Interactive voice response system pre-screening for depression with Spanish-speaking populations

This presentation describes recent research on telephone-based Interactive Voice Response (IVR) screening for depression, using a Spanish phone-optimized adaptation of the two-item Patient Health Questionnaire-2 (PHQ-2) screener. IVR has long and successfully served hard-to-reach populations for screening, advocacy of behavior change, and other health support, including behavioral health initiatives. Tailoring messages according to a participant's age, gender, health benefit structure, and native language are crucial to connect this technology with diverse populations. This research combines quantitative and qualitative methods to better understand how Spanish-speaking populations respond to various translations of the PHQ-2 depression screening questions. First, the quantitative component compares phone-participant engagement rates for Spanish speakers with engagement rates of English speakers. Second, the qualitative component assesses feedback on several translations of the PHQ-2 questions from Spanish-speaking focus group participants. The focus group method is utilized to gather feedback to better understand issues related to culturally-appropriate translations of these sensitive, approximate, and affective questions. There are significant differences in engagement with the modified PHQ-2 question set between English and Spanish speaking populations. One hypothesis about the difference in rates is that the standard English PHQ-2 questions may be challenging to translate into Spanish. Focus group sessions will be utilized to understand more about this relationship. This analysis is on-going. Discussion points for this session include how to make PHQ-2, a powerful depression screening tool, viable for use among Hispanic and Latino populations. In the longer term, research on culturally-appropriate expression of behavioral and affective phrases may improve behavior-change initiatives in an IVR format.