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Abstract
Poor mental health is global concern that affects individuals, families, and communities, with large areas locally and globally lacking services. Rural areas are particularly at risk for experiencing the burden of mental health problems, with the traditional solution of increasing the number of providers remaining insufficient. As a result, novel solutions are needed to improve mental health care in rural communities. The purpose of this pilot study is to establish initial evidence for a low-intensity mental health intervention delivered by nurses in a rural primary care setting. Utilizing the Health Belief Model as a framework, mental health chats targeted barriers to utilization of mental health care services, and provided a cue to discuss mental health concerns. Desired outcomes included increased mental health care utilization behaviors, decreased barriers to care, and improved patient satisfaction.
The study sample consisted of 94 rural residents visiting their primary care provider. Participants were randomized by cluster into a control or intervention condition. The intervention condition included a psychoeducation brochure and mental health chat encouraging the patient to discuss psychosocial symptoms with the primary care provider. The control condition only included a psychoeducation brochure. Logistic regression, analysis of covariance, and mediated path analysis were used to explore four research questions.
While not every hypothesis was supported, participants in the intervention group were 3.95 times more likely to discuss mental health related problems with their nurse and/or provider. These findings demonstrate support for the effectiveness of low-intensity mental health interventions delivered by nurses, which represents a form of task shifting. Findings did not support the effectiveness of the intervention in reducing barriers to care, increasing provider satisfaction, or the mediating effect of barriers to care on mental health discussions with nurses and providers. Barriers to care may be complex enough that a one-time conversation was insufficient to alter change. Systemic approaches to reduce stigma are potentially needed to facilitate an environment conducive to change. The findings from this study provide impetus for additional research to further explore the effectiveness of mental health interventions that build on existing community resources and infrastructure.
