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.

Background

Half of primary care patients from low-income or minority populations live with anxiety, depression, or other mental health problems. Community health centers provide primary care for many of these patients. However, only about 70 percent of community health centers offer mental health services.

When community health centers do offer mental health services, it still can be difficult for patients to get the care they need. For example, health centers may not have enough staff to serve all of their patients, or staff may not speak the same language as the patients. Health centers may not have systems in place to make sure medical staff can easily and quickly share information about the services patients need.

Project Purpose

The researchers used a type of research called a discrete choice experiment to learn if it would be helpful for getting information from patients about how to make mental health care better.

With this method, participants answer questions that have two choices. For each question, people make hard choices about what is more important—for example, daytime appointments in Spanish versus evening appointments in English only. By studying what people choose, researchers can see what matters most. This method is often used in consumer product design research. 

Methods

The study took place at a rural community health center near the United States–Mexico border. Most of the patients were Mexican American.

First, the research team worked closely with patients, staff, and health center directors as partners to find out what aspects of mental health services were most important to patients. They trained community health workers to bring together groups of patients and learn about their ideas. The community health workers spoke with 64 primary care patients in eight groups. The researchers also interviewed 15 health center staff to get their ideas about ways to provide mental health services. The researchers studied the results of these group discussions and interviews to learn what patients and health center employees thought was most important for helping people get mental health care.

Using the findings from the group discussions and interviews, the researchers created a survey with different options for getting mental health services. Patients had to choose between important aspects of care. For example, the survey asked if patients would prefer to get care from a highly trained health professional in another location or a less experienced professional with an office within the clinic.

In the study, 604 primary care patients took the survey. The researchers looked at all the answers to see which features of mental health care were most important.

Findings

The researchers found that patients and staff agreed on what made it hard to get mental health services.

The researchers found that patients wanted their health center to help more people understand what mental illness is. The patients wanted to know what they could do on their own to help with daily stress. They suggested creating support groups for people to talk about stress.

When researchers reviewed the answers to the survey, they found that two features of mental health services were important to patients, but they hadn’t shown up in the group discussions. First, patients wanted the services to be available at their own health center. Second, they wanted a provider who spoke their language and understood their culture.

Limitations

Everyone in this study was from the same community health center. The patients were mostly Mexican American. The results might be different at other health centers or with different patients. However, this project took a lot of time and work. It might be hard to do this kind of study at other health centers.

The researchers did not test whether the suggestions for improving mental health care helped patients get better.

Conclusions

The researchers found that group discussions and interviews with patients and community health center staff were useful for getting information about what matters to patients and planning ways to deliver care that matches those priorities.

Adding the survey helped researchers learn what aspects of mental health services are most important to patients. This information can help community health centers focus on the most important services for patients.

Sharing the Results

The research team shared the results with patients, community health workers, other healthcare team members, and the community health center leadership. The health center added several mental health providers who are able to provide care on a regular basis at the health center. The researchers also published articles about the study in medical journals (see below).

Project Information

Scott C. Carvajal, PhD
University of Arizona Mel and Enid Zuckerman College of Public Health
$612,347
Integrating and Comparing Community-Based Participatory and Conjoint Analysis

Key Dates

June 2012
April 2015
2012
2015

Study Registration Information

Tags

Has Results
Award Type
Funding Opportunity Type
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: March 4, 2022