Results Summary

What was the research about?

Depression is a health problem that makes people feel sad, hopeless, or empty most days. Depression makes it hard for people to take care of themselves. It is common among people who have other health problems, such as diabetes or heart disease. Many people with low income have depression.

This study about depression treatment took place at three community health clinics. The research team wanted to learn if adding help from a community health worker, or a promotora in Spanish, to regular care could improve depression and overall health. Promotoras spoke English and Spanish. They had training in helping patients learn how to manage their diseases, work with their doctors, and know what community resources were available.

What were the results?

This study found no differences between patients who had help from promotoras and patients who received regular care alone. After 12 months, patients in both groups managed their illnesses better, felt less depressed, had less pain, and had less stress.

Who was in the study?

The study included 348 patients, almost all of whom were Latino, at three health clinics in Los Angeles, California. About 85 percent were women and 91 percent were born outside the United States. Patients were adults with low income and an average age of 57. Each patient had depression along with diabetes, heart disease, or both.

What did the research team do?

The research team assigned patients to one of two groups by chance. Patients in the first group met with trained promotoras once a week for six weeks in person or by phone. Then, for three more months, patients talked with the promotoras once a month by phone or in person. Promotoras talked with patients about their mood and health problems, ways to communicate with their doctors or nurses, and ways to take care of themselves. Promotoras also helped patients meet needs such as getting food or rides to the health clinic.

Patients in the second group received regular care at the health clinic. Patients in both groups received care from doctors and nurses for depression and other illnesses.

The research team gathered information from the patients using surveys before the study started, 6 months after the study started, and 12 months after the study started. The team compared information from patients in both groups.

What were the limits of the study?

After the study started, the Los Angeles health clinics made changes to improve regular care, including hiring community health workers. These changes made the two study groups more alike than the study team had planned, which made it hard to measure the effect of the promotoras. The study team also didn’t get survey results from 30 percent of patients 12 months after the study started. Results may have been different if the team had feedback from all patients.

Future research could look at ways promotoras and other community health workers help patients manage their health and health care.

How can people use the results?

Both care from promotoras and regular care that included community health workers helped patients manage their diseases, feel less depressed, have less pain, and have less stress. Clinics can consider using these methods to help Latino patients with depression and other long-term health problems.

Final Research Report

View this project's final research report.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

  • Reviewers’ comments and the investigator’s changes in response included the following: To address its adherence to PCORI’s Methodology Standards, the awardee clarified the ways patient and stakeholder engagement and contributions led to changes in study design. The awardee described how it used patient input in formulating the research question.
  • The awardee revised the data analysis section of the methods section to more completely describe the statistical approaches it used to calculate power to detect clinically meaningful differences, conduct the main analyses, account for missing data, and do sensitivity analyses to evaluate the effects of the high attrition of participants during the follow-up period.
  • The awardee revised its conclusions to clarify that the active promotora intervention did not significantly improve primary or secondary outcomes, and to acknowledge that the study did not prove that either of the interventions were responsible for improvements in the study outcomes over time.

Conflict of Interest Disclosures

Project Information

Kathleen Ell, DPH
University of Southern California
$1,341,801
10.25302/3.2018.AD.13047364
A Helping Hand to Activate Patient-Centered Depression Care among Low-Income Patients (AHH)

Key Dates

September 2013
December 2017
2013
2017

Study Registration Information

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Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: January 25, 2023