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Mental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making.
The primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research.
This pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings.
Participants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex.
Rather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals.
ClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771
DERR1-10.2196/37712
Low patient engagement in care and ineffective patient-provider communication are 2 major contributors to health care disparities [
Recovery-oriented practices that prioritize person-centered care, patient autonomy, and empowerment may help reduce health care disparities by engaging patients in services and supporting them to play an active role in their care and treatment decisions [
To maximize the potential benefits of a culturally sensitive and recovery-oriented approach to patient engagement and communication for minoritized groups, we developed a peer-led patient navigation program—Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH). This manuscript describes the study protocol for a randomized controlled trial to assess the feasibility and acceptability of PARTNER-MH and organizational factors that could impact its implementation in Veterans Health Administration (VHA) settings.
PARTNER-MH incorporates peer support and patient navigation care models to deliver a manualized patient activation, engagement, and communication intervention to racially and ethnically minoritized Veterans in VHA outpatient mental health clinics. The aims of PARTNER-MH are as follows: (1) to engage racially and ethnically minoritized patients in mental health care, (2) to increase patient activation by giving patients the tools to become active collaborators in their care, and (3) to improve patients’ communication skills and participation in shared treatment decision-making.
As depicted in
To increase patient activation, PARTNER-MH uses a peer support care model to create early and ongoing relationships with patients, develop trust, and empower patients to take charge of their health and health care. PARTNER-MH peers provide education to raise awareness of available services, address patient-level barriers to care such as self-stigma or negative beliefs associated with mental illness and treatment, and provide individualized mental health treatment navigation services to assist with care coordination [
PARTNER-MH seeks to facilitate patient engagement by addressing patients’ social contexts such as their racial and social identities, living environment, and lived experiences that shape their health and health care experiences. The PARTNER-MH approach to patient engagement also involves addressing negative social determinants of health such as unmet social needs that might be preventing their engagement in care. These include food and housing insecurity, legal issues, and social isolation. Addressing patients’ unmet social needs also serves as a catalyst to engage them in conversations about what matters to them as well as social and cultural experiences that may affect their health and health care.
Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) conceptual model. SDM: shared decision-making.
Another objective of PARTNER-MH is to improve patients’ communication with their providers by identifying and addressing barriers to effective patient-provider communication. This area of focus also includes helping patients prepare for their mental health visits by identifying goals, preparing questions for providers, supporting collaborative relationships with providers, and participating in shared treatment decision-making.
Aim 1 (primary aim) is to assess the feasibility and acceptability of PARTNER-MH in a VHA mental health care setting.
Aim 2 is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making (SDM). We hypothesize that patients randomized to the PARTNER-MH intervention group will report greater patient engagement, patient activation, and SDM than patients randomized to the control group.
Aim 3 is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors, using the Consolidated Framework for Implementation Research (CFIR) [
This pilot study used a convergent mixed methods design [
The interventionists for this pilot study are 2 certified VHA peer support specialists, selected through usual VHA hiring practices and assigned to the mental health service line, who have completed the PARTNER-MH training program. The training program consists of 40 hours of didactic sessions that cover topics such as patient navigation, patient engagement, social determinants of health, diversity and racial discrimination in health care, effective communication, and professional development.
Fidelity assessment was conducted quarterly using a sample of 8 patients in the active group (8/29, 28%) stratified by 2 peers. A total of 2 clinical psychologists from the study team used the PARTNER-MH fidelity 17-item checklist and audio-recorded intervention sessions or conducted live participant observations to assess fidelity. Fidelity assessment outcomes were then discussed with peers as well as the steps needed to reinforce or correct deviations from study procedures. In addition, peers receive weekly supervision to reinforce training information, address challenges, and provide support (aim 1).
PARTNER-MH is a theory-driven, peer-led intervention that was developed using participatory approaches [
PARTNER-MH is a 6-month intervention that consists of individualized sessions with an assigned peer. Sessions are delivered in person, over the phone, or via videoconferencing, depending on patient preferences. Owing to the COVID-19 pandemic and restrictions on in-person visits, most of the sessions were delivered via telehealth. The PARTNER-MH sessions were delivered weekly for the first month, biweekly for the second and third months, and monthly thereafter. Peers and patients also met more often, as needed. The sessions lasted approximately an hour and were tailored to meet patient goals and needs related to engagement, access to services, care coordination, health care communication, and personal support. Peers used the PARTNER-MH handbook to guide and organize their sessions, but they also had the flexibility to use their lived experiences and training to inform the sessions. The flexibility of the PARTNER-MH structure also allowed patients to cover different modules at their own pace.
This module covers topics related to social needs assessment (social determinants of health), rapport building, information about patients’ social contexts, strengths, racial and other identities, recovery story, and goal setting.
Information about Veterans Health Administration metal health services, treatment team composition, treatment options, and how to make the most of services are discussed in this module.
This module focuses on ways to be engaged in one’s care, discussions of engagement behaviors, and setting goals for being engaged.
This module describes the importance of visit preparation, how to prepare for psychiatric medication and therapy visits, and how to set goals for visits that are aligned with one’s recovery goals.
Shared decision-making and effective communication are discussed in this module. Patients role-play with peers and examine barriers to effective communication, strategies to improve communication, and collaboration with providers.
PARTNER-MH was offered to racially and ethnically minoritized Veterans receiving mental health services from an outpatient mental health clinic at a large VHA medical center in the Midwest and associated community-based outpatient clinics. The program targeted Veterans across psychiatric diagnostic categories who were relatively new to the broad array but somewhat complicated configuration of VHA outpatient mental health clinics, often requiring help to navigate mental health services. To be eligible for the study, participants must (1) belong to a racially or ethnically minoritized group, (2) be aged ≥18 years, and (3) have a new medication management or therapy appointment scheduled within 12 months before enrollment in the study or have recently re-established treatment after an absence of 2 years. Veterans are excluded if they (1) have mental or cognitive impairments that limited their ability to give consent (eg, having acute psychotic symptoms or being cognitively impaired during the consent or interview process), (2) have hearing difficulties that prevent participation in the interviews, or (3) received medication management services at the clinic for >12 months before enrollment in the study.
Participant recruitment for PARTNER-MH is complete. Multiple strategies were used to recruit participants to capture a diverse group of racially and ethnically minoritized patients. They included inviting eligible patients identified through electronic health records and sending them an introductory letter informing them about the study. The letter gave the participants a method for opting out of further contact. In the absence of such notification, 10 days after the letter’s receipt was expected, study staff called the patient to explain the study in greater detail, conduct initial screening, and ask eligible patients whether they wished to participate. Other recruitment strategies included clinician referrals, patient self-referrals, direct advertisements, and snowball sampling (ie, asking enrolled participants to refer others). All eligible patients were given a research packet that included an invitation letter and a study information sheet.
Approval was obtained from the Indiana University Institutional Review Board in November 2017 (1708628270) and the Veterans Affairs (VA) Research and Development review committee. Protocol modifications will undergo further review by the institutional review board, be communicated to the research team, and updated in the clinical trials registry.
Participants completed baseline assessment before being randomized into the study arms to ensure balance and reduce selection bias. Allocation to the treatment arm was carried out using a computer-generated randomization list with randomly varying block sizes of 4 and 8 to maximize allocation concealment. Furthermore, although blinding was not feasible for this project because of the study’s limited staffing and the need to collect participant feedback on the feasibility and acceptability of the intervention, study personnel involved in screening and enrollment were masked to the computer-generated randomization assignment and were not included in delivering the intervention. Moreover, peers were not involved in data collection and did not have access to participants’ assessment results.
Participants in the wait-list control group received regular VHA mental health services (eg, individual or group psychotherapy, consults, and medication management) for the 6 months after enrollment. To overcome potential issues of contamination, where a peer could deliver PARTNER-MH services to control group participants, participants in the control group were encouraged not to use peer services unless they dropped out of the study. Chart reviews were conducted to assess contamination.
The data collection for this study is ongoing. Screening, enrollment, and survey data were collected and stored via VA REDCap (Research Electronic Data Capture; Vanderbilt University), behind the VA firewall. Outcomes were assessed over the phone at baseline and at 3, 6 (primary end point), 9, and 12 months. Outcome data also included qualitative interviews to evaluate participants’ experience of the intervention and organizational factors that may impact its future implementation and the integration of the quantitative and qualitative data. Study participants were compensated with a US $35 gift card for each assessment except for the primary end point (at 6 months), for which they received a US $50 gift card. In addition, because of the COVID-19 in-person visit restrictions, participants received a US $10 gift card for each month they remained enrolled in the study to facilitate access to telehealth delivery of the intervention and retention. A brief exit survey was sent to participants who discontinued the study to evaluate their experiences in the program. Participants’ enrollment in the study was recorded in their medical records, which peers had access to. A data safety and monitoring board was also established to evaluate the data quality and safety of the study.
Aim 1 is to assess the feasibility and acceptability of PARTNER-MH in a VHA mental health care setting.
The feasibility of PARTNER-MH will be determined based on participants’ recruitment, enrollment, and retention rates. Program acceptability for participants will be evaluated using session attendance, number of contacts with peer navigators, and the Patient Satisfaction Survey, which is an 11-item questionnaire rated on a 3-point Likert scale ranging from 1 (not at all) to 3 (very). Satisfaction with the peer was evaluated using a survey that included questions about the patient’s relationship with the peer and views of support provided by the peer. Descriptive summaries of recruitment, enrollment, retention, and satisfaction rates will be reported. Participant feedback from qualitative interviews will also be used to inform the feasibility and acceptability of PARTNER-MH (aim 3).
Aim 2 is to evaluate the preliminary effects of PARTNER-MH on patient engagement, patient activation, and SDM.
Aim 2 has three main outcome measures: patient activation, patient engagement, and SDM. In addition, sociodemographic data (eg, age, sex, race, ethnicity, education, and marital status) were collected at baseline. Tertiary and health-related outcomes that included communication self-efficacy, depression, mental health, and physical health functions were also assessed at all time points and are listed in the
The
Patient engagement will be assessed using the
Finally, we will administer the
The
The
The
The
The
Power calculations are provided, but as a pilot, this study is powered only to detect large differences between groups. With a sample of 22 participants in the intervention group and 15 in the wait-list control group, we have 80% power at a .05 significance level to detect an effect size of 0.965 for tests between groups using 2-sided 2-sample
The internal consistency of each scale for primary and secondary outcomes will be verified in this study sample using Cronbach α. Distributions of the scale scores will be examined to determine whether transformation of the data or nonparametric tests are required for the analyses. In this study, 2-sample
As depicted in
Joint display for mixed methods data collection and analysis.
Aim 3 is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH, as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the CFIR [
We will use domains of the CFIR [
Data collection for aim 3 will be guided by the CFIR using semistructured interviews. We will conduct interviews with patients and providers to obtain their perspectives on the intervention and on their experiences of participating in the PARTNER-MH program. Interviews will also assess organizational factors such as time and other resources that may affect the delivery and content of the intervention as well as the impact of the program on Veteran outcomes.
We will invite all 30 Veterans from the intervention group to participate in a qualitative interview. In addition, we will include a purposeful sample of 5 mental health staff members (prescribing and nonprescribing clinicians) with experience in working with peers and patients enrolled in the program.
Interviews from aim 3 will be transcribed, deidentified, and entered into NVivo (QSR International), a qualitative analytical software program, to help organize the data. To facilitate the completion of qualitative data coding and analysis in a short time frame, we will incorporate several features recommended in rapid qualitative assessment [
Through an iterative, consensus-building process, we will review transcripts to identify emergent themes consistent with techniques of immersion and crystallization [
To facilitate the rigor of the data analysis process, we plan to hold regular meetings with the coding team to examine coding across analysts, resolve differences in coding, identify and resolve coding drift, and conduct iterative refinement of code definitions. We will maintain memos of our coding processes, coding decisions, and analyses. We will also continually assess and maintain consistency and consensus in our coding practices [
Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare CONSORT (Consolidated Standards of Reporting Trials) flow diagram.
Participant demographics are presented in
Participant demographics.
Demographics | Overall (N=50), n (%) | Intervention group (n=30), n (%) | Wait-list control group (n=20), n (%) | |||||||
|
.31 | |||||||||
|
18-24 | 1 (2) | 0 (0) | 1 (5) |
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|||||
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25-34 | 12 (24) | 8 (26.7) | 4 (20) |
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35-44 | 9 (18) | 7 (23.3) | 2 (10) |
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45-54 | 14 (28) | 6 (20) | 8 (40) |
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55-64 | 12 (24) | 7 (23.3) | 5 (25) |
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|
65-75 | 2 (4) | 2 (6.7) | 0 (0) |
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|
.21 | |||||||||
|
White | 3 (6) | 3 (10) | 0 (0) |
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Black | 35 (70) | 20 (66.7) | 15 (75) |
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Asian | 1 (2) | 0 (0) | 1 (5) |
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Other | 5 (10) | 2 (6.7) | 3 (15) |
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Multi | 6 (12) | 5 (16.7) | 1 (5) |
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Hispanic | 6 (12) | 4 (13.3) | 2 (10) | .72 | |||||
|
.04a | |||||||||
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Male | 31 (62) | 22 (73.3) | 9 (45) |
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Female | 19 (38) | 8 (26.7) | 11 (55) |
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|
.07 | |||||||||
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HSb or GEDc | 10 (20) | 3 (10) | 7 (35) |
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Some college or 2 year degree | 24 (48) | 17 (56.7) | 7 (35) |
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4-year college degree | 9 (18) | 7 (23.3) | 2 (10) |
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>4 years college | 7 (14) | 3 (10) | 4 (20) |
|
aStatistically significant.
bHS: high school.
cGED: General Educational Development.
Baseline secondary outcome measures.
Measures | Overall (N=50) | Intervention group (n=30) | Wait-list control group (n=20) | |||||||||
Altarum Consumer Engagement Commitment to Everyday Health Behavior subscale, mean (SD) | 13.7 (5.2) | 13.7 (4.7) | 13.6 (5.9) | .91 | ||||||||
Altarum Consumer Engagement Informed Choice subscale, mean (SD) | 10.5 (5.0) | 10.6 (4.8) | 10.4 (5.4) | .89 | ||||||||
Altarum Consumer Engagement Navigation subscale, mean (SD) | 15.2 (3.8) | 15.5 (4.4) | 14.8 (2.8) | .41 | ||||||||
Patient Activation Measure for Mental Health Activation scores, mean (SD) | 51.5 (11.3) | 52.8 (11.0) | 49.6 (11.8) | .38 | ||||||||
SDM-Q-9a, mean (SD) | 26.8 (9.4) | 25.8 (9.1) | 28.3 (9.7) | .23 | ||||||||
|
.86 | |||||||||||
|
Not at all | 10 (20) | 6 (20) | 4 (20) |
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|||||||
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A little | 10 (20) | 6 (20) | 4 (20) |
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|||||||
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Some | 9 (18) | 4 (13) | 5 (25) |
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|||||||
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A lot | 15 (30) | 10 (33) | 5 (25) |
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|||||||
|
N/Ab | 6 (12) | 4 (1) | 2 (10) |
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|||||||
|
.91 | |||||||||||
|
Nothing at all | 7 (14) | 5 (16.7) | 2 (10) |
|
|||||||
|
A little | 16 (32) | 9 (30) | 7 (35) |
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|||||||
|
Some | 12 (24) | 7 (23.3) | 5 (25) |
|
|||||||
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A lot | 11 (22) | 6 (20) | 5 (25) |
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|||||||
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Every goal set | 4 (8) | 3 (10) | 1 (5) |
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|
.06 | |||||||||||
|
Not at all | 4 (8) | 4 (13.3) | 0 (0) |
|
|||||||
|
A little | 4 (8) | 0 (0) | 4 (20) |
|
|||||||
|
Some | 9 (18) | 5 (16.7) | 4 (20) |
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|||||||
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A lot | 22 (44) | 14 (46.7) | 8 (40) |
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|||||||
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Completely | 11 (22.2) | 7 (23.3) | 4 (20) |
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|||||||
|
.97 | |||||||||||
|
Yes | 16 (32) | 10 (33.3) | 6 (30) |
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|
No | 29 (58) | 17 (56.7) | 12 (60) |
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|
Unsure | 5 (10) | 3 (10) | 2 (10) |
|
aSDM-Q-9: shared decision-making-9.
bN/A: not applicable.
Baseline tertiary outcome measures.
Secondary measures | Overall (N=50), mean, (SD) | Intervention group (n=30), mean, (SD) | Wait-list control group (n=20), mean, (SD) | |
University of California, Los Angeles Loneliness Scale | 16.2 (5.2) | 17.1 (4.2) | 14.8 (6.3) | .22 |
Perceived Efficacy in Patient-Physicians Interaction-5 | 35.7 (10.8) | 35.2 (10.6) | 36.4 (11.4) | .61 |
Working Alliance Inventory-Short Revised | 39.8 (14.2) | 38.0 (15.4) | 42.6 (11.9) | .39 |
Perceived Discrimination in Healthcare Questionnaire | 7.3 (5.8) | 7.9 (5.9) | 6.4 (5.7) | .30 |
Patient Health Questionnaire-9 | 13.6 (6.5) | 14.9 (6.4) | 11.5 (6.3) | .05 |
Veterans RAND 12-item Health Survey Physical Health | 41.6 (7.7) | 41.7 (7.2) | 41.5 (8.8) | .98 |
Veterans RAND 12-item Health Survey Mental Health | 32.4 (8.2) | 31.0 (9.2) | 34.7 (5.8) | .06 |
Data collection for the trial ended in May 2022. Data analysis is projected to be completed by December 1, 2022.
This pilot study aims to evaluate the feasibility, acceptability, and preliminary effects of a peer-led patient navigation intervention for racially and ethnically minoritized Veterans in VHA mental health clinics. We anticipate that the findings of this study will help identify barriers to and facilitators of the delivery of the intervention, its feasibility in VHA clinical settings, and its acceptability to the study participants. This pilot study will also facilitate the evaluation of the preliminary impacts of the intervention on patient engagement, patient activation, SDM, and related health outcomes.
Mental health care disparities are persistent and contribute to increased comorbidities, mortality, and health care cost expenditures among individuals of racially and ethnically minoritized backgrounds [
To move beyond the documentation of disparities, PARTNER-MH was designed to leverage the potential of peer support and patient navigation care models to effectively improve patient engagement, activation, and participation in SDM in mental health care among patients of minoritized backgrounds. PARTNER-MH uses a social determinant health care framework by assessing patients’ unmet social needs to engage them in care and learn about their lived experiences and social contexts. The additional focus of PARTNER-MH on improving patients’ communication self-efficacy and participation in SDM may contribute to improved satisfaction with services, treatment adherence, and outcomes. The program’s delivery over 6 months may also increase the percentage of patients who become engaged in care and achieve their mental health goals.
This feasibility trial will also help identify potential unanticipated challenges in the program and its implementation. For instance, it may help identify patients who may benefit the most from this intervention and the optimal length of intervention to facilitate sustained engagement in the program. It may also help identify interventionist characteristics and setting contexts that are most appropriate for this intervention.
A limitation of this study is that participants were not blinded to the study conditions, which may have affected participant behaviors and study outcomes. Moreover, PARTNER-MH is a patient-facing intervention, which may limit its impact on provider behaviors and ultimately, patient participation in collaborative treatment decision-making with their providers. Although this is a potential limitation of the intervention, other studies have shown that patient-focused interventions have some success in improving patient-provider communication and reducing health care disparities. For example, a patient-coaching intervention was shown to reduce patient-provider miscommunication and disparities in pain control among minoritized patients [
In addition, as PARTNER-MH focuses on patient engagement, activation, and patient-provider communication—issues that are cross-cutting among other disease populations—the lessons learned in this study could be applied to minoritized patients with other chronic health conditions in other settings. PARTNER-MH also offers the potential to advance the field of peer support and patient navigation by creating a training program for VHA peer support specialists to deliver peer-led navigation services in outpatient mental health clinics over 6 months.
The mixed methods approach is a strength of this study that will help evaluate participants’ experiences of the intervention and identify areas of improvement and contextual factors that could influence its future implementation. In addition, the feasibility of PARTNER-MH is tested under real-world conditions such as using existing VHA hiring procedures and assigning study peers to the mental health organizational chart with mixed roles to provide PARTNER-MH and usual peer support services. This aspect of the study approach is also a strength that should provide rich implementation information for future consideration.
This pilot study will lay the foundation for future testing of PARTNER-MH and contribute to mental health disparities intervention research that targets underrepresented, minoritized patients. The proposed study will provide preliminary data for a larger trial to examine the effectiveness of PARTNER-MH. On the basis of the findings of this pilot study, future studies may also address a broader array of clinical and health services outcomes such as the impact of PARTNER-MH on patients’ use of mental health services and treatment outcomes. They may also identify potential implementation strategies for PARTNER-MH and evaluate its economic impact on the health care expenditure of the VHA. Future trials are also needed to determine the broad-based acceptance and effectiveness of PARTNER-MH across diverse VA facilities.
The results of this study will be made available to health care professionals, researchers, and the public through publications, academic conferences, and other presentations. Study results will also be presented to VHA patient engagement boards, clinical partners, and other stakeholders.
The outcome of this study will establish the feasibility and acceptability of PARTNER-MH, a peer-led patient navigation intervention to improve patient engagement, patient activation, and participation in SDM among racially diverse Veterans in mental health clinics. If the findings of this pilot study are positive, they will provide support for rigorous testing of PARTNER-MH in a larger trial. If found to be effective then, PARTNER-MH will significantly affect the mental health care experiences and outcomes of racially diverse patient populations. Moreover, as a peer-led intervention, PARTNER-MH could be promoted as a potentially easily scalable approach to increase mental health equity.
Altarum Consumer Engagement
Consolidated Framework for Implementation Research
Patient Activation Measure for Mental Health
Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare
Perceived Efficacy in Patient-Physician Interaction-5
Research Electronic Data Capture; Vanderbilt University
repeated measures ANOVA
shared decision-making
Veterans Affairs
Veterans Health Administration
The authors acknowledge the contribution of Dr Mandi Pratt-Chapman and the Institute for Patient-Centered Initiatives and Health Equity for the George Washington Cancer Center to the development of the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare. The authors also thank the Veterans who participated in the study.
This work was supported by a Department of Veterans Affairs Health Services Research and Development Career Development Award to JE (CDA-2 16-153).
Data are not available to share due to Department of Veterans Affairs and ethical retractions; however, annotation instructions and vocabulary are available upon request.
JE, DJB, ALR, SP, TD, MJB, MPS, MS, MC, and MSM made substantial contributions to the conception or design of the work and to data interpretation. JE, CO, KW, DSZ, EA, and JES contributed to the data collection and analysis. JA and JM were the study interventionists and contributed to the refinement of the intervention. JE wrote the initial draft of the manuscript. All authors have read, revised, and approved the final manuscript.
None declared.