This study evaluates the effectiveness of a culturally tailored intervention, Bridges to Better Health and Wellness (BRIDGES), aimed at reducing chronic disease disparities among Puerto Ricans with serious mental illness (SMI). Participants receive monthly sessions with health care managers to address patient-provider stigma and care coordination.
BRIDGES is a multi-level Healthcare Manager Intervention (HMI) that addresses both patient and provider barriers to healthcare. It includes culturally adapted modules to reduce stigma and promote chronic disease prevention. The study uses a hybrid type 1 effectiveness-implementation randomised controlled trial to test its impact on primary care service use, chronic disease outcomes and stigma reduction over 12 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
DOUBLE
Enrollment
300
A culturally adapted, multilevel intervention consisting of monthly 60-minute sessions over a 12-month period. Sessions will be conducted by graduate clinical psychology students acting as healthcare managers. The intervention focuses on care coordination, patient activation, and reducing provider stigma to improve access to preventive primary care services.
Participants will continue to receive standard psychiatric care, including routine visits with their mental health providers at the designated clinical sites. They will also receive a booklet with information on how best to link with primary care providers. This ensures that participants are aware of available resources and basic health care recommendations, but does not include any active follow-up or intervention components.
Mayagüez Medical Center Primary Care Psychology Clinic
Mayagüez, Puerto Rico, Puerto Rico
PHSU Wellness Center
Ponce, Puerto Rico, Puerto Rico
Recipt of Preventive Primary Care
29-item questionnaire developed by team members. It uses preventive primary care indicators from the US Preventive Service Task Force Guidelines extracted from medical records and examines the use of physical health services over the past 6-months.Indicators are grouped into six categories: physical examinations, screenings for women, screenings for men, laboratory tests, vaccinations, and education. An aggregate preventive primary score is calculated representing the proportion of services for which each participant was eligible depending on age and gender.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Hemoglobin A1c
The A1C test is a simple common blood test used to measure blood sugar levels over the past 3 months.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Lipid Panel
The Lipid panel is a simple common blood test used to examine cardiovascular health by analyzing cholesterol in the blood. This test examines four types of lipids in the blood, namely: 1) Total cholesterol, 2 Low-density lipoprotein (LDL), 3) High-density lipoprotein (HDL), and 4) Triglycerides.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Basic Metabolic Panel
It is a simple common blood group of tests used to examine different naturally occurring chemicals in the blood. The tests can give information heart, kidneys, and liver function. It includes Blood urine nitrogen (BUN), carbon dioxide (C02), Creatinine, Glucose, Serum chloride, Serum potassium, Serum sodium, and Serum Calcium.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Smoking - Severity Dependence Scale
Five-item scale, used to assess severity of smoking.
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Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Physical Activity - International Physical Activity Questionnaire
This is a 7-item measure widely used to examine 4 types of physical activity: 1) vigorous, 2) moderate, 3) walking and 4) sitting.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Health Literacy - Test of Functional Health Literacy for Adults
Questionnaire with 12 items measuring adult functional health literacy in the health care setting.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Self-Stigma - Self-Stigma of Mental Illness Scale
This 40-item measure examines self stigma's four dimensions (awareness, agreement, self-application and self esteem).
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Provider Stigma - The Mental Health Stigma Scale for Health Professionals
12-item measure examining provider stigma dimensions (social distance, negative character attributions and self-sufficiency).
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention
Patient-Provider Relationship - Patient Assessment of Chronic Illness Care
20-item scale used to assess participants' perspectives on the quality and patient-centeredness of chronic illness care received during the past 6 months from their primary care provider.
Time frame: baseline,6 and 12 months follow up and 6 and 12 months post intervention