Health Promotion Research Center, Department of Health Systems and Population Health, University of Washington, Seattle, WA, United States.
Southeast Washington Aging and Long-Term Care, Yakima, WA, United States.
Front Public Health. 2023 Jan 30;10:1079082. doi: 10.3389/fpubh.2022.1079082. eCollection 2022.
BACKGROUND: Embedding evidenced-based programs (EBPs) like PEARLS outside clinical settings can help reduce inequities in access to depression care. Trusted community-based organizations (CBOs) reach older adults who are underserved; however, PEARLS adoption has been limited. Implementation science has tried to close this know-do gap, however a more intentional focus on equity is needed to engage CBOs. We partnered with CBOs to better understand their resources and needs in order to design more equitable dissemination and implementation (D&I) strategies to support PEARLS adoption. METHODS: We conducted 39 interviews with 24 current and potential adopter organizations and other partners (February-September 2020). CBOs were purposively sampled for region, type, and priority older populations experiencing poverty (communities of color, linguistically diverse, rural). Using a social marketing framework, our guide explored barriers, benefits and process for PEARLS adoption; CBO capacities and needs; PEARLS acceptability and adaptations; and preferred communication channels. During COVID-19, interviews also addressed remote PEARLS delivery and changes in priorities. We conducted thematic analysis of transcripts using the rapid framework method to describe the needs and priorities of older adults who are underserved and the CBOs that engage them, and strategies, collaborations, and adaptations to integrate depression care in these contexts. RESULTS: During COVID-19, older adults relied on CBO support for basic needs such as food and housing. Isolation and depression were also urgent issues within communities, yet stigma remained for both late-life depression and depression care. CBOs wanted EBPs with cultural flexibility, stable funding, accessible training, staff investment, and fit with staff and community needs and priorities. Findings guided new dissemination strategies to better communicate how PEARLS is appropriate for organizations that engage older adults who are underserved, and what program components are core and what are adaptable to better align with organizations and communities. New implementation strategies will support organizational capacity-building through training and technical assistance, and matchmaking for funding and clinical support. DISCUSSION: Findings support CBOs as appropriate depression care providers for older adults who are underserved, and suggest changes to communications and resources to better fit EBPs with the resources and needs of organizations and older adults. We are currently partnering with organizations in California and Washington to evaluate whether and how these D&I strategies increase equitable access to PEARLS for older adults who are underserved.
背景:在临床环境之外嵌入循证项目(EBPs),如 PEARLS,可以帮助减少获得抑郁症治疗方面的不平等。值得信赖的社区组织(CBOs)能够接触到服务不足的老年人;然而,PEARLS 的采用一直受到限制。实施科学已经试图缩小这种知与行的差距,但是为了让 CBO 参与进来,需要更加关注公平问题。我们与 CBO 合作,以更好地了解他们的资源和需求,从而设计出更公平的传播和实施(D&I)策略,以支持 PEARLS 的采用。
方法:我们对 24 个当前和潜在的采用组织和其他合作伙伴进行了 39 次访谈(2020 年 2 月至 9 月)。CBO 是根据区域、类型和优先考虑贫困的老年人群体(有色人种社区、语言多样化社区、农村社区)进行有针对性抽样的。我们使用社会营销框架,我们的指南探讨了采用 PEARLS 的障碍、益处和过程;CBO 的能力和需求;PEARLS 的可接受性和适应性;以及首选的沟通渠道。在 COVID-19 期间,访谈还讨论了远程 PEARLS 交付和优先事项的变化。我们使用快速框架方法对转录本进行主题分析,以描述服务不足的老年人和参与他们的 CBO 的需求和优先事项,以及在这些情况下整合抑郁症护理的策略、合作关系和适应性。
结果:在 COVID-19 期间,老年人依赖 CBO 来满足基本需求,如食物和住房。隔离和抑郁也是社区内的紧迫问题,但对晚年抑郁症和抑郁症治疗仍存在污名化。CBO 希望采用具有文化灵活性、稳定资金、可访问培训、员工投资、并与员工和社区需求和优先事项相匹配的 EBP。研究结果为新的传播策略提供了指导,以便更好地传达 PEARLS 适合服务不足的老年人的 CBO,以及哪些项目组件是核心,哪些是可适应的,以更好地与组织和社区相匹配。新的实施策略将通过培训和技术援助以及资金和临床支持的匹配来支持组织的能力建设。
讨论:研究结果支持 CBO 作为服务不足的老年人的适当抑郁症护理提供者,并表明需要对沟通和资源进行更改,以使 EBP 更符合组织和老年人的资源和需求。我们目前正在与加利福尼亚州和华盛顿州的组织合作,评估这些 D&I 策略是否以及如何增加服务不足的老年人获得 PEARLS 的公平机会。
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