The Program for the Study of Health Care Relationships funded 11 researchers in CT to study various aspects of health care relationships and adherence. The individuals listed below each received grants for one year (2001-02). They were awarded funds on the basis of a competitive review process and the scientific merit of their proposals. The wide range of disciplines they represent and their research interests demonstrated the diversity and complexity inherent in studying health care relationships.

• Development of an Instrument to Measure Patients' Trust of Health Care Providers
• Exploration of the Effect of Nausea, Self-Efficacy, and Health Care Relationships on Medication Adherence in HIV/AIDS Patients
• Advance Care Planning: A Team Approach
• Assisting Older Adults To Communicate Their Pain After Surgery
• The Effect of a Specialized RN Intervention Designed to Maximize Patient-Provider Relationships on Adherence to Anti-Depressant Medication
• Pilot Study of Rapid Electronic Adherence Reporting with Provider Feedback on Adherence to Antiretroviral Therapy (HCR 01-12)
• Development of a Measure of Family Management of Childhood Chronic Illness
• The Contribution of Health Care Professionals to Parent and Child Self-Management of Type 1 Diabetes
• Enhancing Treatment Access and Adherence among Women of Hispanic Origin: The Roles of Relationships and Cultural Responsiveness in Behavioral Health Care
• Elicitation of Patient with Adaptive Conjoint Analysis

Enhancing Treatment Access and Adherence among Women of Hispanic Origin: The Roles of Relationships and Cultural Responsiveness in Behavioral Health Care

Larry Davidson (P.I.), Manuel Paris, Luis Bedregal, and Luis Anez

The objective of the proposed initiative was to examine the mediating roles of healthcare relationships and cultural responsiveness with women of Hispanic origin with behavioral health needs in treatment access, adherence, and satisfaction. Through qualitative interviews, we first explored the impact of cultural factors on the behavioral health encounters of a sample of Latina women, thereby facilitating understanding of the particular challenges posed by culture and gender in the provision of accessible, effective services for this population. We also evaluated the influence of relational and cultural aspects of care on service use using standard quantitative measures of perceived behavioral health needs, perceived therapeutic alliance and degree of collaboration and cultural competence, ethnic identity, degree of acculturation, and level of satisfaction with services among Latina women who presented across three sites (behavioral, health clinic, medical clinic, and faith-based agency).

Study results demonstrated that out of the 43 respondents that completed the initial open-ended questionnaire, 49% identified depression as the main reason for receiving services, 9% reported substance abuse, and the remaining 42% reported other reasons for coming to treatment, such as childhood issues, referrals from other agencies, and other emotional problems including anxiety. Services received included psychotherapy (individual and group), medication management, and case management. Ninety-eight percent of the participants rated their experience with services from good to excellent. Moreover, 90% of the participants perceived medication and psychotherapy as the most important aspects of the services they received. Additionally, 95% expressed that, if required, they would use these services again.

Furthermore, at post-test, participants from the behavioral health clinic and medical clinic had significantly improved scores from the already favorable scores on the Therapeutic Collaboration Scale (TCS) administered at the initial interview. In other words, participant perception of clinician competency increased during the course of the therapeutic relationship at the above-mentioned clinics. However, for the faith-based agency, we noted that the TCS scores decreased in comparison to the other two sites. We believe that this finding could be related to the fact that the behavioral health and medical clinic have an established behavioral health and spiritual component built into the services that are provided. Although the faith-based agency has a strong spiritual component, as most of the counselors are ministers from local churches, it may be lacking the behavioral health expertise that may be needed to provide a full spectrum of care. This finding stresses the need for the integration of both spiritually and behaviorally based treatments, in order to provide culturally sound services.

Regarding participant responses on the Scale of Ethnic Experience (SEE), results demonstrated that participants in this study strongly identified with their own ethnicity and did not feel part of the American mainstream culture. These results were more evident in the behavioral health clinic group than in the faith-based agency group. In fact, participants from the behavioral health clinic significantly endorsed higher scores than participants from both the medical clinic and the faith-based agency on items that assessed sense of belonging to their own ethnic group. Moreover, participants from the behavioral health clinic had significantly lower scores than participants from the faith-based agency on items that measured acculturation to mainstream American society. This trend was congruent with differences between the behavioral health clinic group and the faith-based agency group on other acculturation variables, such as first generation status (97.5% and 82.6%, respectively) and bilingualism (20% and 34.8%, respectively).

Responses on the Therapeutic Alliance with Clinician (TAC) scale revealed that participantsŐ level of satisfaction with their clinicians ranged from moderately satisfied to extremely satisfied. Additionally, the Satisfaction With Services (SWS) scale yielded high mean scores on questions assessing level of satisfaction with their experience with services, with the physical appearance of the facility where they were receiving services, and with their service providers. Additionally, participants at all three sites felt that they generally, if not definitely, received the kind of services they wanted. However, a difference was found in the way the behavioral health clinic and medical clinic group responded in comparison to the faith-based agency. We speculate that one possible reason for the decrease in test scores of individuals from the faith-based agency as compared to individuals from the behavioral health and medical clinics was the direct result of the spectrum of services that are offered at the three sites. The behavioral health clinic and medical clinic offer a wide array of services, in addition to behavioral health treatment, however, the faith-based agency offers spiritually based therapeutic services, and those clients that would be in need of other services (case management, medications), would have to be referred elsewhere. Nonetheless, participants were pleased with services across the three different locations.

Finally, responses on the Perceived Need for Care Questionnaire (PNCQ) demonstrated that participants had behavioral health needs regarding information (about mental illness, its treatments, and availability of services), medicine, psychotherapy, case management, and skills training. This finding stresses the importance of providing education to minority Latina clients about issues regarding their diagnosis and treatment, including symptomatology, availability of services in the community, aspects related to medication management and psychotherapy, and the provision of skills training (including vocational training and English proficiency).

Copyright 2003Yale University School of Nursing, Yale University, New Haven, CT 06536All Rights Reserved