition (n = 17), 10 studies showed that the CAMI condition performed significantly better on at least the primary outcome measure than the control condition. All 10 studies adapted Context, Content, and Concepts-three of the dimensions of cultural adaptation defined by the ecological validity framework used in this study (Bernal et al., 1995). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Culturally adapted evidence-based treatments for adults with substance use problems: A systematic review and meta-analysis

BACKGROUND

This systematic review/meta-analysis aimed to synthesize empirical evidence from randomized controlled trials on the efficacy of culturally adapted interventions (CAIs) for substance use and related consequences for adults of color.

METHODS

Six electronic databases were searched to identify eligible studies. Two reviewers independently screened studies, extracted data, and assessed risks of bias. We used robust variance estimation in meta-regression to synthesize effect size estimates and conduct moderator analyses.

RESULTS

Twenty-two studies met the inclusion criteria and were included in the review. The overall effect size was 0.23 (95 % Confidence Interval [CI] = 0.12, 0.35). The subgroup effect sizes for comparing CAIs with inactive controls and with active controls were 0.31 (CI = 0.14, 0.48) and 0.14 (CI=-0.02, 0.29), respectively. The effect sizes for alcohol use, illicit drug use, unspecified substance use outcomes, and substance use related consequences were 0.25 (CI = 0.08, 0.43), 0.35 (CI =-0.30, 1.00), 0.22 (CI=-0.17, 0.62), and 0.02 (CI=-0.11, 0.16), respectively. Moderator analysis showed that CAIs' effects might not vary significantly by treatment model, dose, country, follow-up assessment timing, participant age, or gender/sex.

CONCLUSIONS

Research on substance use interventions that are culturally adapted for people of color is growing, and more high-quality studies are needed to draw definitive conclusions about CAIs' treatment effects. Our study found CAIs to be a promising approach for reducing substance use and related consequences. We call for more efficacy/effectiveness and implementation research to further advance the development and testing of evidence-based CAIs that meet the unique needs and sociocultural preferences of diverse populations.

Peer Support in Behavioral Health care: why it can work in the Latinx context

Las personas de origenes latinoamericanos son menos propensas a comprometerse con el cuidado de salud mental y la participación en servicios de salud mental, comparado a otros grupos raciales y étnicos. Las bajas tasas de participación en servicios de salud mental en parte de la comunidad Latinx en los Estados Unidos (EE. UU.) se puede atribuir parcialmente alfuncionamiento de los sistemas de cuidado, los cuales no son sensibles a la cultura Latinx o al español como lengua. Las Investigaciones han demostrado que intervenciones centradas en la cultura, que promueven los valores culturales de la comunidad Latinx, informan una mayor participación y satisfacción en el tratamiento y los servicios de salud mental. Un enfoque efectivo, informado por la cultura, que puede mejorar la participación de la comunidad Latinx en servicios de salud mental es el apoyo de compañerxs. En el enfoque de apoyo de pares, se contrata a personas con experiencias vividas en salud mental y adicciones como compañeros de apoyo para ayudar a quienes han vivido experiencias similares. Los estudios de investigación que miden la efectividad de los enfoques de apoyo entre pares han mostrado mejoras en las vidas de quienes reciben el apoyo, ayudando con el sentido de esperanza, calidad de vida, y bienestar. Los resultados también han demostrado disminución de hospitalizaciones, visitas a la sala de emergencia y menor uso de sustancias y participación en actividades criminales. El apoyo entre compañerxs en el contexto Latinx parece un ajuste natural dados sus valores colectivos compartidos (p. ej., simpatía, personalismo, respeto, confianza, familismo). Este articulo discute como los valores de apoyo entre compañerxs se relacionan con los valores colectivistas; y como se pueden infundir más los valores Latinx en el entrenamiento, desarrollo y supervisión de los compañerxs de apoyo para mejorar el cuidado de salud mental informado por la cultura.   

Computerized Clinical Training Simulations with Virtual Clients Abusing Alcohol: Initial Feasibility, Acceptability, and Effectiveness

Although masters-level social work students typically build clinical skills via role-playing with their peers or instructors, several innovative training simulations are emerging in the literature that may enhance existing skill-building methodologies. We evaluated the initial feasibility, acceptability, usability, and effectiveness of three computerized simulations (two cognitive behavioral therapy, one motivational interviewing) during an interpersonal practice course among 22 students in a Master of Social Work program accredited by the Council on Social Work Education. Trainees repetitively practiced their clinical skills with virtual clients while receiving feedback via real-time nonverbal cues, transcript review, and performance assessment across pre-specified theoretical learning objectives. Across the three simulations, at least 86.4% of students completed the required protocol and completed M = 468.95 (SD = 178.27) minutes of simulated sessions. Students improved their scores (range 0 to 100) across all the simulations from M = 63.41 (SD = 11.13) to M = 93.64 (SD = 3.24). Students found the simulations to be acceptable with strong usability. Paired sample t-tests revealed students reported greater self-efficacy in general clinical skills, exploration skills, insight skills, and action skills between pre-test and post-test after completing the simulations (all p < 0.001). Students reported that the clinical skills learned from the simulations translated into successful interactions with real-world clients during their field placements. We discuss the results of this initial feasibility study within the context of simulation-based learning and the potential for broader implementation within MSW programs.

Cultural Adaptation of 2 Evidence-Based Alcohol Interventions for Antiretroviral Treatment Clinic Patients in Vietnam

In Vietnam where alcohol use is culturally normative and little treatment is available, persons living with HIV (PLWH) who consume alcohol at unhealthy levels are at greatly increased risk for negative health outcomes. We describe the first systematic adaptation of 2 evidence-based alcohol interventions for use in Vietnam: a combined motivational enhancement therapy/cognitive behavioral therapy and a brief alcohol intervention. Using the situated information, motivation and behavioral skills model, and systematic procedures for tailoring evidence-based treatments, we identified core intervention content to be preserved and key characteristics to be tailored for relevance to the clinical setting. We describe the use of in-depth interviews with antiretroviral treatment clients and providers, expert input, and counselor training procedures to develop tailored manuals for counselors and clients. Adapting evidence-based alcohol treatments for global settings is facilitated by the use of a model of behavior change and systematic procedures to operationalize the approach.

Development of a Culturally Tailored Motivational Interviewing-Based Intervention to Improve Medication Adherence in South Asian Patients

BACKGROUND

South Asians (SAs) are among the fastest growing ethnic population in Western countries and have a higher risk of cardiovascular diseases relative to the general population. SAs living in Canada also have poorer adherence to medical regimens for treating cardiovascular disease, relative to other ethnic groups. Motivational interviewing (MI) maybe effective in improving health-related behaviour change in patients; however, the research is nascent on the effectiveness of MI in SAs and may also require cultural adaptation.

AIM

To develop a culturally tailored MI-based intervention to improve medication adherence in hypertensive SA patients living in Canada.

METHODS

Previous literature about medication adherence in SAs was reviewed, along with transcripts and responses to open-ended survey questions from our previous studies with SAs, to draft an MI intervention manual. The manual received extensive feedback from the study team, SA community members and health-care providers who work with SA patients. The feedback was used to refine the manual and make it culturally tailored and relevant to SA hypertensive patients living in Canada.

RESULTS

A culturally tailored MI-based manual which we called a "motivational communication manual" was developed to support a study focused on improving medication adherence in SA hypertensive patients. The development process, components (eg, being culturally sensitive, family involvement, providing education about medications, reminders, etc.) and cultural nuances included in the manual are described in this paper.

CONCLUSION

This is the first culturally tailored MI-based intervention manual that has been developed with the aim of improving medication adherence in hypertensive SA patients and that includes direct feedback from SA community members. Use of this manual may improve the accessibility and adoption of MI-based practices in improving health behaviours in SAs living in Canada as well as encourage further research studies and clinical trials with SA patients.

Vida PURA: results from a pilot randomized trial of a culturally adapted screening and brief intervention to reduce unhealthy alcohol use among Latino day laborers

Latino immigrant men are at increased risk for unhealthy alcohol use. Vida PURA is a culturally adapted evidence-based intervention that consists of promotores providing screening and brief intervention to reduce unhealthy alcohol use among Latino immigrant men. The purpose was to assess the efficacy of Vida PURA in a pilot randomized control trial. Participants were screened for eligibility at a day labor worker center using the Alcohol Use Disorders Identification Test (AUDIT). Those with an AUDIT score ≥ 6 (N = 121) were randomized into an intervention (N = 77) or control group (N = 44). Participants in the intervention group received a brief intervention from a promotor including personalized feedback, motivational interviewing to assess their readiness to change, and referral to services. Participants in the control group received information about local substance use treatment services. We assessed changes in AUDIT scores, drinks per drinking day, drinking days, and frequency of heavy episodic drinking at 2 and 8 weeks following the baseline survey using a mixed-effects regression model. Many men had high AUDIT scores, indicating dependence. Both the intervention and control groups reduced their alcohol-related behaviors over time, but there were no significant differences between the groups. A culturally adapted brief intervention may not be enough to significantly reduce alcohol use among Latino day laborers, especially among those that are dependent. We discuss lessons learned from this trial, including the value of community-based approaches to reaching high-risk and underserved populations.

A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs

OBJECTIVE

This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored.

METHOD

Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months.

RESULTS

Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]).

CONCLUSIONS

Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Process for developing a culturally informed brief motivational intervention

The present study culturally enhances a standard brief intervention for alcohol use. Through an iterative process engaging key stakeholders; including patients, and expert consultants, this research sought to enhance current evidence based interventions. Five culturally informed enhancements consistent with Motivational Interviewing were introduced into standard brief interventions. These culturally informed enhancements can be refined to address the cultural risk and protective factors of other priority populations. The distinctions and advantages of this approach over prior cultural adapted interventions is discussed. Importantly, the present study outlines a process for refining the culturally informed brief intervention to other target populations.

A randomized trial of culturally accommodated versus standard group treatment for Latina/o adolescents with substance use disorders: Posttreatment through 12-month outcomes

OBJECTIVES

Latina/o adolescents are at particular risk for substance use disorders (SUDs) and effective treatments are needed. Some critics indicate that standard evidence-based treatments may not meet the needs of Latina/o adolescents and culturally accommodated treatments are needed; however, few comparative studies have been conducted to test this assumption. This randomized trial was designed to test a standard group-based version of a cognitive-behavioral treatment (S-CBT) against its culturally accommodated equivalent (A-CBT) for a sample of Latina/o adolescents with SUDs.

METHOD

Seventy Latina/o adolescents were randomly assigned to 1 of 2 treatment conditions and followed over 4 posttreatment time points with the last at 12-months. Generalized longitudinal mixed models for count data were conducted to evaluate treatment differences across time for adolescent substance use. The cultural variables ethnic identity, acculturation, and familism were included in the analysis as potential moderators of treatment outcome.

RESULTS

A significant difference was found at the 12-month follow-up in favor of the culturally accommodated treatment (d = .92, 95% confidence interval, CI [.43, 1.42]) and parental familism moderated treatment outcome (d = .60, 95% CI [.12, 1.08]).

CONCLUSION

This is one of the first studies to demonstrate that a culturally accommodated treatment differentially improved outcomes compared with that of its standard equivalent for a sample of Latina/o adolescents with SUDs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Vida PURA: An assessment of the fidelity of promotor-delivered screening and brief intervention to reduce unhealthy alcohol use among Latino day laborers

We assessed the fidelity of promotores conducting screening and brief intervention (SBI) to reduce unhealthy alcohol use among Latino immigrant day laborers in the Vida PURA study. We reviewed 32 audio-recorded brief interventions to assess promotor adherence to the intervention protocol and to evaluate their motivational interviewing (MI) technique with the Motivational Interviewing Treatment Integrity (MITI) 4.2.1 tool. Promotores delivered three core intervention steps in 78% of recordings and achieved basic MI competence across all domains and proficiency in 50% of measures. Our results suggest that promotores can be trained to deliver SBI in community settings with fidelity.

Gender and Cultural Adaptations for Diversity: A Systematic Review of Alcohol and Substance Abuse Interventions for Latino Males

BACKGROUND

Latino men are disproportionately affected by the consequences of alcohol and substance abuse when compared to non-Latino white men. Latino men also face greater barriers to accessing, engaging, and completing alcohol and substance abuse treatment services. Culturally adapted interventions are promoted to overcome these barriers. However, the effectiveness of these efforts is unclear.

OBJECTIVES

The purpose of this review was to summarize the published evidence regarding gender-adapted and culturally adapted alcohol and substance abuse treatment that aims to improve physical, behavioral, and social outcomes in Latino men.

METHODS

A systematic literature search was conducted for articles reporting on culturally and/or gender-adapted alcohol and/or substance abuse interventions designed exclusively for Latino adults, including a Latino population sample of at least 10% and any proportion of Latino male participants. A thematic analysis based on predetermined themes was used to evaluate the nature of adaptations.

RESULTS

Searches yielded 2685 titles, resulting in 12 articles that fit review parameters. The most scientifically rigorous findings suggest culturally adapted interventions may outperform standard treatment. Nevertheless, a fraction of the interventions did not improve outcomes compared to standard treatment. Considering the scarce number of publications, it is difficult to discern if null findings reflect ineffective interventions or methodological limitations.

CONCLUSIONS

While studies are limited and findings are mixed, culturally tailored work shows promise. The growth rate of the Latino population and the current epidemic nature of substance abuse in the United States generate urgency to identify methods to diminish the disparate burden of alcohol and substance abuse in Latinos.

Exploring Structural, Sociocultural, and Individual Barriers to Alcohol Abuse Treatment Among Hispanic Men

Hispanic men have poor access to alcohol abuse treatment, low treatment engagement, and low treatment completion rates despite the contrasting burden of alcohol-related consequences they face. The purpose of this study was to examine Hispanic male perspectives regarding alcohol abuse treatment-seeking behaviors and the structural, sociocultural, and individual factors that may influence initiation and continued engagement in treatment in this population. Individual interviews were conducted with a sample of 20 Hispanic men (age: 44.6 ± 11.3 years). Thematic analysis was completed using a hybrid deductive–inductive approach centered in an a priori codebook that was further supplemented with iterative exploration of transcripts. Results suggested treatment-seeking behaviors were highly influenced by (a) structural factors related to poor treatment access, as well as lack of linguistic- and cultural-responsiveness of available treatment; (b) sociocultural factors related to difficulties problematizing alcohol abuse due to lack of community awareness, societal normalization of consumption, and stigmatization of alcohol abuse treatment; and (c) individual factors related to lack of individual knowledge. This work highlights the perceived lack of congruency between available treatment and the linguistic, cultural, and gender norms of Hispanic men. There is need for responsive treatment strategies that comprehensively consider the gendered- and sociocultural-factors that govern treatment seeking and engagement behaviors. Findings also suggest a need for targeted alcohol abuse awareness building efforts in the Hispanic community. Specifically, the detrimental effects of alcohol-related problems and potential benefits of treatment should be addressed in order to diminish social stigma of abuse and of treatment.

The Future of Research on Alcohol-Related Disparities Across U.S. Racial/Ethnic Groups: A Plan of Attack

OBJECTIVE

Research suggests striking disparities in alcohol use, problems, and treatment across racial/ethnic groups in the United States. However, research on alcohol-related disparities affecting racial/ethnic minorities remains in its developmental stages. The current article aims to support future research in this growing field by highlighting some of the most important findings, questions, and approaches, focusing on psychosocial research.

METHOD

This article advances seven research needs (i.e., questions and topics meriting attention) that we believe are of crucial importance to the field. We draw on the existing literature to illuminate under-explored areas that are highly relevant to health intervention and that complement the field's existing focus.

RESULTS

Identified research needs include research that (a) better describes disparities in alcohol-related health conditions and their drivers, (b) identifies appropriate screening and brief intervention methods for racial/ethnic minorities, (c) investigates disparities in access to and use of alcohol treatment and support services, (d) examines the comparative efficacy of existing alcohol interventions and develops tailored interventions, (e) explores the impacts of specific alcohol policies across and within racial/ethnic groups, and (f) describes the full spectrum of alcohol-related harms and how and why these may vary across racial/ethnic groups. We also call for (g) continuing research to monitor disparities over time.

CONCLUSIONS

This article points to specific strategies for describing, explaining, intervening on, and monitoring some of the most substantial alcohol-related disparities. Conclusions outline methods and processes that may be advantageous in addressing these priorities, including the use of longitudinal designs; consideration of life course changes; attention to nontraditional intervention settings; and inclusion of disadvantaged populations in all aspects of research.

Use of a Smartphone Recovery Tool for Latinos with Co-Occurring Alcohol and Other Drug Disorders and Mental Disorders

OBJECTIVE

Addressing alcohol and other drug disorders and other mental disorders among adult Hispanics/Latinos is of critical concern, as they are one of the fastest-growing ethnic groups with a disproportionate rate of disease, mental disorders, and poverty. Although improvement in outcomes is associated with sustained participation in ongoing treatment for co-occurring alcohol and other drug disorders/mental disorders, continuing care is rare for these chronic conditions, especially for Latinos with more limited access to culturally and linguistically competent services.

METHODS

The evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders, thus developing CASA-CHESS to address a high level of need for services, high rates of relapse, and lack of existing culturally competent services for Latinos.

RESULTS

Of the 79 Latino clients who completed residential treatment and received a smartphone equipped with CASA-CHESS, 26.6% discontinued using CASA-CHESS and 73.4% remained active for four or more months. CASA-CHESS usage was sustained over the four months across all three tenets of self-determination theory (competence, relatedness, and autonomy), with the most commonly utilized services being relevant to relatedness (e.g., messaging, discussion boards). CASA-CHESS clients demonstrated a similar pattern of usage to A-CHESS clients.

CONCLUSIONS

Findings illustrate that Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders will use a smartphone application to assist with their recovery, continuing their access to resources, case management, and quality information after leaving residential treatment. Consistent with previous findings, our results also emphasize the importance of social support during the four months post-discharge. Such evidence-based, theory-driven digital interventions may extend access to culturally and linguistically competent services.

Cultural adaptations to augment health and mental health services: a systematic review

BACKGROUND

Membership in diverse racial, ethnic, and cultural groups is often associated with inequitable health and mental health outcomes for diverse populations. Yet, little is known about how cultural adaptations of standard services affect health and mental health outcomes for service recipients. This systematic review identified extant themes in the research regarding cultural adaptations across a broad range of health and mental health services and synthesized the most rigorous experimental research available to isolate and evaluate potential efficacy gains of cultural adaptations to service delivery.

METHODS

MEDLINE, PsycINFO, CINAHL, EMBASE, and grey literature sources were searched for English-language studies published between January 1955 and January 2015. Cultural adaptations to any aspect of a service delivery were considered. Outcomes of interest included changes in service provider behavior or changes in the behavioral, medical, or self-reported experience of recipients.

RESULTS

Thirty-one studies met the inclusion criteria. The most frequently tested adaptation occurred in preventive services and consisted of modifying the content of materials or services delivered. None of the included studies focused on making changes in the provider's behavior. Many different populations were studied but most research was concerned with the experiences and outcomes of African Americans. Seventeen of the 31 retained studies observed at least one significant effect in favor of a culturally adapted service. However there were also findings that favored the control group or showed no difference. Researchers did not find consistent evidence supporting implementation of any specific type of adaptation nor increased efficacy with any particular cultural group.

CONCLUSIONS

Conceptual frameworks to classify cultural adaptations and their resultant health/mental health outcomes were developed and applied in a variety of ways. This review synthesizes the most rigorous research in the field and identifies implications for policy, practice, and research, including individualization, cost considerations, and patient or client satisfaction, among others.

A randomized controlled trial of culturally adapted motivational interviewing for Hispanic heavy drinkers: Theory of adaptation and study protocol

BACKGROUND

The NIH Strategic Plan prioritizes health disparities research for socially disadvantaged Hispanics, to reduce the disproportionate burden of alcohol-related negative consequences compared to other racial/ethnic groups. Cultural adaptation of evidence-based treatments, such as motivational interviewing (MI), can improve access and response to alcohol treatment. However, the lack of rigorous clinical trials designed to test the efficacy and theoretical underpinnings of cultural adaptation has made proof of concept difficult.

OBJECTIVE

The CAMI2 (Culturally Adapted Motivational Interviewing) study design and its theoretical model, is described to illustrate how MI adapted to social and cultural factors (CAMI) can be discriminated against non-adapted MI.

METHODS AND DESIGN

CAMI2, a large, 12month randomized prospective trial, examines the efficacy of CAMI and MI among heavy drinking Hispanics recruited from the community (n=257). Outcomes are reductions in heavy drinking days (Time Line Follow-Back) and negative consequences of drinking among Hispanics (Drinkers Inventory of Consequences). A second aim examines perceived acculturation stress as a moderator of treatment outcomes in the CAMI condition.

SUMMARY

The CAMI2 study design protocol is presented and the theory of adaptation is presented. Findings from the trial described may yield important recommendations on the science of cultural adaptation and improve MI dissemination to Hispanics with alcohol risk.

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations

OBJECTIVES

To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice.

METHODS

Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015.

RESULTS

A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described.

CONCLUSIONS

On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness.

PRACTICE IMPLICATIONS

Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

Patterns of Unhealthy Alcohol Use among Latino Day Laborers

OBJECTIVE

We sought to describe patterns of unhealthy alcohol use among Latino immigrant day laborers and identify correlates of these behaviors.

METHODS

Participants (N = 104) completed surveys on substance use, alcohol-related problems, mental health, and demographics. We assessed differences in unhealthy alcohol use by subject characteristic using chi-square tests of independence and 2-sample tests of proportions.

RESULTS

Unhealthy alcohol use was common with 65% having an AUDIT score of 8 or higher. Living situation and income were significantly associated with unhealthy alcohol use and high levels of depression and anxiety were associated with increased alcohol-related problems.

CONCLUSIONS

Interventions to reduce unhealthy alcohol use should consider the role of stable housing, income and mental health.

Development and Preliminary Testing of a Promotora-Delivered, Spanish Language, Counseling Intervention for Heavy Drinking among Male, Latino Day Laborers

This study developed and then tested the feasibility, acceptability and initial efficacy of a 3-session, culturally adapted, intervention combining motivational enhancement therapy (MET) and strengths-based case management (SBCM) delivered by promotoras in Spanish to reduce heavy drinking among male, Latino day laborers. A pilot two-group randomized trial (N=29) was conducted to evaluate the initial efficacy of MET/SBCM compared to brief feedback (BF). Alcohol-related measures were assessed at 6, 12 and 18weeks after baseline. Most intervention group participants (12/14) attended all counseling sessions and most participants (25/29) remained in the study at 18weeks. Alcohol related measures improved in both groups over time with no statistically significant differences observed at any of the time points. However the comparative effect size of MET/SBCM on weekly drinking was in the large range at 6-weeks and in the moderate range at 12-weeks. Post hoc analyses identified a statistically significant reduction in number of drinks over time for participants in the intervention group but not for control group participants. Despite the extreme vulnerability of the population, most participants completed all sessions of MET/SBCM and reported high satisfaction with the intervention. We feel our community partnership facilitated these successes. Additional studies of community-partnered and culturally adapted interventions are needed to reduce heavy drinking among the growing population of Latinos in the U.S.

Cultural accommodation of group substance abuse treatment for Latino adolescents: Results of an RCT

Comparative studies examining the difference between empirically supported substance abuse treatments versus their culturally accommodated counterparts with participants from a single ethnic minority group are frequently called for in the literature but infrequently conducted in practice. This randomized clinical trial was conducted to compare the efficacy of an empirically supported standard version of a group-based cognitive-behavioral treatment (S-CBT) to a culturally accommodated version (A-CBT) with a sample of Latino adolescents primarily recruited from the juvenile justice system. Development of the culturally accommodated treatment and testing was guided by the Cultural Accommodation Model for Substance Abuse Treatment (CAM-SAT). Seventy Latino adolescents (mean age = 15.2; 90% male) were randomly assigned to 1 of 2 group-based treatment conditions (S-CBT = 36; A-CBT = 34) with assessments conducted at pretreatment, posttreatment, and 3-month follow-up. Longitudinal Poisson mixed models for count data were used to conduct the major analyses. The primary outcome variable in the analytic models was the number of days any substance was used (including alcohol, except tobacco) in the past 90 days. In addition, the variables ethnic identity, familism, and acculturation were included as cultural moderators in the analysis. Although both conditions produced significant decreases in substance use, the results did not support a time by treatment condition interaction; however, outcomes were moderated by ethnic identity and familism. The findings are discussed with implications for research and practice within the context of providing culturally relevant treatment for Latino adolescents with substance use disorders.

Assessing treatment fidelity in a cultural adaptation of motivational interviewing

The efficacy of motivational interviewing (MI) for addictions is well documented. Grounding MI in social/cultural priorities may enhance treatment response. We evaluate the method of assessing competence using the motivational interviewing treatment integrity system (MITI) for standard MI and culturally adapted MI (CAMI) delivered to Latino heavy drinkers. Twenty audiotapes (MI, n = 10; CAMI, n = 10) were MITI coded by two raters unaware of treatment assignment. Inter-rater reliabilities were excellent (.78-.99) except for CAMI complex reflections, global ratings of empathy, and MI spirit. The MITI reliably evaluates MI and CAMI treatment fidelity. Future research should investigate lower reliabilities for MI global and complex reflections cross-culturally.

Vida PURA: A Cultural Adaptation of Screening and Brief Intervention to Reduce Unhealthy Drinking Among Latino Day Laborers

BACKGROUND

Brief intervention is known to reduce drinking in primary care; however, because health care access is limited for Latino immigrants, traditional brief interventions are unlikely to reach this population.

METHODS

Using Barrera and Castro's framework, our study aims to culturally adapt a screening and brief intervention program to reduce unhealthy alcohol use among Latino day laborers, a particularly vulnerable group of Latino immigrant men. We conducted 18 interviews with Latino day laborers and 13 interviews with mental health and substance use providers that serve Latino immigrant men. Interviews were conducted until saturation of themes was reached. Themes from interviews were used to identify sources of mismatch between traditional screening and brief intervention in our target population.

RESULTS

Unhealthy alcohol use was common, culturally accepted, and helped relieve immigration-related stressors. Men had limited knowledge about how to change their behavior. Men preferred to receive information from trusted providers in Spanish. Men faced significant barriers to accessing health and social services but were open to receiving brief interventions in community settings. Findings were used to design Vida PURA, a preliminary adaptation design of brief intervention for Latino day laborers. Key adaptations include brief intervention at a day labor worker center provided by promotores trained to incorporate the social and cultural context of drinking for Latino immigrant men.

CONCLUSIONS

Culturally adapted brief intervention may help reduce unhealthy drinking in this underserved population.