Engagement In Health Services Research Articles

Person-Centered Cultural Assessment Can Improve Child Mental Health Service Engagement and Outcomes

ABSTRACT Objective Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children’s mental health care. Methods Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child’s problems and family help-seeking. Results Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families’ values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response. Conclusions The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).

System navigation models to facilitate engagement in pediatric behavioral health services: A systematic review.

Despite increased prevalence and identification of pediatric behavioral health concerns, families face many barriers when attempting to access behavioral health services. System navigators, or individuals experienced in navigating the health system, help to engage families in services by helping individuals overcome barriers for accessing care. However, limited research to date has systematically reviewed the implementation and effectiveness of navigation models in pediatric populations. We systematically reviewed published studies examining navigation models for pediatric populations (up to age 18) referred to behavioral health services. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO for studies that evaluated a navigation model and included service use outcomes. We aggregated data pertaining to characteristics of the study and navigation model, service use outcomes, and implementation outcomes. Eight studies met inclusion criteria. Families who participated in navigation services were more likely to complete diagnostic assessments and received an increased dosage (e.g., time spent, services completed) of behavioral health treatments. There was notable variability across studies in terms of processes involved in the navigation models. Findings indicate that system navigation is a promising method for improving service use for pediatric populations referred to behavioral health services. Future research may continue to examine the effectiveness and implementation of the model, to best understand its benefits and what processes may contribute to improved service outcomes. Public Significance Statement: This paper reviews the effectiveness of system navigator models, which are designed to engage children and families in behavioral health services. The interventions reviewed are associated with increased behavioral health service use in children and show promise as a method of overcoming barriers to accessing behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Diagnosed Incidence of Non-Affective Psychotic Disorders Amongst Adolescents in British Columbia and Sociodemographic Risk Factors: A Retrospective Cohort Study.

ObjectivesTo estimate the diagnosed incidence of non-affective psychotic disorder between the ages of 13 and 19 years in South-Western British Columbia (BC) and to examine variation in risk by sex, family and neighbourhood income, family migration background, parent mental health contact and birth year.MethodsLinked individual-level administrative data were used to construct a cohort of individuals born in 1990–1998 and residing in South-Western BC (n = 193,400). Cases were identified by either one hospitalization or two outpatient physician visits within 2 years with a primary diagnosis of a non-affective psychotic disorder (ICD-10: F20–29, ICD-9: 295, 297, 298). We estimated cumulative incidence, annual cumulative incidence and incidence rate between the ages of 13 and 19 years, and conducted Cox proportional hazards regression to estimate associations between sociodemographic factors and risk over the study period.ResultsWe found that 0.64% of females and 0.88% of males were diagnosed with a non-affective psychotic disorder between the ages of 13 and 19 years, with increasing risk observed over the age range, especially amongst males. Incidence rate over the entire study period was 106 per 100,000 person-years for females and 145 per 100,000 person-years for males. Risk of diagnosis was elevated amongst those in low-income families and neighbourhoods, those with a parent who had a health service contact for a mental disorder, and more recent birth cohorts. Risk was reduced amongst children of immigrants compared to children of non-migrants.ConclusionsFindings from this study provide important information for health service planning in South-Western BC. Future work should examine whether variations in diagnosed incidence is driven by differences in health service engagement or reflect genuine differences in risk.

Local implementation evaluation of a suicide prevention predictive model at a large VA health care system.

The Veterans Health Administration (VHA) implemented REACH VET, which analyzes health records to identify veterans at statistically elevated risk for suicide and other adverse outcomes compared to other veterans in VHA. This project evaluated REACH VET program implementation at a large VA health care system by examining program fidelity and treatment engagement, receipt of suicide prevention interventions, and suicide-related behaviors in the 6months following identification. Over a 12-month period, 218 unique cases were identified by REACH VET within a local VA system. Data were extracted from the VA's electronic medical records. Protocol adherence for required clinical and administrative steps was 94% and above. After identification, 88% received outpatient mental health treatment, 21% had a psychiatric hospitalization, and 83% engaged in Safety Planning around the time of identification or in the following six months. Twenty-six percent of cases were identified by another existing method for identifying high-risk veterans. Five percent had a medically documented suicide attempt, and none were known to die by suicide in the following 6months. Local evaluation suggested high protocol fidelity and high engagement in mental health and suicide prevention services following identification among veterans who remained at elevated risk in the 6months that followed.

A qualitative investigation of promotores' perspectives on task-shifting evidence-based mental health care for Latinxs in a rural community.

Promotores de salud (i.e., community health workers) have the potential to provide much-needed mental health services in Latinx communities, particularly in areas with provider shortages. This study used qualitative methods to explore promotor/a perspectives on mental health task shifting, with a focus on developing understanding of their definition of a promotor/a, obtaining feedback on the appropriateness of sample content of an evidence-based intervention for anxiety and depression in their community, and considering concerns regarding potential barriers to future implementation of services to Latinxs in a rural community. Promotores de salud (N = 16) were recruited from a network of primary care practices to participate in three semistructured focus groups. Qualitative analyses revealed that promotores viewed themselves as caretakers of their community and believed that mental health care fell within that role. After being presented with materials of an evidence-based behavioral intervention for anxiety and depression during the focus groups, promotores expressed that the sample materials seemed appropriate for their community, as well as a general perception that they could deliver such strategies with future training. Promotores voiced concerns about potential barriers to patients accessing mental health care, including mental health stigma and poor community mental health literacy, and discussed the potential benefits of involving promotores to address some of these barriers. Overall, results of this study indicate promotor/a support of the idea of mental health task shifting, as well as a perception that their involvement may improve future mental health service utilization and engagement among Latinxs in a rural community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

How Do Lay Health Workers Engage Caregivers? A Qualitative Study to Enhance Equity in Evidence-Based Parenting Programs

ABSTRACT Engaging caregivers in their children’s mental health treatment is critical for delivering high quality, evidence-based care, particularly for young children with externalizing behaviors. Lay health workers (LHWs), including peer providers and promotoras de salud, have been identified as important workforces in addressing structural and stigma-related barriers to engagement in mental health services. Importantly, research has suggested that LHWs may be integral in efforts to address engagement disparities in evidence-based behavioral parent training programs (BPTs) for Latinx caregivers. The purpose of the study was to understand how different LHW workforces engage caregivers within their usual services, in order to inform strategies that improve access to and engagement in BPTs. Qualitative interviews were conducted with two different LHW workforces: volunteer LHWs (i.e., promotoras de salud) (n = 14), who were part of a community-embedded network, and paid LHWs (i.e., parent support partners, home visitors) (n = 9) embedded within children’s mental health agencies. Participants were predominately Latinx (79%) and female (96%). Qualitative analyses revealed three primary themes related to engagement strategies used by LHWs to address barriers to care: 1.) Building Trust, 2.) Empowerment, 3.) Increasing Access. Although the majority of themes and sub-themes were consistent across the two LHW workforces, agency-embedded LHWs often discussed having the means to provide resources through their organizations, whereas community-embedded LHWs discussed acting as a bridge to services by providing information and conducting outreach. Findings have implications for partnering with different workforces of LHWs to increase equity in access to BPTs.

Adolescent Perspectives on How an Adjunctive Mobile App for Social Anxiety Treatment Impacts Treatment Engagement in Telehealth Group Therapy

Adjunctive mobile mental health apps to supplement mental health treatment have been growing in recent years given their ability to address treatment engagement barriers. However, few studies have explicitly examined how these mobile apps impact treatment engagement, and even fewer have investigated this topic through adolescents’ perspectives. To this end, we conducted semi-structured interviews with five adolescents who used an adjunctive mobile mental health app in combination with telehealth cognitive behavioral group therapy for social anxiety. Using a multidimensional framework of treatment engagement, we elicited their perspectives on how the app impacted their engagement in telehealth group therapy and gathered their suggestions for improving the app. Using a consensual qualitative research approach, we learned that adolescents felt the app increased their comfort with others in therapy and their expectations about the effectiveness of mental health apps. They also indicated that the app prepared them for in-session participation and facilitated out-of-session skills practice. Adolescents had valuable suggestions such as adding app features to facilitate social connectedness between group members and adding appointment reminders in the app. This preliminary study highlights implications for future adjunctive mobile mental health app developers and researchers to increase adolescents’ treatment engagement in mental health services.

Mental health service engagement with family and carers: what practices are fundamental?

BackgroundSubstantial and important benefits flow to all stakeholders, including the service user, when mental health services meaningfully engage with carers and family members. Government policies around the world clearly supports inclusiveness however health service engagement with family and carers remains sporadic, possibly because how best to engage is unclear. A synthesis of currently used surveys, relevant research and audit tools indicates seven core ways that families and carers might be engaged by health services. This study sought to confirm, from the perspective of family and carers, the importance of these seven health service engagement practices.MethodsIn a mixed method online survey, 134 family members and carers were asked what they received and what they wanted from mental health services. Participants also quantified the importance of each of the seven core practices on a 0–100 point likert scale.ResultsAlmost 250 verbatim responses were deductively matched against the seven themes, with additional unaligned responses inductively categorised. The findings triangulate with multiple diverse literatures to confirm seven fundamental engagement practices that carers and family want from health services. Conceptually, the seven practices are represented by two broad overarching practice themes of (i) meeting the needs of the family member and (ii) addressing the needs of the service user.ConclusionPolicy, clinical practice, training and future research might encompass the seven core practices along with consideration of the intertwined relationship of family, carers and the service user suggested by the two broader concepts.

Adult mental health service engagement with patients who are parents: Evidence from 15 English mental health trusts.

Ascertaining whether mental health service users have children is a clinical requirement in UK health services, and acknowledgement of a patient's parenting role is necessary to enable engagement with their parenting experience and to facilitate support, both of which are associated with improved outcomes for the parent-child dyad. The current study sought to investigate the practice of mental health practitioners working in UK adult mental health services with regard to the following: Ascertaining whether patients have children; engagement with the parenting role of patients; engagement with the construct of 'think patient as parent'. Self-report online/paper survey of 1105 multi-disciplinary adult mental health practitioners working in 15 mental health trusts in England. A quarter of adult mental health practitioners did not routinely ascertain whether patients had dependent children. Less than half of practitioners engaged with the parenting experience or the potential impact of parental mental health on children. The parenting role of patients is not routinely captured by large numbers of practitioners working in adult mental health settings. This is despite it being a mandatory requirement and an integral component of the systematic care of the adult, and preventative care for the offspring. Failure to engage with patients who are parents is a missed opportunity with profound downstream public health implications. The practice deficits identified in this study should be viewed in terms of broader structural failures to address the intergenerational transmission of poor mental health. Some parents who have mental health difficulties may struggle to provide appropriate and effective care to their children. The parenting role can also exacerbate mental health difficulties. Identification of dependent children is a mandatory component of adult mental health clinical practice and is necessary to understand a parent's support needs. A quarter of adult mental health practitioners are failing to do so. A missed opportunity to engage with the support needs of the parent-child dyad.

Future Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.

ABSTRACT Nearly half of children meeting criteria for a mental health disorder in the United States (U.S.) do not receive the treatment they need. Unfortunately, lack of access to and engagement in mental health services can be seen at even higher rates for historically marginalized groups, including low-income, racial, and ethnic minority youth. Lay Health Workers (LHWs) represent a valuable workforce that has been identified as a promising solution to address mental health disparities. LHWs are individuals without formal mental health training who oftentimes share lived experiences with the communities that they serve. A growing body of research has supported the mobilization of LHWs to address service disparities around the globe; however, challenges persist in how to scale-up and sustain LHW models of care, with specific barriers in the U.S. In this paper, we describe LHWs’ different roles and involvement in the mental health field as well as the current state of the literature around LHW implementation. We integrate the RE-AIM Framework with a conceptual model of how LHWs address disparities to outline future directions in research and practice to enhance equity in the reach, effectiveness, adoption, implementation, and maintenance of LHW models of care and evidence-based practices for historically marginalized communities within the U.S.

Embedded researchers' purpose and practice: Current perspectives from Australia.

The embedded researcher model proposes that if research is co-produced with academics, clinical staff will have greater engagement with and ownership of the research findings, and they will be able to integrate evidence in practice. This paper describes the role and purpose of embedded researchers in Australian healthcare settings. A purposive sample of current and former embedded researchers were invited to participate in an exploratory online survey. Embedded researchers were defined as individuals with research qualifications who worked, or had worked, for at least 30% of their time in a healthcare organisation doing research or research capacity building. Most embedded researchers described a dual purpose, in building clinicians' capacity for research while also undertaking clinical research. Only a small proportion of respondents described their purpose as supporting and improving clinical practice. Most embedded researchers described working to both traditional academic key performance indicators and a complementary range of clinical performance and healthcare service indicators. Embedded researchers provide more research development and engagement in health services than is recognised or currently reported. In addition to traditional academic indicators, they described a broad range of clinical and health service indicators which measured capacity building.

In Case You Haven't Heard…

Education, income and mental health disparities within the Asian Pacific American (APA) community continue to impact their higher education journey. To help address the needs of APA students, McDonald's is launching APA Next, an education program aimed at empowering and uplifting students throughout their academic journey — both in the classroom and beyond — with financial and personal development resources, a news release stated. The distribution of income among APAs being the most unequal among all racial and ethnic groups, paired with a higher level of unmet mental health needs and lower level of mental health service engagement among APA youth, showcase the need for programs like APA Next, officials stated. As part of its commitment to feeding and fostering communities, McDonald's is building on 14 years of providing support and advancement opportunities for APA students with APA Next. Through a series of content that offers career advice from leading APA voices to online mental health resources via Shine, a self‐care app founded by two women of color, this diverse toolbox of resources is designed to help students and families prepare for “what's next” in modern academia.

Interactions Between Health Professionals and Lesbian, Gay and Bisexual Patients in Healthcare Settings: A Systematic Review

ABSTRACT The ways in which health professionals (HPs) interact with individuals from sexual minorities can impact their perception of the health service and influence engagement. This systematic literature review aimed to identify and synthesize the qualitative literature exploring interactions between HPs and lesbian, gay and bisexual (LGB) patients in healthcare settings. A search strategy was developed and applied to CINAHL and Medline, inclusion criteria were then applied to results by two screeners with good agreement. Thematic analysis was carried out on papers meeting the inclusion criteria in three stages, beginning with coding the text line-by-line, developing descriptive themes and finally, analytical themes. Electronic searches identified 348 papers with 20 of these meeting the inclusion criteria. Thematic analysis found five themes; HPs’ lack of knowledge regarding LGB specific issues, identification of sexual orientation, discomfort in interactions, LGB patients’ experience of heteronormative attitudes and perceived judgment or other negative attitudes.

A Multidimensional Examination of the Measurement of Treatment Engagement: Implications for Children’s Mental Health Services and Research

ABSTRACT Objective: The gap between rates of children’s mental health problems and their participation in services highlights the need to address concerns related to engagement in mental health services more effectively. To identify, understand, and resolve engagement concerns appropriately requires effective measurement. In this study, we employed a multidimensional conceptual framework of engagement to examine the measurement of engagement in intervention studies focused on improving children’s and/or families’ engagement in services. Method: We coded 52 randomized controlled trials (RCTs) of interventions designed to enhance treatment engagement published between 1974 and 2019 to examine what engagement constructs have been measured, how these constructs have been measured, who has provided information about engagement, and when and why engagement measures have been administered. Results: Attendance was measured in 94.2% of studies, and 59.6% of studies measured only attendance. Furthermore, most studies (61.5%) measured only one engagement dimension. One hundred twelve unique indicators of treatment engagement were used (61.6% measuring attendance). Infrequent measurement of youth (19.2% of studies) or caregiver (26.9%) perspectives was apparent. About half (54.7%) of measures were completed on one occasion, with 53.7% of measures completed after treatment was concluded. Conclusions: Results highlight how the field’s measurement of engagement has focused narrowly on attendance and on interventions that improve attendance. We consider promising new directions for capturing the multidimensional, dynamic, and subjective aspects of engagement, and for leveraging measurement in research and practice settings to feasibly and effectively identify, monitor, and address engagement challenges.

Mental Health Perspectives Among Black Americans Receiving Services From a Church-Affiliated Mental Health Clinic.

Black Americans face substantial barriers to mental health services that are due, in part, to historical and contemporary issues of anti-Black racism. Identifying novel models of care that increase access and engagement in mental health services is important. One such model was developed by a predominantly Black church in Harlem, New York City, which built a free mental health clinic to serve the surrounding community. However, treatment barriers and facilitators of this care model have not been reported. Therefore, the authors conducted a qualitative study to identify Black Americans' (N=15) perspectives of their experiences seeking and receiving care from this church-affiliated mental health clinic and the role of the church in promoting mental health service utilization. Treatment facilitators included health care that was free of charge, services affiliated with a trusted institution, and access to culturally competent care that integrated their faith perspectives. Participants perceived the churches as having the potential to provide psychoeducation, destigmatization, and connection to mental health services. The perspectives shared suggest that this novel model of care may address several barriers to mental health care faced by some Black American populations.

Healthcare worker training to improve quality of care for sexual and gender minority people in sub-Saharan Africa: learning from efforts in Uganda.

IntroductionTraining in care for sexual and gender minority (SGM) populations is critical for ending the HIV epidemic. SGM people, particularly men who have sex with men (MSM) and transgender women, experience disproportionate HIV infection across the globe. The objective of this commentary was to synthesize facilitators of and barriers to SGM health training efforts for healthcare workers in Uganda, in order to help inform potential priorities, strategies and next steps to advance culturally responsive HIV‐related care for SGM communities across Uganda and sub‐Saharan Africa.DiscussionSGM health training often includes education on: foundational concepts and language; stigma, discrimination and SGM health disparities; understanding and addressing implicit bias; sensitive and effective communication and building SGM‐inclusive and welcoming healthcare environments. Clinicians’ education includes sexual and gender histories, sex‐positive HIV counselling, sexually transmitted infections, HIV pre‐exposure prophylaxis and gender‐affirming hormone therapy. SGM communities in sub‐Saharan Africa have often experienced discrimination, persecution, incarceration and physical violence, and they encounter unique barriers to engagement in sexual health services and HIV prevention and treatment. SGM health training efforts in Uganda reveal challenges to and opportunities for advancing equity for SGM communities in sexual health and HIV medical care across the region. In Uganda, SGM community advocacy, as well as policies and programmes of the Ministry of Health and US President’s Emergency Plan for AIDS Relief, have increased readiness and need for scaling up training and skills‐sharing in SGM‐focused HIV and sexual healthcare, including Ugandan‐led and international initiatives.ConclusionsNumerous challenges exist to widespread culturally responsive HIV and sexual healthcare for SGM communities in sub‐Saharan Africa. Lessons learned from healthcare worker training efforts in Uganda may inform future replication, adaptation and dissemination initiatives to meet the needs of more SGM communities in the region. Evaluation of SGM health training programmes to determine the impact on HIV virological suppression and sexual health outcomes will be critical for identifying best practices and strategies that may support advancing HIV epidemic control for SGM communities in Uganda and across sub‐Saharan Africa.

Improving Engagement in Behavioral and Mental Health Services Through Animal-Assisted Interventions: A Scoping Review.

Client engagement in behavioral and mental health services has been strongly linked to improved outcomes and treatment completion. Animal-assisted interventions (AAIs) are increasingly used to improve client engagement, for example, by involving a dog in therapy to support a client's sense of safety. Although existing research suggests that human-animal interactions may promote engagement, further research is needed to understand the underlying mechanisms, identify procedures needed for treatment fidelity, and determine the populations in which this intervention would be most effective. The aim was to identify the existing knowledge base to inform future research and practice in these areas. A review was conducted using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines to answer three questions: What research has been completed regarding the use of animals to affect client engagement, including measurement of potential processes of change? How have interventions that use animals been structured and protocolized? How is engagement operationally defined by these studies? Ten studies were identified for review. Preliminary evidence indicates that AAIs may support client engagement in behavioral and mental health services. A wide range of conceptualizations in which populations and settings could benefit from AAIs were identified, but it remains unclear who would benefit most. The review did not substantively address the efficacy of AAIs for increasing engagement or factors that may drive engagement. Further research is needed to quantify the impact of AAIs on service engagement and to identify mechanisms of change.

Outcomes of a Metaintervention to Improve Treatment Engagement Among Young Adults With Serious Mental Illnesses: Application of a Pilot Randomized Explanatory Design

PurposeThe objective of this study was to conduct a preliminary evaluation of a new young adult–centered metaintervention to improve treatment engagement among those with serious mental illness. MethodsYoung adults, clinic staff, and policy makers provided feedback on the intervention, which is a two-module engagement program provided by a clinician and person with lived experience (peer) during intake. A two-group pilot randomized explanatory trial design was conducted, comparing treatment as usual with treatment as usual plus the engagement program, Just Do You. The primary outcomes were treatment engagement and presumed mediators of program effects measured at 3 months after baseline. ResultsThe randomized explanatory trial indicated that young adults in Just Do You were more engaged in treatment than treatment as usual and that changes in several mediators of engagement occurred. Mechanisms that demonstrated between-group differences were stigma, perceived expertise of providers, trust in providers, and beliefs about the benefits of treatment. Results also provide diagnostic information on mediators that the program failed to change, such as hope, self-efficacy, and emotional reactions to treatment. These results inform next steps in the development of this promising intervention. ConclusionsJust Do You illustrated feasibility, acceptability and preliminary impact. It represents an innovative metaintervention that has promise for improving treatment engagement in mental health services among young adults who have a history of poor engagement.

Migrant Communities at the Center in Co-design of Health Literacy-Based Innovative Solutions for Non-communicable Diseases Prevention and Risk Reduction: Application of the OPtimising HEalth LIteracy and Access (Ophelia) Process.

The drivers of high prevalence of non-communicable diseases (NCD) among migrants are well-documented. Health literacy is regarded as a potential tool to reduce health inequalities and improve migrant's access to and quality of health care. Yet, little is known about the health literacy needs among these groups and how to address them. This paper outlines the protocol for a migrant community-based co-design project that seeks to optimize health literacy, health promotion, and social cohesion in support of prevention of NCDs among migrants in Lisbon using the OPtismizing HEalth LIteracy and Access (Ophelia) process. This participatory implementation research project starts with a mixed-methods needs assessment covering health literacy strengths, weaknesses and needs of migrants, and local data about determinants of health behaviors, service engagement, and organizational responsiveness. Diverse migrant groups will be engaged and surveyed using the Health Literacy Questionnaire and questions on sociodemographic and economic characteristics, health status, use of health services, and perceived impact of the COVID-19 pandemic. Semi-structured interviews with migrants will also be conducted. Based on data collected, vignettes will be developed representing typical persons with diverse health literacy profiles. Migrants and stakeholders will participate in ideas generation workshops for depth co-creation discussions in simulated real-world situations based on the vignettes, to design health literacy-based multisectoral interventions. Selected interventions will be piloted through quality improvement cycles to ensure ongoing local refinements and ownership development. Through a genuine engagement, the project will evaluate the uptake, effectiveness and sustainability of the interventions. This protocol takes a grounded approach to produce evidence on real health literacy needs from the perspective of key stakeholders, especially migrants, and embodies strong potential for effective knowledge translation into innovative, locally relevant, culturally and context congruent solutions for prevention of NCDs among migrants. Given the diverse communities engaged, this protocol will likely be adaptable to other migrant groups in a wide range of contexts, particularly in European countries. The scale-up of interventions to similar contexts and populations will provide much needed evidence on how health literacy interventions can be developed and applied to reduce health inequality and improve health in diverse communities.

Scaling Up and Out HIV Prevention and Behavioral Health Services to Latino Sexual Minority Men in South Florida: Multi-Level Implementation Barriers, Facilitators, and Strategies

Latino sexual minority men (LSMM) are disproportionately affected by HIV in the United States. Concurrently, behavioral health disparities, including mental health and substance use concerns, worsen HIV disparities affecting LSMM. Yet, evidence-based HIV prevention and behavioral health services are insufficiently scaled up and out to this population, perpetuating health disparities, thwarting efforts to control the HIV epidemic, and highlighting the need for culturally relevant evidence-based implementation strategies that address these disparities. Participants included 28 LSMM with varying degrees of engagement in HIV prevention and behavioral health services, and 10 stakeholders with experience delivering HIV prevention and behavioral health services to LSMM in South Florida, an HIV epicenter in general and in particular for LSMM. Participants completed semistructured interviews (English/Spanish) regarding LSMM's barriers and facilitators to engaging in HIV prevention and behavioral health services. Interviews were audio recorded and analyzed using thematic analysis. The 16 themes that emerged from the qualitative analysis were consistent with the consolidated framework for implementation research, an implementation research framework that articulates barriers and facilitators to implementing clinical interventions. Findings suggested the need for implementation strategies that simplify and reduce costs of HIV prevention and behavioral health services, address syndemic challenges impacting service use among LSMM, reduce stigma about service utilization, leverage peer networks, increase provider and community knowledge about services, and build LSMM's readiness and motivation to engage in services. Such strategies may ultimately address HIV and behavioral health disparities among LSMM and facilitate achievement of ending the HIV epidemic goals in this disproportionally affected population.