Examining theoretical mediators in a culturally adapted, community health worker-led intervention for depression and anxiety
Abstract
Objective: Emerging research suggests that mental health interventions led by community health workers (CHW) are effective and increase access to services for minoritized groups. However, the question of how these interventions work has rarely been tested. In this secondary analysis of data from a randomized clinical trial of a CHW-led intervention that included training in mindfulness and encouraged active engagement and self-efficacy in managing mental health care, we aimed to examine several mediators of change based on theoretical mechanisms of action.
Method: A sample of 1,044 racially and ethnically diverse adults (mean age 42.6; 83.8% female-identifying) with moderate to severe depression or anxiety symptoms were randomly assigned to the Strong Minds, Strong Communities psychoeducational intervention or an enhanced control condition. Models tested the direct effects of the intervention on outcomes (depression, anxiety, and functional impairment) as well as the indirect effects of proposed mediators (mindfulness, patient activation, self-efficacy, and working alliance).
Results: Multiple mediator models showed consistent, significant indirect effects of mindfulness across all outcomes, suggesting partial mediation. Patient activation was a significant partial mediator for depression only. Results for the working alliance were consistently nonsignificant. Exploratory analyses examined moderation by racial/ethnic group (Latinx, Asian, non-Latinx Black, and non-Latinx…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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