Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.


Getting help for mental health problems can be hard, especially for patients who live in rural areas or don’t have much money. Talking to people in the community can help researchers understand what makes it easier for people to get the help they need. Community discussions may also make community members feel more able to make positive changes for themselves or their community.

Project Purpose

This study compares two ways of learning about community and patient priorities for mental health. Researchers wanted to know if talking with a large group of community members or a small group of community leaders was better for understanding local needs and helping participants feel that their views were included in important decisions.


The researchers did this study in Jefferson County, Arkansas. Most of the people there are African American and have low incomes.

Researchers spoke with 50 community leaders in several two-hour focus groups. A local advisory group helped to identify the community leaders to take part in the focus groups.

The research team also held larger group discussions, called community forums, with up to 100 people. Researchers spoke with 208 community members in seven two-hour community forums. People from all over the community were invited to participate in the community forums.

Before and after each session, the researchers asked all participants to take a survey that asked whether they

  • Felt they could solve their own problems
  • Felt powerful or powerless in their own lives
  • Felt groups of people could work together to make positive changes in their communities
  • Were optimistic about making their lives better
  • Thought getting angry about bad things (“righteous anger”) could be helpful

The researchers compared what they heard in the focus groups with what they heard in the community forums. The researchers also compared how people answered the survey questions before and after the sessions.

The researchers also compared the survey answers from the focus groups to the survey answers from the forums to see if there was any difference in how people’s feelings changed.


Similar topics came up in both focus groups and community forums. These topics included the following:

  • The community needs more awareness and understanding of mental health problems and how they affect people’s lives. Some people may not seek help for mental health problems because they are embarrassed or worried about what others will think.
  • Support from the community is an important part of staying mentally healthy and helping people with mental health problems get better.
  • People found it hard to get the kind of mental health help they needed and worried that the mental health help that is available is not very good.
  • People thought it would be easier to get mental health help at a regular doctor’s office or through organizations in the community.

Community leaders who participated in focus groups were more likely to talk about specific ways a community could improve mental health care. People in the community forums tended to talk more about changes that would create jobs or address other community problems.

In both groups, participants were more focused on community changes than on how to help individuals get mental health treatment. Finally, participants thought the most important thing was making it easier for people in the community to ask for and get help when they need it.

People’s survey answers did not change much after taking part in either type of group. Also, the overall results were not very different for community members versus community leaders. However, researchers found that community leaders who participated in the focus groups were more likely to feel that “righteous anger” could be helpful after the sessions than they did before.


Most people who took part in the study were middle-aged women, so the results may be different for other people, such as men or people from other age groups.

The survey used in this study was designed to help researchers understand the feelings of patients with mental health needs, not community members. It may not have been the ideal survey for this study. Also, participants filled out the survey immediately before and immediately after the group discussions, but the discussions might not have made a difference in how they felt until several days later.

The research team worried that the community members would not be able to read well enough to understand the survey, so they read the survey out loud and asked participants to choose their answer using a clicker. However, most people in the community forums did not complete the surveys when the research team used this approach. To get more participation, the research team added a seventh community forum and used a paper-and-pencil survey.


Similar topics came up in focus groups with community leaders and forums with community members. Community leaders who participated in focus groups were more likely to talk about specific ways a community could improve mental health care.

Participating in focus groups or forums made no measurable difference in how people felt afterwards about mental health problems in their community or their confidence in their ability to make changes in their lives or communities.

Sharing the Results

The research team shared their findings at the same community sites where they had hosted the discussion groups. A community member who helped with the study also led a discussion about the findings on Facebook.

Project Information

J. Greer Sullivan, MD, MSPH
University of Arkansas for Medical Sciences
Addressing Mental Health Needs of Rural African Americans

Key Dates

June 2012
December 2014

Study Registration Information


Has Results
Award Type
Funding Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 14, 2024