Spotlight on Research

Asthma Research in Puerto Rico

The asthma research carried out in Puerto Rico focuses on interventions to improve patient activation and adherence to the prevention, treatment and management of asthma among Latino children and their families. The intervention is built on concepts of agency and empowerment in the context of chronic disease management and patient interactions with health care professionals. The study uses a culturally adapted intervention designed to empower or “activate” patients/families to better communicate with their primary care physician (PCP) by establishing a communication link between the PCP, patients, and the asthma counselor. The cultural adaptation trains providers to become more knowledgeable about patients’ ethno-cultural practices in asthma care. Four clinics (2 control and 2 clinics that will receive the intervention) will randomly be selected from the San Juan Metropolitan area. The patient sample will include 250 children and adolescents with moderate to severe doctor-diagnosed asthma (100 control, 150 intervention group; age 3-17 years) and their parents. It is expected that patients receiving the intervention as compared to controls, will show significant reduction in asthma symptoms, a greater reduction in emergency room visits and hospitalizations, and greater satisfaction with quality of care and of life.

A Pilot Program on Cultural Beliefs and Practices

In the United States, minority children have higher rates of asthma compared to anglo children. For Puerto Ricans (Island and Mainland), these rates may result from interactions among a hierarchy of factors operating at the genetic-biological, environmental, individual/familial, community-school, and health care system organizational levels.

This pilot focuses on the individual and organizational levels. Our aim is to provide in-depth information on the cultural beliefs and treatment practices in asthma care among Latino children, their caregivers, and their providers through the use of focus groups and ethnographic interviews conducted in Puerto Rico. Researchers will explore the use of home remedies in combination with, or in substitution of standard medical therapy for the treatment and management of asthma. They will also discover how a provider's knowledge and sensitivity of cultural beliefs and treatment practices affect the medical treatment and management of asthma. A total of 30 participants and 10 primary care pediatricians will be recruited. In Puerto Rico, 16 parents of children with asthma (8 Dominicans and 8 Puerto Ricans) will participate in focus groups from primary care health clinics. In addition, 20 parents of asthmatic children (10 from each ethnic-sub-group), including six from the focus groups, will receive in-depth ethnographic interviews using a semi-structured interview format. An evaluation will determine the feasibility of a structured questionnaire designed to measure folk-beliefs and home remedies among pediatric Latino asthmatics and their caregivers.

School Systems Enhancement Project

The collaboration between a local public school system and the Center for Multicultural Mental Health Research (CMMHR) was initiated in Feb. 2002 in order to improve service delivery to students and families from racial and ethnic minorities. Drs. Alegria, Mulvaney-Day and Rappaport are the investigators of the project, a team of mental health services researcher with particular expertise in research with multicultural populations and service delivery in schools. The emphasis of this collaboration is on developing a participatory process with special education providers, teachers and school administrators that can generate concrete recommendations about optimizing service delivery. CMMHR brings resources in research processes in order to help the providers develop a greater understanding of the dynamics operating at a systems level. There are two small projects currently being conducted. In one school, the implementation of a school-based Teacher Assistance Team is being tracked using a case study approach and qualitative research techniques. In another school, the academic progress of non-English speaking students is being evaluated, and a small project to improve bilingual services in this school is in the planning stages. The focus for both of these small pilots is to understand more deeply the individual and system level factors influencing children from racial and ethnic minorities who are disproportionately placed in special education classrooms. Our goal is to develop sustainable school based interventions that can intercept the path leading from learning problems to behavioral problems to the possibility of more serious mental health problems in late adolescence and adulthood.

The Right Question Project Pilot Study (RQP)

A pilot study was begun in January 2004 at the Center for Multicultural Mental Health Research (CMMHR) to adapt the RQP education strategy to a mental health setting and to test the effectiveness of three 20 minute health education modules. RQP is an education strategy developed by The Right Question Project, Inc. (RQP), a non-profit organization that works primarily with low- and moderate-income communities with a history of disengagement from education, health care, and other social services.

The RQP methodology teaches clients to identify important issues, formulate questions, and devise plans to communicate and act in effective ways that address factors impacting their health. The RQP strategy is designed to build a permanent skill that clients can apply in health care as well as in other contexts that involve self-advocacy (i.e., getting better child care). Thus far, implementation of the Right Question Project has shown that clients of any education or literacy level can easily participate and benefit from the three-step approach. The focus of the module is to help patients learn how to formulate and ask questions of their health care providers, in order to improve the quality of their care. The adaptation and modification of RQP materials has been a collaborative effort involving the Co-Directors of RQP. Inc., Dan Rothstein and Luz Santana, Dr. Margarita Alegria, Director of CMMHR, and members of the CMMHR staff. The pilot study uses a quasi-experimental design with two groups of 100 patients from two matched clinics that serve primarily Latino patients. Participants in the treatment group receive the training modules and are interviewed about their experience in mental health care. Participants in the comparison group will be interviewed about their experience in care without receiving the RQP training. The two groups will be compared across a number of different outcomes related to patient empowerment, activation and retention in care in order to evaluate the effectiveness of the intervention.