The physical health care needs of Latinxs ( is a term adopted by advocates to refer to men and women, Latinos and Latinas) with serious mental illness (SMI)—individuals unable to complete education, work, or independent living goals because of psychiatric illness—are hindered by a fragmented care system that fails to meet their cultural concerns. Research on African Americans with SMI showed peer navigator programs (PNPs) to be 1 possible solution to these kinds of problems. Peer navigators are full-time, provider agency employees in recovery from SMI and from the same ethnic group as service recipients (Latinx). They partner with service recipients in day-to-day tasks to help them better engage in and benefit from health care systems.
The purpose of this project was to conduct community-based participatory research (CBPR) to understand the health care needs of Latinxs with SMI, barriers to these needs, and solutions to these barriers. We then used this information to adapt the PNP for African Americans with SMI for Latinxs with SMI. A subsequent comparative effectiveness research study tested the impact of PNP, vs integrated care (IC) alone, on service engagement and secondary outcomes including perceived health, recovery, empowerment, and quality of life.
A CBPR team that included 6 Latinxs with SMI, researchers, and service providers conducted all research. The CBPR team conducted 2 studies. Study 1 was a qualitative project with 35 Latinxs with SMI or their service providers. Focus groups were completed with data being coded for themes by independent raters. Study 2 was a controlled trial with 110 research participants randomized to PNP or IC alone. More than 80% of participants' primary diagnosis was anxiety disorder or depression. Research participants completed measures of service engagement (scheduled and achieved appointments) plus secondary outcomes including perceived physical health, recovery, empowerment, and quality of life at baseline and 4, 8, and 12 months.
Focus group participants reported specific needs related to overall health with special focus on preventive services and healthy living. Barriers to these needs included services that failed to address cultural perspectives including absence of language skills, immigration concerns that undermine engagement, and inclusion of family in decision-making. Solutions included adaptation of services to represent cultural concerns of Latinxs, integrated care settings, and entitlements. Participants also identified strengths of navigator services, especially those provided by peers. This information was used to adapt the PNP for Latinxs with SMI. Analyses showed a statistically higher overall rate of scheduled and achieved appointments during the year of the project in the PNP compared with IC group. Secondary outcomes related to recovery, empowerment, and quality of life improved significantly more with PNP than with IC alone.
PNPs seem to help Latinxs with SMI better engage in care, leading to improved secondary health outcomes. These findings have implications for service programs that address the physical health needs of Latinxs with SMI. In particular, the program manual provides in-the- field strategies for staff members to help them meet the needs of service recipients.
Future research will need to examine several subpopulations identified in the focus groups. These include comorbid substance use disorder, first language of participant (English vs Spanish), community of origin (examining, for example, differences in perspectives of Mexican vs South American residents), and immigration status.
