Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study.

BACKGROUND: Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making. OBJECTIVE: The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research. METHODS: This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings. RESULTS: Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex. CONCLUSIONS: Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals. TRIAL REGISTRATION: ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37712.

Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA.

To design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders' views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors' survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention's focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors' selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention's focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.

Nutrition of Black Women During Pregnancy.

OBJECTIVE: To examine the consistency and adequacy of nutritional intake in a population of Black women in the second and third trimesters of pregnancy. DESIGN: This was a longitudinal descriptive study. Data were collected from women with low-risk pregnancies at 22- to 24-week prenatal visits and two subsequent visits. SETTING: Participants were recruited from urban prenatal clinics in one city in the Northeastern United States. PARTICIPANTS: Pregnant women who self-identified as Black (N = 195). METHODS: A 24-hour diet recall was obtained at each of the three study time points. Food models and measuring cups were used to improve the accuracy of portion size reporting. Data from diet recalls were manually entered in Food Processor software to compute nutritional content. RESULTS: A linear mixed-effects model was used to examine dietary intake. Dietary patterns were stable from the second to the third trimesters, and caloric intake was inadequate. Women met minimal daily requirements for carbohydrate and protein intake, but the overall percentages of fat, protein, and carbohydrates indicated that additional calories needed to come from protein. Although more than 80% of women regularly took prenatal vitamins, micronutrient and fiber intake were consistently inadequate. CONCLUSION: Prenatal care to help women identify foods that are rich in fiber, protein, and micronutrients is important for the health of women and newborns. Knowing that nutritional intake is consistently inadequate, nurses can counsel pregnant women whenever they have contact with them to attempt to improve nutritional intake and make women aware of inexpensive nutrient sources.

Measuring coping in pregnant minority women.

Coping strategies may help explain why some minority women experience more stress and poorer birth outcomes, so a psychometrically sound instrument to assess coping is needed. We examined the psychometric properties, readability, and correlates of coping in pregnant Black (n = 186) and Hispanic (n = 220) women using the Brief COPE. Exploratory and confirmatory factor analysis tested psychometric properties. The Flesch-Kincaid Reading Level test assessed readability. Linear regression models tested correlates of coping. Findings suggested two factors for the questionnaire: active and disengaged coping, as well as adequate reliability, validity, and readability level. For disengaged coping, Cronbach's α was .78 (English) and .70 (Spanish), and for active coping .86 (English) and .92 (Spanish). A two group confirmatory factor analysis revealed both minority groups had equivalent factor loadings. The reading level was at the sixth grade. Age, education, and gravidity were all found to be significant correlates with active coping.