Identifying and overcoming challenges in promoting mental wellbeing for Asian & Pacific Islander immigrants in San Francisco: A CBPR approach

Background: Though Asian & Pacific Islanders (APIs) may have similar rates of mental health issues as the general population they tend to underutilize mental health (MH) services due to various socio-cultural and ecological factors. Developing community-based, culturally competent and language-specific MH interventions is critical in improving the mental well-being of API communities.

Objective: To examine six API communities' (Cambodian, Cantonese, Laotian, Samoan, Filipino and Vietnamese) perceptions of mental health and barriers to MH services and to assess the collaborative process in developing culturally-relevant and community-oriented interventions.

Methods: In the 1st phase, coalition organizations conducted community-based participatory research (CBPR) to understand perspectives of six API communities on mental health (12 focus groups, N=139 participants), and in the 2nd phase, conducted 15 workgroup meetings with 36 community partners to develop culturally-appropriate programs based on resulting recommendations. Ongoing process evaluation was conducted through semi-structured interviews to assess coalition organizations' experience in both phases.

Results: Stigma and various socio-cultural and ecological factors influencing mental wellbeing were identified as barriers to MH services. Recommendations on how to develop programs that leveraged community assets and culture emerged, including: (1) building community-based organizations' (CBOs) capacity to address mental wellbeing, (2) integrating MH promotion in CBO programming (e.g. cultural festivals), and (3) developing a bicultural/bilingual MH workforce. Filipino, Southeast Asian, and Samoan working groups formed to collaboratively develop 3-year program plans based on recommendations. Collaboration increased community awareness of MH issues, fostered co-learning, and increased capacity of CBOs to address mental wellbeing of their communities.

Discussion: Understanding API ethnic-specific cultural perspectives on mental wellbeing is crucial in developing MH interventions that are culturally-appropriate and build upon existing community assets. Utilizing a CBPR approach through collaboration with community organizations at all stages not only creates awareness and buy-in, but also builds their capacity to plan and implement effective interventions.