Improving hispanic patients' chronic illness self-management in rural settings: A CHW-delivered depression management and reduction intervention

A CHW-delivered depression management intervention, aimed at reducing a mental health barrier among chronically ill patients, is presented. The intervention is initiated by CHRISTUS Health – U.S. and Mexico provider – to complement an existing CHW-based chronically ill care management program with high risk, uninsured Latino patients called CarePartners (CPP). Evaluation data indicate that significant numbers of CPP patients currently show little improvement in their clinical biometrics and health behaviors. Many of these patients manifest symptoms of depression, a known barrier to improvements in clinical indicators, patient self-management and engagement in healthy behaviors. The mental health intervention provides CHWs training in an existing culturally sensitive depression management curriculum entitled “zEs Difícil Ser Mujer?” (“Is it Difficult Being a Woman?”) Following training, teams of two CHWs deliver the curriculum in seven-sessions. Each session engages CPP participants in learning about and applying in themselves knowledge about and means to reduce depressive indications. Participants learn and apply an understanding of depression's stigma and how to identify and deal with depression symptoms and related forms of depressive thinking. The culturally sensitive curriculum helps participants understand factors that have impelled them to be depressed and teaches skills to manage and reduce symptoms and their effects on their daily lives. CHWs also provide mental health referral information when needed, give navigation assistance and follow up to ensure that the referral connection is made. CHWs collaboratively develop mental health action plans with CPP participants and provide ongoing support in the management of their depression.