Spanish-speaking Mexican-American parents' experiences while navigating the dental care system for their children.

OBJECTIVES: The purpose of this study is to describe Mexican-American parents' experiences navigating the dental care system for their children. METHODS: Thirty in-depth qualitative interviews were conducted with Spanish-speaking caregivers of young children in an urban county of Northern California, asking about their experiences navigating dental care for their children. Interviews were digitally recorded, translated, transcribed, coded, and analyzed using standard qualitative procedures. RESULTS: Caregivers reported challenges that highlight how various aspects of navigating the health care system are elemental to oral health literacy. These included making appointments, finding a provider they trust, using their dental insurance, and communicating with the dental care provider. CONCLUSIONS: When addressing oral health literacy, it is important to consider the navigational components to improve children's oral health literacy.

A storytelling intervention reduces childhood caries risk behaviors among American Indian and Alaska Native mothers in Northern California.

OBJECTIVES: To evaluate a storytelling intervention targeting the oral health beliefs, knowledge, and behaviors of AIAN pregnant women and mothers. METHODS: Fifty-three adult AIAN women from three tribal communities in Northern California participated. The intervention story delivered oral health messaging using a traditional storytelling format. The effect of the intervention on self-reported oral health behaviors, dental knowledge, and beliefs was assessed using a pretest-posttest design, with an additional six-month follow-up. Tests of repeated measures using Generalized Linear Models were conducted to assess changes in oral health knowledge, beliefs, and behaviors. RESULTS: Knowledge and beliefs significantly increased as a result of the intervention and persisted after six months. A consistent, significant increase in positive oral health behaviors from baseline to six-months was also observed. CONCLUSIONS: The results of this intervention study suggest promise for traditional storytelling to increase oral health-related knowledge, beliefs, and behaviors among self-identified AIAN pregnant women and mothers.

Using Storytelling to Address Oral Health Knowledge in American Indian and Alaska Native Communities.

INTRODUCTION: We conducted a qualitative analysis to evaluate the acceptability of using storytelling as a way to communicate oral health messages regarding early childhood caries (ECC) prevention in the American Indian and Alaska Native (AIAN) population. METHODS: A traditional story was developed and pilot tested among AIAN mothers residing in 3 tribal locations in northern California. Evaluations of the story content and acceptability followed a multistep process consisting of initial feedback from 4 key informants, a focus group of 7 AIAN mothers, and feedback from the Community Advisory Board. Upon story approval, 9 additional focus group sessions (N = 53 participants) were held with AIAN mothers following an oral telling of the story. RESULTS: Participants reported that the story was culturally appropriate and used relatable characters. Messages about oral health were considered to be valuable. Concerns arose about the oral-only delivery of the story, story content, length, story messages that conflicted with normative community values, and the intent to target audiences. Feedback by focus group participants raised some doubts about the relevance and frequency of storytelling in AIAN communities today. CONCLUSION: AIAN communities value the need for oral health messaging for community members. However, the acceptability of storytelling as a method for the messaging raises concerns, because the influence of modern technology and digital communications may weaken the acceptability of the oral tradition. Careful attention must be made to the delivery mode, content, and targeting with continual iterative feedback from community members to make these messages engaging, appropriate, relatable, and inclusive.

An Experimental Test of the Two-Dimensional Theory of Cultural Sensitivity in Health Communication.

Based on a theoretical framework describing culturally sensitive (CS) health communication, this experiment tested the relative contributions of surface structure and deep structure in the recall of oral health information from pamphlets varied in written message and images. Using a 2 × 2 factorial design, Spanish-speaking Mexican heritage mothers of children under six (n = 160) were randomly assigned to read one of four 12-page pamphlets containing the same oral health information in Spanish: (1) standard written message/standard images; (2) standard written message/CS images; (3) CS written message/standard images; and (4) CS written message/CS images. Participants completed a 22-item oral health knowledge questionnaire before and after reading the pamphlet. Controlling for the effects of pretest scores, acculturation, and educational level on information recall, findings showed significant positive main effects for CS images (F(1, 152) = 5.03, p = .026, partial ŋ2 = .032) and CS written message (F(1, 152) = 5.21, p = .024, partial ŋ2 = .033). There was no interaction. These results support the two dimensions of CS and their independent effects. They should be applicable to a variety of health communication channels. Further research is needed to investigate the causal mechanism behind the observed effects.

Importance of Content and Format of Oral Health Instruction to Low-income Mexican Immigrant Parents: A Qualitative Study.

PURPOSE: This study's purpose was to explore how content and format of children's oral health instruction in the dental clinic is perceived by parents and might affect parents' knowledge and behaviors. METHODS: Thirty low-income Mexican immigrant parents of children age five years and under were recruited from dental clinics in 2015 to 2016. In-person qualitative interviews in Spanish about their children's and their own experiences of dental care and home oral hygiene practices were conducted, digitally recorded, translated, and transcribed. Data analysis involved iteratively reading text data and developing and refining codes to find common themes. RESULTS: Twenty-five of 30 parents recalled receiving oral hygiene instruction, and 18 recalled receiving nutrition instruction and were included in analyses. The format and effectiveness of instruction varied. More engaging educational approaches were recalled and described in more detail than less engaging educational approaches. As a result of oral hygiene and nutritional instruction, most parents reported changing their oral hygiene home behaviors for their children; half aimed to reduce purchasing sugary foods and drinks. CONCLUSIONS: Most parents recalled receiving oral hygiene and nutrition instruction as part of their child's dental visit and reported incorporating the instruction and recommendations they received into their children's home routine.

Beliefs and practices regarding solid food introduction among Latino parents in Northern California.

Latino children are more likely to be obese than non-Hispanic white children, and feeding patterns that begin in infancy may contribute to this disparity. The objective of this study was to elucidate beliefs and practices related to the introduction of solids and solid food feeding in the first year of life among low-income Latino parents residing in Northern California. We conducted 26 semi-structured interviews that explored the timing of introduction of solids, selection of foods to serve to infants, feeding strategies, sources of information on solid food feeding and concerns about infant weight. We found that most parents relied on traditional practices in selecting first foods for infants and had a strong preference for homemade food, which was often chicken soup with vegetables. Parents generally described responsive feeding practices; however a minority used pressuring practices to encourage infants to eat more. Very few parents practiced repeated gentle introduction of unfamiliar food to increase acceptance. High calorie low nutrient foods were typically introduced at around 12 months of age and parents struggled to limit such foods once children were old enough to ask for them. Parents were concerned about the possibility of infants becoming overweight and considered health care providers to be an important source of information on infant weight status. The results of this study can be used to inform the development of interventions to prevent obesity in Latino children with similar demographics to our study population.

Current State of Child Health in Rural America: How Context Shapes Children's Health.

PURPOSE: Children's health is influenced by the context in which they live. We provide a descriptive essay on the status of children in rural America to highlight features of the rural environment that may affect health. DESCRIPTION: We compiled information concerning components of the rural environment that may contribute to health outcomes. Areas addressed include the economic characteristics, provider availability, uniquely rural health risks, health services use, and health outcomes among rural children. ASSESSMENT: Nearly 12 million children live in the rural United States. Rural counties are economically disadvantaged, leading to higher rates of poverty among rural versus urban children. Rural and urban children are approximately equally likely to be insured, but Medicaid insures a higher proportion of children in rural areas. While generally similar in health, rural children are more likely to be overweight or obese than urban children. Rural parents are less likely to report that their children received preventive medical or oral health visits than urban parents. Rural children are more likely to die than their urban peers, largely due to unintentional injury. CONCLUSION: Improving rural children's health will require both increased public health surveillance and research that creates solutions appropriate for rural environments, where health care professionals may be in short supply. Most importantly, solutions must be multisectoral, engaging education, economic development, and other community perspectives as well as health care.

Survey of Knowledge, Beliefs, and Behaviors of Migrant Vietnamese Parents Regarding Young Children's Oral Health.

Purpose: The purpose of this study was to investigate the oral health knowledge, beliefs, and behaviors of migrant Vietnamese parents of 1-5 year-olds in San Jose, California.Method: A verbally-administered survey was conducted with a convenience sample of 45 Vietnamese parents recruited at San Jose public libraries. Following preliminary screening, written informed consent was obtained from eligible individuals. A pre-tested, structured 94-item questionnaire was used to collect information regarding parent demographics, and the parent's knowledge, beliefs, and behaviors about children's oral health. Simple descriptive statistics were used to analyze the data.Results: Vietnamese parents acknowledged a number of basic concepts regarding early childhood caries (ECC), such as influences of sugar consumption, oral hygiene, and bottle use. Unlike other groups, they reported some familiarity with the role of bacteria in caries etiology. Oral health knowledge and beliefs, however, were not reflected in parental oral health behaviors such as supervision of children's brushing. Knowledge about the preventive role of fluoride was limited and varied among the population. Parental knowledge and behaviors did not vary by education level or length of residence in US.Conclusion: Vietnamese parents demonstrated reasonably good oral health knowledge, but poor behavioral guidance of their children's oral health, indicating the need for continued parental education emphasizing age-appropriate oral care and the preventative role of fluoride.

The basic research factors questionnaire for studying early childhood caries.

BACKGROUND: We describe development of the Early Childhood Caries (ECC) Basic Research Factors Questionnaire (BRFQ), a battery of measures assessing common potential predictors, mediators, and moderators of ECC. Individual-, family-, and community-level factors that are linked to oral health outcomes across at-risk populations are included. Developing standard measures of factors implicated in ECC has the potential to enhance our ability to understand mechanisms underlying successful prevention and to develop more effective interventions. METHODS: The Early Childhood Caries Collaborating Centers (EC4), funded by National Institute of Dental and Craniofacial Research, developed the BRFQ, which was used across four randomized trials to develop and test interventions for reducing ECC in at-risk populations. Forty-five investigators from across the centers and NIDCR were involved in the development process. Eight "measures working groups" identified relevant constructs and effective measurement approaches, which were then categorized as "essential" or "optional" common data elements (CDEs) for the EC4 projects. RESULTS: Essential CDEs include 88 items, with an additional 177 measures categorized as optional CDEs. Essential CDEs fell under the following domains: oral health knowledge, oral health behavior, utilization/insurance and cost, parent/caregiver dental self-efficacy, quality of life, caregiver and family characteristics, and child characteristics. CONCLUSIONS: The BRFQ makes available a battery of measures that support efforts to understand population risk factors for ECC and to compare oral health outcomes across populations at risk. The BRFQ development process may be useful to other clinical research networks and consortia developing CDEs in other health research fields. TRIAL REGISTRATION: All the trial that used the BRFQ were registered at Clinicaltrial.gov NCT01116726 , April 29, 2010; NCT01116739 , May 3, 2010; NCT01129440 , May 21, 2010; and NCT01205971 , September 19, 2010.

Oral health beliefs, knowledge, and behaviors in Northern California American Indian and Alaska Native mothers regarding early childhood caries.

OBJECTIVES: To assess the oral health beliefs, knowledge, and behaviors related to early childhood caries (ECC) risk in a convenience sample of American Indian and Alaska Native (AIAN) mothers residing in rural Northern California communities. METHODS: Fifty-three mothers of young children were recruited from three tribal communities in Northern California with the assistance of the California Rural Indian Health Board, Inc. and its California Tribal Epidemiology Center and Dental Support Center. Trained study staff administered questionnaires to obtain basic socio-demographic information, to survey participants on their oral health beliefs, knowledge, and behaviors as related to ECC risk, and to identify possible barriers to their accessing professional oral health care. Analyses of covariance were used to explore associations between socio-demographic indicators and oral health behaviors, after controlling for knowledge, beliefs and barriers to care. RESULTS: Overall, 53 percent of participants reported their oral health as "fair" or "poor." Mothers' education (high) and being employed were positively associated with better oral health behavior scores. Additionally, 72 percent of mothers reported having one or more barriers to oral health care including access. There was a significant relation (P = 0.03) between high number of reported barriers to oral health care and low oral health behavior scores. CONCLUSIONS: Despite generally high-level oral health knowledge, perceptions of self and child oral health remains low in this sample of AIAN mothers. Factors identified as being associated with oral health behaviors in this sample were similar to those found in other health disparities populations.

How Neighborhoods Influence Health: Lessons to be learned from the application of political ecology.

AIM: This paper articulates how political ecology can be a useful tool for asking fundamental questions and applying relevant methods to investigate structures that impact relationship between neighborhood and health. Through a narrative analysis, we identify how political ecology can develop our future agendas for neighborhood-health research as it relates to social, political, environmental, and economic structures. Political ecology makes clear the connection between political economy and neighborhood by highlighting the historical and structural processes that produce and maintain social inequality, which affect health and well-being. These concepts encourage researchers to examine how people construct neighborhood and health in different ways that, in turn, can influence different health outcomes and, thus, efforts to address solutions.

An ethnographic study of salt use and humoral concepts in a Latino farm worker community in California's Central Valley.

BACKGROUND: This article reports on the use of domestic or table salt for its perceived health effects and healing properties in a Latino farmworker community. It explores how contemporary salt usage beliefs can be seen to have roots in long-standing humoral theories of medicine and health. METHODS: This qualitative investigation comprised 30 in-depth individual interviews and five focus groups conducted in Spanish with Mexican and Central American immigrants in one small city in California's Central Valley (N = 61 total participants). Interviews and focus groups were audiotaped, translated into English and transcribed. Several researchers independently and iteratively read transcripts, developed and applied codes, and engaged in thematic analysis. RESULTS: Strongly emergent themes identified the importance of balance in health, and beliefs about the effects on salt on health. Valued for its culinary role, for bringing out the flavors in food, and used by people of all ages, salt use is part of a robust set of cultural practices. Salt was regularly mixed with foods in different combinations and ingested to restore balance, prevent disequilibrium or reduce vulnerability to diverse illnesses, promote rehydration, and address symptoms of exposure to extremes of temperature or physical or emotional stress. Statements made and practices engaged in by participants were highly suggestive of health and healing beliefs common to humoral belief systems based primarily on a hot-cold dichotomy in classifications of foods and healing behaviors. We evaluate these statements and practices in the context of the existing literature on historical and contemporary humoral beliefs in Latin American communities, in Mexico and Central America, and in the United States. CONCLUSION: Humoral theory is a useful framework for understanding contemporary rural Latino migrant farmworkers' perceptions of the importance of salt for their health.

Retention strategies for health disparities preventive trials: findings from the Early Childhood Caries Collaborating Centers.

OBJECTIVES: To identify successful strategies for retention of participants in multiyear, community-based randomized controlled trials (RCTs) aiming to reduce early childhood caries in health disparities populations from diverse racial/ethnic backgrounds and across diverse geographic settings. METHODS: Four RCTs conducted by the Early Childhood Caries Collaborating Centers (EC4), an initiative of the National Institute of Dental and Craniofacial Research, systematically collected information on the success of various strategies implemented to promote participant retention in each RCT. The observational findings from this case series of four RCTs were tabulated and the strategies rated by study staff. RESULTS: Participant retention at 12 months of follow-up ranged from 52.8 percent to 91.7 percent, and at 24 months ranged from 53.6 percent to 85.9, across the four RCTs. For the three RCTs that had a 36-month follow-up, retention ranged from 53.6 percent to 85.1 percent. Effectiveness of different participant retention strategies varied widely across the RCTs. CONCLUSIONS: Findings from this case series study may help to guide the design of future RCTs to maximize retention of study participants and yield needed data on effective interventions to reduce oral health disparities.

Acceptability of Salt Fluoridation in a Rural Latino Community in the United States: An Ethnographic Study.

Compared to other population groups in the United States, caries (tooth decay) is a disproportionately prevalent disease among Latino populations, especially among low-income and rural sub-groups and children under five years of age. Fluoride is a primary preventive for caries. While water fluoridation is a major and effective public health means for delivering fluoride on a mass scale, it does not reach many rural areas or population groups such as Latinos who eschew drinking water from municipal sources. This study examines the acceptability to such groups of salt fluoridation, an alternate means of delivering fluoride long used on a global scale. An ethnographic study in California's rural Central Valley was performed. Thirty individual interviews and 5 focus groups (N = 61) were conducted in Spanish to investigate low-income Latino migrant caregivers' experiences, views and understandings of domestic salt, oral health, caries prevention and fluoride. Audio data were transcribed, translated, coded and thematically analyzed. Table salt was readily available and frequently consumed. Both adult and child daily sodium consumption was high. Despite a general feeling that it was good, and present in dentifrices or dietary supplements, most participants had little knowledge about fluoride. Concerns were raised about cardio-vascular and other possibly deleterious effects if an increase in salt consumption occurred because fluoridated salt was viewed as having 'extra' benefits. Once informed about fluoride's safety and role in caries prevention, most participants expressed willingness to use fluoridated salt, especially if it benefitted children. Reassurance about its safety and benefits, and demonstration of its taste, were important aspects of acceptance. Taste was paramount. Participants would not consume more fluoridated salt than their current salt as that would result in unpleasant changes in food flavor and taste. While salt fluoridation is acceptable, the feasibility of producing and distributing fluoridated salt in the United States is, however, complex and challenging.

Oral Health Care of Vietnamese Adolescents: A Qualitative Study of Perceptions and Practices.

PURPOSE: To explore the oral health perceptions and practices of Vietnamese adolescents 13 to 17 years old in San Jose, Calif. METHODS: A purposeful sample of 10 Vietnamese parents with adolescent children were recruited at a Temple in San Jose, Calif. After gaining parental consent and adolescent assent, Vietnamese adolescents participated in an audio-taped, 20 to 30 minute, individual, semi-structured interview in English to explore their perceptions about oral health. Interview data were transcribed verbatim. All statements related to each question were identified, and similar statements were grouped into categories. RESULTS: Ten adolescents participated in the study. All reported tooth appearance as the most important reason for oral care, and that oral health, diet and general health were related. All were concerned about dental pain. Of the respondents, 9 believed that having good teeth would give them more confidence, and help them find jobs and romantic partners, while 2 did not follow recommended oral hygiene routines or recognize early signs of disease. Seven participants favored U.S. dentists over Vietnamese dentists. Frequently reported barriers to seeking dental care were fear of dental treatment (n=7) and inability to pay for dental care (n=6). CONCLUSION: When educating Vietnamese adolescents, dental hygienists need to highlight availability of pain control, encourage better performance of personal oral hygiene and recommend dental clinics with sliding fee scales to low-income families. This approach to oral health education may enhance dental health and seeking of regular dental visits.

Using community participation to assess acceptability of "Contra Caries", a theory-based, promotora-led oral health education program for rural Latino parents: a mixed methods study.

BACKGROUND: Latino children experience more prevalent and severe tooth decay than non-Hispanic white and non-Hispanic black children. Few theory-based, evaluated and culturally appropriate interventions target parents of this vulnerable population. To fill this gap, the Contra Caries Oral Health Education Program, a theory-based, promotora-led education program for low-income, Spanish-speaking parents of children aged 1-5 years, was developed. This article describes qualitative findings of the acceptability of curriculum content and activities, presents the process of refinement of the curriculum through engaging the target population and promotoras, and presents results from the evaluation assessing the acceptability of the curriculum once implemented. METHODS: Focus groups were conducted with low-income Spanish-speaking parents of children 1-5 years living in a city in an agricultural area of California. Interviews were digitally recorded, translated and transcribed, checked for accuracy and the resulting data was thematically coded and analyzed using a social constructionist approach. The Contra Caries Oral Health Education Program was then implemented with a separate but similar sample, and after completing the program, participants were administered surveys asking about acceptability and favorite activities of the education program. Data were entered into a database, checked for accuracy, open-ended questions were categorized, and responses to close-ended questions counted. RESULTS: Twelve focus groups were conducted (N = 51), 105 parents attended the Contra Caries Oral Health Education Program, and 83 parents filled out surveys. Complete attendance and retention was high (89% and 90%, respectively). This study found that their children's oral health is a high priority. Parents were not only interested in, but actually attended classes focused on increasing their knowledge and skills with respect to early childhood oral health. The Contra Caries content and format was perceived as acceptable by parents. Strong opinions about curriculum content were expressed for including information on how caries starts and progresses, weaning from the bottle, oral health care for children and adults, motivational strategies for children's tooth brushing, dental visits and cavity restorations. CONCLUSIONS: The Contra Caries Oral Health Education Program was acceptable to low-income, Spanish-speaking parents of children 1-5 years. Participating in the curriculum development and revision process likely played an important role in the parents' high acceptability of the program.

Idioms of Distress Among Depressed White-Non-Mexican and Mexican-Origin Older Men.

Older men are less likely than older women to receive depression treatment. Latino older men in particular have been found to have significantly lower rates of depression treatment than their white-non-Mexican (WNM) counterparts. Prior research has shown that men are less likely than women to express overt affect and/or report depression symptoms that may prompt primary care physicians' inquiry about depression. Previous studies have overlooked the idioms of distress common among older men. This study investigates: a) the range of idioms of distress that emerge in the narratives of depressed older men, and b) the use of these idioms among depressed WNM and Mexican-origin older men. The present report is based on qualitative data collected through the Men's Health and Aging Study (MeHAS), a mixed-method study of clinically depressed WNM and Mexican-origin older (65 and above) men recruited in primary care settings. Qualitative analysis of 77 interviews led to identification of idioms of distress and informed idiom categories. Study findings show that: a) both groups of men utilized a range of idioms of distress that met current DSM criteria for depression, b) both groups were also likely to utilize idioms that feel outside clinical depression criteria, and c) there were similarities as well as differences between WNM and Mexican-origin men. This study provides a larger vocabulary that clinicians might consider in recognizing depression and initiating depression care for older men from diverse ethnic backgrounds. This is important to improve depression care among older men in general and those of Mexican-origin in particular.

An interpretive study of food, snack and beverage advertisements in rural and urban El Salvador.

BACKGROUND: Globalization and increased marketing of non-nutritious foods and beverages are driving a nutrition transition in developing countries, adversely affecting the health of vulnerable populations. This is a visual interpretive study of food, snack, and beverage advertisements (ads) in rural and urban El Salvador to discern the strategies and messages used to promote consumption of highly processed, commercialized products. METHODS: Digital photographs of billboard and wall advertisements recorded a convenience sample of 100 advertisements, including 53 from rural areas and 47 from urban areas in El Salvador. Advertisements were coded for location, type of product, visual details, placement and context. Qualitative methods were used to identify common themes used to appeal to consumers. RESULTS: Advertisements depicted "modern" fast foods, processed snacks and sugary beverages. Overall, the most prominent themes were: Cheap Price, Fast, Large Size, and Modern. Other themes used frequently in combination with these were Refreshment, Sports/Nationalism, Sex and Gender Roles, Fun/Happy Feelings, Family, Friendship and Community, and Health. In rural areas, beverage and snack food ads with the themes of cheap price, fast, and large size tended to predominate; in urban areas, ads for fast food restaurants and the theme of modernity tended to be more prominent. CONCLUSIONS: The advertisements represented a pervasive bombardment of the public with both explicit and subliminal messages to increase consumerism and shift dietary patterns to processed foods and beverages that are low in micronutrients and high in carbohydrates, sugar, fat and salt--dietary changes that are increasing rates of child and adult diseases including tooth decay, obesity, cardiovascular disease and cancer. Global food and beverage industries must be held accountable for the adverse public health effects of their products, especially in low-middle income countries where there are fewer resources to prevent and treat the health consequences. In addition, public health and governmental authorities should learn from the advertising strategies to promote social marketing of public health messages, and enact and enforce regulations to limit the advertisement and sale of unhealthy products, particularly for children in and around schools. This will create healthier social norms and environments for the entire population.

Depression Attributes Among White Non-Hispanic and Mexican-Origin Older Men.

OBJECTIVE: Depression is associated with poor quality of life, higher healthcare costs, and suicide. Older, especially minority, men suffer high rates of depression under-treatment. Illness attributes may influence depression under-treatment by shaping help-seeking and physician recognition in older and minority men. Improved understanding of depression attributes may help to close gaps in care for older men. The study aims are to describe the range and most frequent attributes of depression in a diverse sample of older men and to describe ethnic similarities and differences in depression attributes between white non-Hispanic and Mexican-origin older men. METHODS: In this qualitative study of white non-Hispanic and Mexican-origin older men who were recruited from outpatient primary care clinics in central California, 77 (47 white non-Hispanic and 30 Mexican-origin) men aged 60 and older who were identified as depressed and/or receiving depression treatment in the past year completed in-depth interviews covering their experiences of depression. Transcribed interviews were analyzed per established descriptive qualitative techniques. RESULTS: Twenty-one depression attributes were identified and 9 were present in at least 17% of the interviews. Men often attributed their depression to stressors such as grief/loss and spousal conflicts, feelings of moral failure, and poor health. Although there were similarities in depression attributes between the groups, we found several differences in the frequency of certain attributes. CONCLUSION: Similarities and differences in depression attributes between Mexican-origin and white non-Hispanic older men suggest the confluence of various sociocultural factors. Awareness of the variety of ways that older men understand depression can help clinicians identify and engage them in depression treatment.

A descriptive qualitative study of the roles of family members in older men's depression treatment from the perspectives of older men and primary care providers.

OBJECTIVE: The aim of this study is to describe the roles of family members in older men's depression treatment from the perspectives of older men and primary care physicians (PCPs). METHODS: Cross-sectional, descriptive qualitative study conducted from 2008-2011 in primary care clinics in an academic medical center and a safety-net county teaching hospital in California's Central Valley. Participants in this study were the following: (1) 77 age ≥ 60, noninstitutionalized men with a 1-year history of clinical depression and/or depression treatment who were identified through screening in primary care clinics and (2) a convenience sample of 15 PCPs from the same recruitment sites. Semi-structured and in-depth qualitative interviews were conducted and audiotaped then transcribed and analyzed thematically. RESULTS: Treatment-promoting roles of family included providing an emotionally supportive home environment, promoting depression self-management and facilitating communication about depression during primary care visits. Treatment-impeding roles of family included triggering or worsening men's depression, hindering depression care during primary care visits, discouraging depression treatment and being unavailable to assist men with their depression care. Overall, more than 90% of the men and the PCPs described one or more treatment-promoting roles of family and over 75% of men and PCPs described one or more treatment-impeding roles of family. CONCLUSIONS: Families play important roles in older men's depression treatment with the potential to promote as well as impede care. Interventions and services need to carefully assess the ongoing roles and attitudes of family members and to tailor treatment approaches to build on the positive aspects and mitigate the negative aspects of family support.