Promotoras as mental health practitioners in primary care: A multi-method study of an intervention to address contextual sources of depression

Abstract

We assessed the role of promotoras-briefly trained community health workers-in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, lowincome communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention's impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p