By Eric Lindberg
Struggling with health issues such as diabetes and heart disease can lead to depressive disorder, which in turn may have a negative effect on the ability of individuals to manage their health care, creating a downward spiral that results in increased mortality.
This issue is particularly critical in low-income communities of color, where residents face high rates of chronic health problems.
A research initiative led by Kathleen Ell, the Ernest P. Larson Professor of Health, Ethnicity, and Poverty at the USC School of Social Work, is exploring how new strategies such as the use of community health workers can help low-income and racially and ethnically diverse populations gain the upper hand on their health and mental health issues.
“They talk about their depression, how hard it is from their perspective to reduce that sadness,” Ell said. “They talk about problems with the care system itself—difficulty getting appointments, having to take a day off work. They talk about problems communicating with nurses or doctors. They are telling us where things are good and where they aren’t good.”
The issue of co-occurring depression and chronic illness is especially concerning in safety-net clinics overseen by the Los Angeles County Department of Health Services. Providers face heavy workloads and thus have little time to dedicate to building a therapeutic relationship with their patients.
Further complicating matters, many patients have limited health literacy and may feel uncomfortable discussion their illness and health care preferences with physicians, leading to poor adherence to treatment and worsening health.
“They are impoverished, mainly Spanish-speaking people with multiple serious medical conditions and depression,” said María Aranda, an associate professor with the USC School of Social Work. “It’s not uncommon that some of them are living day-to-day, living with other people in crowded conditions.”
To help bridge the gap between health care workers and these culturally diverse populations, researchers are testing a new model of care called A Helping Hand, in which a community health worker engages with patients to enhance their health literacy, improve their communication with doctors, and help them connect with other health resources in the community. The study is supported by a $1.3 million award from the Patient-Centered Outcomes Research Institute.