Introduction: Addressing the multifaceted health and mental health needs of ethnically and culturally diverse individuals is a challenge within the current health care system. Integrated care provides a promising approach to improve mental health treatment-seeking disparities; however, adaptation of care models to impact African Americans is lacking. Although resources to support engagement of diverse populations in depression care exist, little has been developed to tailor patient preferences in accessing and engaging mental health services that are integrated into primary care.Objective: Our research seeks to add a cultural focus to the existing literature concerning integrated health care models to help address depression and selected co-occurring chronic health conditions in primary care settings.Methods: Thirty-two adult patients of an integrated primary care clinic participated in focus groups discussing their individual health experiences. Nine health care practitioners/administrators from five different integrated practice settings in the Atlanta, GA, area participated in key informant interviews.Main Outcome Measures: Transcripts were analyzed for key themes related to depression care, perceived unmet cultural needs, and desired adaptations.Results: Common themes emerged such as the importance of peer-support and community engagement as areas of patient interest. Participants had good knowledge in recognizing depressive symptoms but were less knowledgeable about treatment options and expectations of treatment. The administrative and practitioner perspective suggests that patient preferences are valued and perceived as valid.Conclusion: It is critical that strategies and models are developed to improve health care among underserved minorities because current models offer variable efficacy among this population.

Background Distrust in government among people of color is a response to generations of systemic racism that have produced preventable health inequities. Higher levels of trust in government are associated with better adherence to government guidelines and policies during emergencies, but factors associated with trust and potential actions to increase trust in local government are not well understood. Methods The COVID-19 Community Recovery study sampled participants from the New York City (NYC) Department of Health and Mental Hygiene’s Healthy NYC, a probability-based survey panel who complete health surveys periodically. Participants who lived in one of three historically disinvested communities in NYC where the NYC Department of Health and Mental Hygiene has dedicated resources to reduce health inequities were included. The cross-sectional survey was fielded from September 30 to November 4, 2021 and could be self-administered online or conducted via CATI (Computer Assisted Telephone Interviewing) in English, Spanish, and Simplified Chinese (Mandarin and Cantonese by phone). Demographic data were summarized by descriptive statistics. Crude and adjusted logistic regression analyses were used to assess factors predictive of trust in local government as a source of information about COVID-19 vaccines. Open-ended responses about strengthening residents’ trust in local government were coded using an iteratively generated codebook. Results In total, 46% of respondents indicated NYC local government was a trusted source of information about COVID-19 vaccines, relatively high compared to other sources. In bivariate analyses, race/ethnicity, age group, educational attainment, length of time living in NYC, and household income were significantly associated with identifying NYC government as a trusted source of information about COVID-19 vaccines. In multivariable logistic regression, no variables remained significant predictors of selecting local government as a trusted source of information. Key recommendations for local government agencies to build residents’ trust include communicating clearly and honestly, addressing socioeconomic challenges, and enhancing public COVID-19 protection measures. Conclusions Study findings demonstrate that nearly half of residents in three historically divested NYC communities consider local government to be a trusted source of information about COVID-19 vaccines. Strategies to increase trust in local government can help reduce community transmission of COVID-19 and protect public health.

Background The COVID-19 pandemic has disproportionately affected some New York City (NYC) neighborhoods that primarily consist of Black, Indigenous, and Latino residents. This has been attributed to a longstanding history of structural racism and disinvestment in these communities, resulting in chronic and infectious disease inequities. To help address these health inequities, the NYC Department of Health and Mental Hygiene have utilized placed-based approaches and operated within NYC’s most affected neighborhoods of North and Central Brooklyn, South Bronx, and East and Central Harlem. During the pandemic, these neighborhoods experienced high hospitalization and COVID-related death rates when compared to the rest of NYC. While stay-at-home orders were implemented to reduce the spread of COVID-19, this may have also affected utilization of non-COVID related healthcare services. Methods To assess the impact of the pandemic on health and social conditions, the NYC Health Department administered the COVID-19 Community Recovery Survey from September 30, 2021 to November 4, 2021, to 1,358 residents in a subset of these neighborhoods. The survey aimed to assess the prevalence of and reasons for delaying non-COVID related healthcare services during the first 18 months of the pandemic. Quantitative analyses were conducted in SAS Enterprise Guide 7.115 and SAS-Callable SUDAAN and weighted with 2015-2019 American Community Survey 5-year estimates. Qualitative analyses were conducted in Microsoft Excel. Results More than half of participants (54%) delayed routine healthcare or mental health services. Fear of contracting COVID-19 (61%), stay-at-home policies (40%), belief that care could safely be postponed (35%), and appointment challenges (34%) were among reasons for delaying routine healthcare. Fear of contracting COVID-19 (38%) and reduced hours of service (36%) were primary reasons for delaying mental healthcare. Reported reasons for the sustained delay of care past 18 months involved COVID concerns, appointment, and insurance challenges. Conclusions The delay of non-COVID related healthcare throughout the pandemic may result in the further widening of the health inequity gap among NYC residents dealing with a higher chronic disease burden before the start of the COVID-19 pandemic in March 2020. Findings from this study can support equitable COVID-19 recovery and guide efforts with health promotion.