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01-05-2018 | Original Paper

A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities

Authors: Cathleen E. Willging, Audrey Harkness, Tania Israel, David Ley, Patricia S. Hokanson, Catherine DeMaria, Aaron Joplin, Verida Smiley

Published in: Community Mental Health Journal | Issue 4/2018

Abstract

Mental health disparities affect lesbian, gay, bisexual, transgender, and queer (LGBTQ) people in rural America. There are few empirically-based mental health interventions for this population. This exploratory study uses a mixed-method approach to assess implementation issues related to the feasibility, acceptability, appropriateness, and preliminary impacts of a novel peer-based intervention designed to enhance support and treatment engagement among rural LGBTQ people with mental distress and/or addiction issues. Quantitative and qualitative results illuminate intervention strengths and areas for improvement. Strengths centered on enhancing social support, advocacy behaviors, and engagement in treatment. Implementation challenges and recommendations to advance the intervention model are discussed.

Aladag, M., & Tezer, E. (2009). Effects of a peer helping training program on helping skills and self-growth of peer helpers. International Journal for the Advancement of Counselling, 31, 255–269.CrossRef

Barefoot, K. N., Rickard, A., Smalley, K. B., & Warren, J. C. (2015). Rural lesbians: Unique challenges and implications for mental health providers. Journal of Rural Mental Health, 39, 22–33.CrossRef

Bowen, A. M., Horvath, K., & Williams, M. L. (2007). A randomized control trial of Internet-delivered HIV prevention targeting rural MSM. Health Education Research, 22, 120–127.CrossRefPubMed

Brashers, E., Haas, M., & Neidig, L. (2000). Collective AIDS activism and individuals’ perceived self-advocacy in physician-patient communication. Human Communication Research, 26, 372–402.CrossRef

Centers for Disease Control and Prevention (2014). Behavioral risk factor surveillance system survey questionnaires. http://www.cdc.gov/brfss/questionnaires.htm.

Corbin, J., & Strauss, A. (2008). Basics of qualitative research: Techniques and procedures for developing grounded theory (3rd ed). Thousand Oaks, CA: Sage Publications.CrossRef

D’Augelli, A. R., & Hart, M. M. (1987). Gay women, men, and families in rural settings: Toward the development of helping communities. American Journal of Community Psychology, 15, 79–93.CrossRefPubMed

D’Augelli, A. R., & Levy, M. (1978). The verbal helping skills of trained and untrained human service paraprofessionals. American Journal of Community Psychology, 6, 23–31.CrossRefPubMed

Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595–605.CrossRefPubMed

Gidugu, V., Rogers, E. S., Harrington, S., Maru, M., Johnson, G., Cohee, J., et al. (2015). Individual peer support: A qualitative study of mechanisms of its effectiveness. Community Mental Health Journal, 51, 445–452.CrossRefPubMed

Gillard, S., Edwards, C., Gibson, S., Owen, K., & Wright, C. (2013). Introducing peer worker roles into UK mental health service teams: A qualitative analysis of the organisational benefits and challenges. BMC Health Services Research, 13, 188.CrossRefPubMedPubMedCentral

Glaser, B. G., & Strauss, A. L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Gruyter.

Grant, T. M., Ernst, C. C., & Streissguth, A. P. (1999). Intervention with high-risk alcohol and drug-abusing mothers: I. Administrative strategies of the Seattle model of paraprofessional advocacy. Journal of Community Psychology, 27, 1–18.CrossRef

Hastings, S., & Hoover-Thompson, A. (2011). Effective support for lesbians in rural communities: The role of psychotherapy. Journal of Lesbian Studies, 15, 197–204.CrossRefPubMed

Heckman, T., & Carlson, B. (2007). A randomized clinical trial of two telephone-delivered, mental health interventions for HIV-infected persons in rural areas of the United States. AIDS and Behavior, 11, 5–14.CrossRefPubMed

Heckman, T. G., Miller, J., Kochman, A., Kalichman, S. C., Carlson, B., & Silverthorn, M. (2002). Thoughts of suicide among HIV-infected rural persons enrolled in a telephone-delivered mental health intervention. Annals of Behavioral Medicine, 24, 141–148.CrossRefPubMed

Heckman, T. G., Somlai, A. M., Peters, J., Walker, J., Otto-Salaij, L., Galdabini, C. A., & Kelly, J. A. (1998). Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care, 10, 365–375.CrossRefPubMed

Humphreys, J., Wakerman, J., Wells, R., Kuipers, P., Jones, J., Entwistle, P., et al. (2007). Improving primary health care workforce retention in small rural and remote communities: How important is ongoing education and training? Canberra: Australian Primary Health Care Research Institute.

Institute of Behavioral Research (2007). TCU Drug Screen II (TCUDS II). Fort Worth, TX: Texas Christian University.

Institute of Medicine (2011). The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington, DC: National Academies Press.

Israel, T., Willging, C. E., & Ley, D. (2016). Development and evaluation of training for rural LGBTQ mental health peer advocates. Journal of Rural Mental Health, 40(1), 40–62.CrossRefPubMedPubMedCentral

Kelly, J. A., Murphy, D. A., Sikkema, K. J., McAuliffe, T. L., Roffman, R. A., Solomon, L. J., et al. (1997). Randomised, controlled, community-level HIV-prevention intervention for sexual-risk behaviour among homosexual men in US cities. Community HIV Prevention Research Collaborative. Lancet, 350, 1500–1505.CrossRefPubMed

Latkin, C. A., & Knowlton, A. R. (2005). Micro-social structural approaches to HIV prevention: A social ecological perspective. AIDS Care, 17(Suppl 1), S102–S113.CrossRefPubMed

Lenihan, G., & Kirk, W. G. (1990). Using student paraprofessionals in the treatment of eating disorders. Journal of Counseling & Development, 68, 332–335.CrossRef

McCall, W. V., Reboussin, B. A., & Rapp, S. R. (2001). Social support increases in the year after inpatient treatment of depression. Journal of Psychiatric Research, 35, 105–110.CrossRefPubMed

McCarthy, L. (2000). Poppies in a wheat field: Exploring the lives of rural lesbians. Journal of Homosexuality, 39, 75–94.CrossRefPubMed

McLaughlin, K. A., Hatzenbuehler, M. L., & Keyes, K. M. (2010). Responses to discrimination and psychiatric disorders among Black, Hispanic, female, and lesbian, gay, and bisexual individuals. American Journal of Public Health, 100, 1477–1484.CrossRefPubMedPubMedCentral

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.CrossRefPubMedPubMedCentral

Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.

Oswald, R. F., & Culton, L. S. (2003). Under the Rainbow: Rural gay life and its relevance for family providers. Family Relations, 52, 72–81.CrossRef

Patton, M. Q. (2015). Qualitative research & evaluation methods: Integrating theory and methods (4th ed.). Thousand Oaks, CA: Sage Publications, Inc.

Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research and Practice, 19, 276–288.CrossRef

Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38–48.CrossRefPubMed

Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38, 65–76.CrossRefPubMed

QSR International (2012). NVivo qualitative data analysis software (Version 10) [Computer software].

Salzer, M. S., Katz, J., Kidwell, B., Federici, M., & Ward-Colasante, C. (2009). Pennsylvania Certified Peer Specialist initiative: Training, employment and work satisfaction outcomes. Psychiatric Rehabilitation Journal, 32, 301–305.CrossRefPubMed

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33 (quiz 34–57).PubMed

Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32, 705–714.CrossRefPubMed

Sobell, L. C., & Sobell, M. B. (1996). Timeline follow back user’s guide: A calendar for assessing alcohol and drug use. Toronto: Addiction Research Foundation.

Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27, 392–401.CrossRefPubMed

Steketee, G., Perry, J. C., Goisman, R. M., Warshaw, M. G., Massion, A. O., Peterson, L. G., et al. (1997). The psychosocial treatments interview for anxiety disorders. A method for assessing psychotherapeutic procedures in anxiety disorders. Journal of Psychotherapy Practice and Research, 6, 194–210.PubMedPubMedCentral

Tobias, C. R., Rajabiun, S., Franks, J., Goldenkranz, S. B., Fine, D. N., Loscher-Hudson, B. S., et al. (2010). Peer knowledge and roles in supporting access to care and treatment. Journal of Community Health, 35, 609–617.CrossRefPubMedPubMedCentral

Waitzkin, H., Getrich, C., Heying, S., Rodriguez, L., Parmar, A., Willging, C., et al. (2011). Promotoras as mental health practitioners in primary care: A multi-method study of an intervention to address contextual sources of depression. Journal of Community Health, 36, 316–331.CrossRefPubMed

Walsh-Burke, K., & Marcusen, C. (1999). Self-advocacy training for cancer survivors. The Cancer Survival Toolbox. Cancer Practice, 7, 297–301.CrossRefPubMed

Weeks, M. R., Convey, M., Dickson-Gomez, J., Li, J., Radda, K., Martinez, M., et al. (2009a). Changing drug users’ risk environments: Peer health advocates as multi-level community change agents. American Journal of Community Psychology, 43, 330–344.CrossRefPubMedPubMedCentral

Weeks, M. R., Li, J., Dickson-Gomez, J., Convey, M., Martinez, M., Radda, K., et al. (2009b). Outcomes of a peer HIV prevention program with injection drug and crack users: The Risk Avoidance Partnership. Substance Use & Misuse, 44, 253–281.CrossRef

Wertheimer, D. M. (1992). Treatment and service interventions for lesbian and gay male crime victims. In G. M. Herek & K. T. Berrill (Eds.), Hate crimes: Confronting violenace against lesbians and gay men (pp. 227–240). Thousand Oaks, CA: Sage Publications, Inc.

Willging, C. E., Israel, T., Ley, D., Trott, E., DeMaria, C., Joplin, A., & Smiley, V. (2016). Coaching peer-based providers for sexual and gender minorities in rural new Mexico. Journal of Gay & Lesbian Mental Health, 20, 214–236.CrossRef

Willging, C. E., Salvador, M., & Kano, M. (2006a). Pragmatic help seeking: How sexual and gender minority groups access mental health care in a rural state. Psychiatric Services, 57, 871–874.CrossRefPubMed

Willging, C. E., Salvador, M., & Kano, M. (2006b). Unequal treatment: Mental health care for sexual and gender minority groups in a rural state. Psychiatric Services, 57, 867–870.CrossRefPubMed

Williams, I., Williams, D., Pellegrino, A., & Warren, J. C. (2012). Providing mental health services for racial, ethnic, and sexual orientation minority groups in rural areas. In K. B. Smalley, J. C. Warren & J. P. Rainer (Eds.), Rural mental health: Issues policies and best practices (pp. 229–252). New York: Springer.

Williams, M. L., Bowen, A. M., & Horvath, K. J. (2005). The social/sexual environment of gay men residing in a rural frontier state: Implications for the development of HIV prevention programs. The Journal of Rural Health, 21, 48–55.CrossRefPubMedPubMedCentral

Willging C. E., Israel T., Ley D., Trott E., DeMaria C., Joplin A, & Smiley V. (2016). Coaching peer-based providers for sexual and gender minorities in rural new Mexico. Journal of Gay & Lesbian Mental Health, 20, 214–236.

Wiltshire, J., Cronin, K., Sarto, G. E., & Brown, R. (2006). Self-advocacy during the medical encounter: Use of health information and racial/ethnic differences. Medical Care, 44, 100–109.CrossRefPubMed

Title: A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities
Authors: Cathleen E. Willging
Audrey Harkness
Tania Israel
David Ley
Patricia S. Hokanson
Catherine DeMaria
Aaron Joplin
Verida Smiley
Publication date: 01-05-2018
Publisher: Springer US
Published in: Community Mental Health Journal / Issue 4/2018
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI: https://doi.org/10.1007/s10597-017-0168-x

At a glance: The STEP trials

Springer Medicine

A Mixed-Method Assessment of a Pilot Peer Advocate Intervention for Rural Gender and Sexual Minorities

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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