“Treated Me . . . like I Was Family”: Qualitative Evaluation of a Culturally-Adapted Health Care Manager Intervention for Latinos with Serious Mental Illness and at Risk for Cardiovascular Disease

Objectives: Latinos with serious mental illness (SMI) experience health care disparities and may benefit from interventions that improve access to, coordination of, and receipt of primary care services. The aim of this qualitative study was to examine the experiences of Latinos with SMI and at risk for cardiovascular disease (e.g., smoking, diabetes mellitus, hypertension, high cholesterol) participating in Bridges to Better Health and Wellness (B2BHW), a 12-month culturally-adapted health care manager intervention delivered by social workers employed in a public outpatient mental health clinic.  B2BHW focuses on care coordination, patient activation, and receipt of preventive primary care (e.g., screenings, vaccinations).  We examined three research questions: 1) What did participants like best about B2BHW?  2) What benefits did they perceive from this intervention? 3) How did they perceive their relationships with their health care managers?

Methods: Twenty-nine Latino participants with SMI completed a post-intervention survey that included an open-ended question about the things they liked most about B2BHW, and a subset of sixteen participants participated in one of three post-intervention focus groups to explore their views and experiences with B2BHW. The three focus groups were conducted at the study clinic in Spanish.  All groups were audiotaped and professionally transcribed. We used content-analysis to analyze the responses to the open-ended question and focus group transcripts.  To ensure the rigor and trustworthiness of our analyses, we used the following established strategies: generation of an audit trail, prolonged engagement with participants, and member-checking presentations.

Results:  Participants were mostly female, Dominican, monolingual Spanish-speakers with an average age of 54.  The most common psychiatric condition was schizoaffective disorder.  On average, participants reported 2.8 medical conditions, most frequently high cholesterol, hypertension, and diabetes mellitus.  All participants completed the B2BHW intervention, and on average attended 10 out of 12 health care manager sessions over the course of 12 months. Results indicated that what mattered most to participants included the health education they received, the positive relationships they were able to form with their health care managers, the care coordination assistance they obtained, and the motivation and activation they gained from this intervention.  Participants in all three focus groups consistently reported having very positive relationships with their health care managers suggesting that this was a highly valued aspect of B2BHW.  They described how health care managers treated them with respeto (respect), cariño (affection), and confianza (trust).

Conclusions: This qualitative study highlights how examining participants’ experiences with a culturally-adapted health care manager intervention can help identify key aspects of the intervention content, approaches, and interpersonal elements that mattered most to participants.  Our findings revealed the centrality that interpersonal aspect of care, particularly those that mirror culturally-compatible norms and expectations, have for Latinos with SMI and how these aspects of care can facilitate the delivery and acceptance of other core intervention elements, such as health education, patient activation, and care coordination.