Acceptability of Behavioral Activation for Depression Among Latinas: A Mixed Methods Study

Latinxs represent the largest ethnoracial minority population in the United States. Despite having significant rates of depression, Latinxs underutilize behavioral health services. This, combined with the association between gender and depression (women have higher rates of depression than men), underscores the importance of developing an improved understanding of how Latinas view behavioral activation (BA), an empirically supported treatment for depression. In this mixed methods study, participants consisted of 77 Latinas; participants were provided with a vignette depicting a fictional character that underwent BA for depression. Participants in the quantitative study completed a measure of treatment acceptability of BA (n = 60); participants in the qualitative study completed a semistructured interview assessing their views on BA (n = 17). Latinas had generally positive attitudes about BA, although they also identified some elements that they perceived might act as barriers to treatment success. Because we were interested in the interplay of cultural factors and treatment acceptability, we also examined enculturation and acculturation as predictors of treatment acceptability-enculturation only was a significant predictor treatment acceptability. Our sample was relatively small, social desirability may have influenced our responses, and it is not known to what extent our results generalize to Latinx men. Latina women find BA to be an acceptable treatment for depression, which suggests promise with regard to clinical outcomes for depressed Latinas receiving BA. Addressing potential barriers to treatment engagement may improve outcomes for depressed Latinas receiving BA.

Addressing COVID-19 vaccination equity for Hispanic/Latino communities by attending to aguantarismo: A Californian US-Mexico border perspective

With an eye to health equity and community engagement in the context of the initial COVID-19 vaccine roll-out, the COVID-19-related concerns of the Latinx (Hispanic/Latino) community in southern San Diego (California, USA) were examined using 42 rapid, ethnographically-informed interviews and two focus groups conducted in early-mid 2021. An anthropologically oriented qualitative analysis delimited the cultural standpoint summarized as aguantarismo, which celebrates human durability in the face of socioeconomic hardship and the capacity to abide daily life's challenges without complaint. After characterizing aguantarismo, its role in both undermining and supporting vaccine uptake is explored. To avoid diverting attention from the structural factors underlying health inequities, the analysis deploys the theoretical framework of critical medical anthropology, highlighting inequities that gain expression in aguantarismo, and the indifference toward vaccination that it can support. In placing critical medical anthropology into conversation with the cultural values approach to public health, the analysis sheds new light on the diversity of human strategies for coping with infectious disease and uncovers new possibilities for effective vaccination promotion. Findings will be useful to public health experts seeking to convert non-vaccinators and optimize booster and pediatric COVID-19 vaccine communications. They will also contribute to the literature on cultural values in relation to Hispanic/Latino or border health more broadly, both by confirming the vital flexibility of cultural standpoints like aguantarismo and by documenting in situ what is to the social science and health literature, albeit not to cultural participants, a novel constellation.

Parenting and Family-Based Care

Children rely heavily on their parents for guidance and support throughout development. When parental support is hindered by racial discrimination, poverty, trauma, and acculturative family distancing, barriers to a child's success are cultivated. It is imperative that providers of children and families address racial and cultural concerns in a humble, curious manner. Cultural adaptations to family-based care can lead to stronger outcomes with families.

Attachment and Social Support in Latinx Young Adults: Investigating the Moderating Role of familismo

Social support is essential for maintaining physical and psychological health. Attachment security is important for seeking and using social support, and several studies provide evidence for attachment-based differences in perceptions of social support, with individuals with secure attachment describing greater social support. However, perceived social support may vary depending on culture and cultural values, and, thus, the link between attachment style and social support may be culturally moderated. Therefore, using a sample of 560 Latinx young adults, the current study examined whether the cultural value of familismo moderated the relation between attachment and social support. The results indicate that familismo moderated the relation such that the effect of attachment on social support appears to be larger among those with lower levels of familismo. Exploratory analyses revealed that this pattern also exists in a sample of non-Latinx young adults but only when examining paternal attachment. Further, exploratory analyses also uncovered relations between familismo and attachment with the mental health of Latinx young adults such that familismo moderated the relation between paternal attachment and depression. These findings highlight the role familismo and cultural values may play in the relation between attachment and social support or mental health outcomes.

Dealing with distress from the COVID-19 pandemic: Mental health stressors and coping strategies in vulnerable latinx communities

Distress secondary to the COVID-19 pandemic has been substantial, especially in vulnerable Latinx communities who are carrying an undue share of the pandemic-related social, health and economic burden in the United States. In collaboration with 43 community health workers (CHWs) and Promotor/as serving the needs of underserved Latinx communities in South Texas and guided by principles of community-based participatory research (CBPR), the purpose of this study was to identify relevant mental health stressors and related consequences, and to identify strategies for coping with distress among underserved Latinx communities during the COVID-19 pandemic. Data were collected on July 2020 using mixed methods to obtain more in-depth information. Surveys were administered, and three focus groups were conducted. Quantitative data were analysed using descriptive statistics, whereas qualitative data were analysed systematically by starting with a priori questions and themes followed by data categorisation, reduction, display and conclusion drawing. Results showed six themes related to mental health stressors including economics (e.g., job insecurity), immigration (e.g., undocumented status), misinformation, family stress (e.g., changes in family dynamics and the home environment), health (e.g., limited healthcare access) and social isolation. Coping skills of the community were categorised into four themes with multiple codes including behavioural strategies (e.g., identifying reliable information), cognitive strategies (e.g., collectivistic thinking), social support and spirituality. Findings indicate that underserved Latinx communities are dealing with substantial distress and mental health concerns secondary to the COVID-19 pandemic; yet these are resilient communities. Implications of these findings can inform development of resources, interventions, best practices and training avenues to address the mental health needs of underserved Latinx communities, while considering relevant cultural and contextual factors that may influence their effectiveness.

Adapting evidence-informed population health interventions for new contexts: a scoping review of current practice

BACKGROUND

Implementing evidence-informed population health interventions in new contexts often requires adaptations. While the need to adapt interventions to better fit new contexts is recognised, uncertainties remain regarding why and when to adapt (or not), and how to assess the benefits (or not) of adaptation. The ADAPT Study aims to develop comprehensive guidance on adaptation. This scoping review informs guidance development by mapping and exploring how adaptation has been undertaken in practice, in public health and health services research.

METHODS

We searched seven databases from January 2000 and October 2018 to identify eligible studies for this scoping review and a related systematic review of adaptation guidance. We mapped the studies of adaptation by coding data from all eligible studies describing the methods, contexts, and interventions considered for adaptation. From this map, we selected a sample of studies for in-depth examination. Two reviewers extracted data independently into seven categories: description, key concepts, types, rationale, processes, evaluation methods, evaluation justification, and accounts of failures and successes.

RESULTS

We retrieved 6694 unique records. From 429 records screened at full text, we identified 298 eligible studies for mapping and selected 28 studies for in-depth examination. The majority of studies in our map focused on micro- (i.e., individual-) level interventions (84%), related to transferring an intervention to a new population group within the same country (62%) and did not report using guidance (73%). Studies covered a range of topic areas, including health behaviour (24%), mental health (19%), sexual health (16%), and parenting and family-centred interventions (15%). Our in-depth analysis showed that adaptation is seen to save costs and time relative to developing a new intervention, and to enhance contextual relevance and cultural compatibility. It commonly follows a structured process and involves stakeholders to help with decisions on what to adapt, when, and how.

CONCLUSIONS

Adaptation has been undertaken on a range of health topics and largely in line with existing guidance. Significant gaps relate to adaptation of macro- (e.g., national-) level interventions, consideration of programme theories, mechanisms and contexts (i.e., a functional view of interventions), nuances around stakeholder involvement, and evaluation of the adapted interventions. Registration Open Science Framework, 2019, osf.io/udzma.

Examining the service-related experiences and outcomes of caregivers involved in a system of care who experienced everyday discrimination

Individuals who report everyday experiences of discrimination are at heightened risk for adverse health outcomes and tend to report underutilization of health services. Systems of care (SOCs) have the potential to engage members of minority groups and to reduce health disparities. We examined the service-related experiences of predominantly Latinx caregivers enrolled in a SOC for their children with severe psychological health needs. We used independent samples t-tests and regression analyses to compare relations among service access, perceived service characteristics, and caregiver stress according to whether caregivers reported frequent or infrequent discrimination. The frequent discrimination group scored significantly higher on dimensions of stress and had greater dosage than the infrequent group. There were no differences in relations between service characteristics and outcomes by group. Findings indicated important differences in the service-related experiences and outcomes of caregivers who reported frequent and infrequent discrimination. We discuss limitations and implications.

Written Exposure Therapy: The Case for Latinos

Despite the substantial impact of trauma and subsequent posttraumatic stress in the Latino population, Latinos often underutilize services to address symptoms. Furthermore, research is still lacking regarding the effectiveness of evidence-based treatments, specifically for Latinos. We review the case of a 29-year-old Latina diagnosed with posttraumatic stress disorder (PTSD) who presented with intrusive memories, nightmares, and negative affect. The client’s progress in treatment was hindered by extreme emotion dysregulation when asked to engage in imaginal exposure, leading her to contemplate premature termination of therapy. Thus, prolonged exposure therapy (PET) was modified based on written exposure therapy to successfully treat the client. Treatment success was reflected in both the client’s self-report and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) (PCL-5) scores at pre- and posttreatment. From this case study, we can conclude that (a) PET can be effectively modified during treatment to include written exposures if the client cannot participate in imaginal exposure; (b) such treatment may be effective for Latinos experiencing posttraumatic stress; and (c) cultural and logistical factors affecting client participation and utilization of services should be addressed in treatment.

Addressing Acculturative Stress in Psychotherapy: A Case Study of a Latino Man Overcoming Cultural Conflicts and Stress Related to Language Use

To foster engagement in treatment and improve therapeutic outcomes for immigrant clients, it is important for therapists to integrate cultural values and to recognize the psychological stressors faced as immigrants learn to adapt and assimilate changes associated with moving to a new country. This case study describes the integration of cultural values when working with immigrant Latino clients who are at an increased risk of experiencing acculturative stress as a result of moving to the United States and having limited English knowledge. The integration of cultural values of familismo and personalismo are also discussed as it related to case conceptualization and treatment process. Finally, the current case provides information about conducting therapy in two languages and transitioning from Spanish to English as part of acculturation process while also addressing multifaceted aspects involved when working with Latino clients.