Cambridge, Mass. – Training patients to take a more active role in their mental health care, both on their own and when talking to a mental health provider, may be an effective way to reduce racial and ethnic disparities, according to a new study from Harvard Medical School researchers published online by JAMA Psychiatry.
Over the past decade, a growing body of research has demonstrated that more confident and better informed patients tend to be healthier, get higher quality care and report being more satisfied with their treatment. At the same time, researchers have noticed racial and ethnic disparities in both patient activation and self-management that correspond to larger health disparities between white and minority patients.
In the study, researchers from the Center for Multicultural Mental Health Research (CMMHR) at Cambridge Health Alliance/Harvard Medical School examined whether it is possible to train patients in what researchers call “patient activation” and “self-management” behaviors, and whether increasing these behaviors leads to better care.
“Patient activation is basically an overall measure of how much I, as the patient, feel like I’m responsible and able to make health-related decisions,” explained study co-author Nicholas Carson, MD, a clinical research associate at the CMMHR and an instructor in psychiatry at Harvard Medical School. “Self-management is more a measure of whether patients know what factors improve or worsen their particular mental health conditions and can follow through on keeping themselves healthy when they’re at home."
Half of the patients in the study were offered three 45-minute trainings on identifying health problems or decisions and asking relevant questions to their mental health providers. They also learned strategies to obtain mental health information and access support on their own. Patients who received the trainings had higher scores on measures of patient activation and self-management and reported greater confidence managing their mental health. However, those who received the trainings were not significantly more likely to stay in treatment, suggesting that other factors might convince patients to participate in treatment.
“Minorities tend to be less confident in talking to their doctors and report being less able to manage their mental health conditions outside the clinic, and they’re also generally less likely to be satisfied with their care and have poorer mental and physical health overall,” said lead author Margarita Alegría, PhD (pictured), director of the CMMHR and a professor of psychology in the Department of Psychiatry at Harvard Medical School. “The challenge is to understand where the disparities really originate and identify how to eliminate them. Are minorities less confident because they’re getting lower quality care, because they are treated with less respect, or is there just a cultural difference in how different people talk to their doctors?”
The researchers found that even when the patients in the study became more involved in their care, their providers were not necessarily receptive to letting patients have a greater role in their care. “We’re currently working on a way to train providers to be more sensitive to their patients’ opinions and feelings,” said Dr. Alegría. “We think improving patient-provider communication from both ends will give us an effective and efficient way to reduce disparities.”
“Activation, Self-management, Engagement, and Retention in Behavioral Health Care: A Randomized Clinical Trial of the DECIDE Intervention.” Margarita Alegría, PhD, Nicholas Carson, MD, Michael Flores, MPH, et al. Published online first by JAMA Psychiatry.
Cambridge Health Alliance is a vital and innovative community health system that provides essential services to Cambridge, Somerville, and Boston’s metro-north communities. It includes three hospital campuses, a network of primary care and specialty practices, and the Cambridge Public Health Dept. CHA is a Harvard Medical School teaching affiliate and is also affiliated with Harvard School of Public Health, Harvard School of Dental Medicine, and Tufts University School of Medicine.