Predictors of Adherence to Treatment in Behavioral Health Therapy for Latino Immigrants: The Importance of Trust

Abstract

A complex array of barriers to care influence patients' adherence to behavioral healthcare services. Understanding barriers to care is critical to ensure sufficient dosage of treatment. This study assessed the influence of perceived barriers on Latino migrants' prospective adherence to treatment for co-occurring mental health and substance use disorders as part of a clinical trial. Eligible participants (18–70 years-old) were recruited from community-based settings and classified according to their intervention session attendance. Baseline assessments included socio-demographic factors, clinical characteristics (i.e., depression, anxiety, post-traumatic stress disorder, substance use), psychosocial and cultural factors (i.e., ethnic identity, health literacy, discrimination), and perceived attitudinal and structural barriers to care. Treatment involved 10-sessions of cognitive-behavioral therapy, psychoeducation, and mindfulness (Integrated Intervention for Dual problems and Early Action) and emphasized participant's engagement in treatment. We used multinomial logistic regression models to examine the association between barriers to care reported at baseline, sociodemographic characteristics, psychosocial and cultural factors, clinical factors, and treatment adherence. Mistrust in previous behavioral health treatment(s) was the reported barrier significantly associated with completion of the program after adjusting for clinical, psychosocial, and cultural factors, with those expressing mistrust in previous treatment(s) showing higher rates of completion compared to those who did not report this barrier. Evidence-based and culturally-tailored interventions provided by ethnically matched providers may overcome cultural mistrust and increase adherence to behavioral health care among Latino immigrants.

Treatment Experiences with Norwegian Health Care among Immigrant Men Living with Co-Occurring Substance Use- and Mental Health Disorders

“…44,45 This could be attributed to difficulty in developing trust in mental health and addiction services due to unfamiliarity with how these services work 31,46 and previous negative experiences with treatment. 35 Moreover, participants revealed that the situation worsened when they had to wait longer to start treatment, leading to more substance use and relapses, which is reported by Pinedo et al 36 as a logistical barrier to treatment.…”

“…Understanding barriers is critical to ensure lower drop-out rates and facilitate adequate use of treatment. 35 The participants stated that receiving treatment from culturally competent HPs facilitated their treatment process, as their needs were understood during the counseling and healing process. This finding is consistent with previous studies 44,52 and a review, 53 where having HPs that were sensitive to cultural nuances was seen as more effective.…”

“…Various studies have shown that immigrants are less likely to use the available mental health and addiction services, 16,35,36 which may be due to lower treatment engagement and unsatisfied treatment needs. There have been a few quantitative studies, but no qualitative research, that has studied treatment experiences from the perspectives of immigrants.…”

Health Professionals’ Experiences with Treatment Engagement Among Immigrants with Co-occurring Substance Use- and Mental Health Disorders in Norway

“…To facilitate the adequate use of available treatment and to ensure lower drop-out rates, it is critical to understand the barriers. 65 PCH 35 and a cultural competence approach 40 have been shown to facilitate treatment engagement. According to the framework suggested by Saha et al, 43 both PCH and cultural competence have overlapping core values that work at the interpersonal level (between health professionals and users) and the health system level.…”

Assessment of the level of health literacy of drug users in the Primary Health Care of the Brazilian Unified Health System

“…An observation should be made regarding the name of the medication used in the public service, in which the generic name of the active ingredient is prescribed by the doctor avoiding the brand name, which may hinder memorization. Dosage change is another result that must be considered because the partial or total non-compliance of the dosage regimen is one of the main barriers to effective drug treatment, especially chronic use medication, leading to aggravations with negative repercussions on the user's quality of life and increased costs to the health system (Falgas-Bague et al, 2019). However, this finding draws attention to the discovery that this change is made mainly by those with a higher level of education, which is not aligned with the general consensus that warns that low education interferes negatively with the understanding of the prescription.…”