Clinical Trial Details
— Status: Completed
Administrative data
| NCT number |
NCT03926247 |
| Other study ID # |
22217 |
| Secondary ID |
U54MD004811 |
| Status |
Completed |
| Phase |
N/A
|
| First received |
|
| Last updated |
|
| Start date |
March 13, 2018 |
| Est. completion date |
February 15, 2022 |
Study information
| Verified date |
May 2022 |
| Source |
University of New Mexico |
| Contact |
n/a |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Interventional
|
Clinical Trial Summary
The goal of this study is to test a transdisciplinary ecological approach to reducing mental
health disparities among Mexican immigrants by adapting and integrating a multilevel
community-based advocacy, learning, and social support intervention (Immigrant Well-being
Project, IWP) into existing efforts at three community partner organizations that focus on
mental health, education, legal, and civil rights issues for Mexican immigrants. This
research is innovative and significant because it employs cutting edge strategies to address
social-structural determinants of mental health and examines the community-engaged process of
adapting and testing the impact of a multilevel intervention originally designed for
refugees. The IWP intervention emphasizes a sustainable and replicable partnership model
between community-based organizations and universities that involves Mexican immigrants and
undergraduate advocates working together to: a) increase immigrants' abilities to navigate
their communities; b) improve immigrants' access to community resources; c) enhance
meaningful social roles by valuing immigrants' culture, experiences, and knowledge; d) reduce
immigrants' social isolation; and e) increase communities' responsiveness to immigrants
through changes in policy and practice. The IWP is administered by university students
enrolled in a service learning course, and has two elements: 1) Learning Circles, which
involve cultural exchange and one-on-one learning opportunities, and; 2) Advocacy, which
involves collaborative efforts to mobilize community resources related to health, housing,
employment, education, and legal issues. Studies of the intervention model with refugees
demonstrated feasibility, appropriateness, acceptability, and evidence that the intervention
decreased participants' psychological distress and increased protective factors, and impacted
changes in system-wide policies and practices. After completing in-depth ethnographic
interviews with 24 Mexican immigrant adults to elucidate their mental health needs,
stressors, current political/economic/social context, and local solutions, and a process of
community engagement and intervention adaptation, a mixed methods strategy with data
collected from 90 participants at four time points over a period of 14 months will be used to
test the impact of the 6-month intervention on reducing psychological distress, increasing
protective factors (access to resources, English proficiency, environmental mastery, and
social support), and achieving system-level changes in organizational, local, and state
policies and practices that impact Mexican immigrants' well-being. Mechanisms of intervention
effectiveness will be explored by testing mediating relationships between protective factors
and psychological distress. Qualitative data will explore feasibility and acceptability of
the intervention, participants' experiences in the intervention, and unexpected impacts;
document multilevel changes and the context of implementation at each site; and inform
interpretation of quantitative data. Quantitative and qualitative data on the quality of the
CBPR partnerships and their relationship to multilevel outcomes will also be examined.
Description:
The goal of this research is to advance the science of community-level mental health
interventions that aim to reduce social inequities and health disparities. The proposed study
will adapt and integrate a successfully implemented multilevel, ecological intervention that
addresses social-structural determinants of mental health into existing efforts at three
community partner organizations that focus on mental health, education, legal, and civil
rights issues for Mexican immigrants in New Mexico. Using a mixed methods longitudinal
design, the processes and outcomes of the collaborative, community-based intervention
efforts, including the impact of the quality of the community-based participatory research
(CBPR) partnerships on individual, organizational, and community-level outcomes, will be
illuminated.
Social and structural inequities contribute significantly to increasing health disparities
globally, with the increasing numbers of migrants throughout the world bearing a
disproportionate burden. The immigrant share of the U.S. population has risen steadily over
the past four decades, comprising 13.5% of the total population in 2015, with Mexican-born
immigrants accounting for 27% of all immigrants. The social, legal, and economic context of
the migration process, including increasing uncertainty, discrimination, stigma, lack of
access to resources, and fear of deportation and family separation based on immigration
policies and public perception of immigrants as a threat all have a critical impact on
adverse mental health outcomes among Mexican immigrants in the U.S. In addition, Mexican
immigrants have low utilization rates for mental healthcare, in part because of barriers that
include lack of health insurance, ineligibility for governmental health programs,
discrimination, lack of interpretation services and culturally appropriate care, and an
anti-immigrant political and economic climate. Although evidence points to the need to
address socio-structural determinants, many mental health interventions offered to Mexican
immigrants have focused on individual-level predictors of mental health. Also, Mexican
immigrants' health outcomes are often viewed within the Latino health paradox, and therefore
are frequently overlooked in mental health research and development of appropriate
interventions, despite mounting evidence of mental health disparities and disproportionate
exposure to trauma. Thus, multilevel, transdisciplinary intervention approaches that address
social-structural determinants of mental health, are culturally appropriate, build upon
Mexican immigrants' strengths, are cost-effective and scalable, and occur in non-stigmatized
settings are needed.
In prior NIH-funded research, the PI and community partners developed and tested a 6-month
community-based advocacy, learning, and social support intervention, which pairs
paraprofessional university students with refugee adults to engage in mutual learning and
social change efforts. The intervention was found to decrease participants' psychological
distress, improve their quality of life, access to resources, social support, and English
proficiency, and improve communities' responsiveness to refugees; and also proved to be
highly acceptable, cost effective, and sustainable. The objective of this study is to: a)
adapt the intervention for Mexican immigrants (Immigrant Wellbeing Project; IWP); b)
integrate IWP into existing efforts at three community partner organizations; and c)
elucidate new understandings of partnership and intervention processes that lead to
sustainable multilevel changes and the reduction of mental health disparities and related
social inequities.
Aim 1. Conduct an in-depth study of the mental health needs, stressors, current
political/economic/social context, and local solutions as experienced by 24 Mexican recent
and non-recent immigrants and their families residing in Bernalillo County New Mexico and
contextualized by staff at three community partner organizations.
Aim 2. Building on the data from Aim 1, use a CBPR approach to adapt the intervention model
(IWP) and integrate it within existing service delivery and social change efforts at three
community partner organizations.
Aim 3. Using a mixed methods longitudinal design, investigate the feasibility and
acceptability of the adapted community-based mental health intervention and test the quality
of the CBPR partnership and impact of the intervention on mental health problems and
protective factors among 90 Mexican immigrants and on organizational and government changes
in policies and practices impacting immigrant mental health.
3.1 The IWP and collaborative adaptation/integration process will be feasible and acceptable
and will serve as a model for implementing and studying multilevel, community-based
intervention efforts.
3.2 IWP participants' psychological distress will decrease significantly over time.
3.3 IWP participants' protective factors (access to resources, English proficiency,
environmental mastery, social support) will increase significantly over time.
3.4 Lower levels of psychological distress will be mediated by the protective factors.
3.5 Qualitative data will document changes in organizational and governmental policies and
practices and the context of implementation at each site, explore other impacts, and inform
interpretation of quantitative data.
3.6 Quality of CBPR partnership at each site will be related to policy/practice changes and
health outcomes.
As one of the core research projects of the Transdisciplinary Research, Equity and Engagement
Center for Advancing Behavioral Health (TREE), this study will benefit from and contribute to
collaborative efforts to elucidate and address the impact of social-structural (e.g., racism,
lack of access to resources) and historical (e.g., violence, trauma, colonization)
determinants of mental health for immigrant and indigenous populations.
