Table 3 Summary of intervention adaptations
Intervention domain adapted | Rationale for adaptation | Description of adaptation |
|---|---|---|
Cultural adaptations | ||
Health-care manager personnel | • Language is a critical barrier to care for many Hispanic clients with limited English proficiency. | • Use bilingual health-care managers to deliver the intervention. |
Client engagement and client health-care manager interactions | • Health-care manager interpersonal skills and interactions with clients need to reflect core cultural norms valued and preferred by Hispanic clients (e.g., personalismo, respeto, dignidad) in order to engender their trust and enhance their engagement. | • Added a section to the intervention manual discussing the importance and rationale for incorporating these cultural norms into health-care manager interpersonal skills and interactions with clients. |
• Added examples in the intervention manual of the type of health-care manager behaviors that demonstrate and reflect each of these cultural norms in their interactions with clients. | ||
Assessment | • Health-care manager assessments need to include the systematic collection of cultural information that can be used to understand Hispanic clients’ perspectives of their health problems, past and present help-seeking, and self-management behaviors, fears, and preferences for care. | • Added the DSM-5 Cultural Formulation Interview adapted for health problems to the assessment protocol used in the initial health-care manager sessions. |
Clients’ health education materials | • Client education materials need to be available in English and Spanish and include formats that are relatable, engaging, and relevant to a Hispanic audience. | • Added clients’ health education materials available in Spanish from national organizations (American Diabetes Association, American Heart Association) and health- related fotonovelas. |
Clients’ activation | • Lack of knowledge and awareness are critical barriers that negatively impact Hispanic clients’ involvement in their own health care and in self-management behaviors of their health conditions. | • Added the personal health record (PHR) as a client education and activation tool and to help facilitate the sharing of medical information between clients and their primary care and mental health providers. |
• Cultural norms associated with deference to authority figures can negatively impact Hispanic clients’ involvement in their medical visits and contribute to clients taking a passive stance toward their primary care physicians. | • Included a client activation checklist to the PHR to help clients’ prepare for their visits with their primary care doctors and be more active during these visits. | |
• The multiple stresses and demands that Hispanic clients face in their everyday lives can be overwhelming and create serious barriers for coping and managing their health conditions | • Added a problem solving module to enhance clients’ problem solving skills to cope with their health issues. | |
Provider adaptations | ||
Preventive care tracking tool | • Social workers may lack basic medical knowledge about preventive primary and cardiovascular care guidelines for adults, and how to interpret basic lab values for cardiometabolic indicators. | • Modified the preventive care tracking tool by adding basic medical information to facilitate the tracking, interpretation, and coordination of preventive primary care services and cardiovascular care. |
Care coordination plan | • Care coordination at our local clinic is more complex than in the original PCARE trial given that our clients receive primary care services from multiple primary care clinics in the community. | • Added a care coordination plan to assist health-care managers tackle the local complexities of coordinating care with multiple doctors and community clinics |
• The plan focuses on developing clear lines of communication to share information about clients’ care and reduce care coordination barriers. | ||
Training curriculum | • Since the original PCARE was delivered by RNs, a training curriculum was needed for our new provider group (social workers) | • A training curriculum consisting of four 3 hour sessions was developed for social workers. It included didactic modules, review and discussion of the program’s manual, role playing activities to practice core health-care managers skills, learning how to read and interpret lab results for cardiometabolic indicators (e.g., lipid panel), and learning how to take simple anthropometric measurements (e.g., weight, blood pressure, waist circumference). |