A primary care programme to improve identification and stepped-care support of Asians with mental health and lifestyle issues

Abstract

Introduction: Asians living in Western countries have a higher incidence of mental health and lifestyle issues, but are less likely to disclose these to health-care professionals due to stigma. Instead, they tend to present to primary care with somatic concerns. AIM: To assess the feasibility and acceptability of a well-validated electronic screening and stepped-care support tool (eCHAT) to identify mental health and lifestyle issues among Asian patients. METHODS: A mixed-methods (interviews and survey) co-design approach explored patient and clinic staff perspectives on a translated version of eCHAT (AsiaCHAT). Recruitment was through a large primary care organisation with a high proportion of Asian patients. Of the 307 approached, 277 participated (92% acceptance rate). RESULTS: Problems of depression (n = 12) and anxiety (n = 69) were identified among patients, as were sexual health concerns (n = 22) among younger participants. Overall, participants and clinic staff rated AsiaCHAT as a useful and acceptable tool for disclosing and discussing patient concerns. Problems of finances, time constraints and competing demands made long-term implementation challenging. DISCUSSION: AsiaCHAT is a promising tool for identifying mental health and lifestyle concerns among Asians presenting to primary care. The electronic screener supports patient and provider discussion of sensitive topics and the stepped-care support function helps direct care. Its flexible functionality means that there is potential to integrate it into busy clinic settings as well as online patient portals, and the programme aligns with current policy to improve Asian health in New Zealand.