An expert shares how technology-based intervention can help address health disparities in Hispanic/Latino/Latinx communities

Dr. Adrian Aguilera is an Associate Professor in the School of Social Welfare at UC Berkeley and the Department of Psychiatry and Behavioral Sciences at UC San Francisco. He is trained as a clinical psychologist and is an expert in cognitive and behavioral approaches to treat depression and anxiety. Dr. Aguilera’s research is focused on developing and testing technology-based interventions to address health disparities in low-income and other vulnerable populations. His work has focused on utilizing mobile phone technologies to disseminate mental health interventions. He is passionate about leveraging digital health for access and equity.

Each year, National Hispanic Heritage Month is held from September 15 to October 15 as a way to celebrate the diverse histories, cultures, and contributions of individuals who’ve come from Spain, Mexico, the Caribbean, Central, and South America, as well as those of their ancestors.

As part of our efforts to highlight relevant experiences of these diverse communities, this National Hispanic Heritage Month we spoke with Dr. Adrian Aguilera about his work which focuses on bridging the existing gap of health disparity in Hispanic/Latino/Latinx communities. You can learn more about his technology-based work below:

In terms of mental health care, the percentage of adults within the Hispanic/Latinx community who receive treatment is lower than the U.S. average.[2] Could you elaborate on why that is?

Dr. Aguilera: The rates of access and treatment utilization are lower among members of the Latino community than average and there are various reasons. Some are structural barriers that are related to Latinos being disproportionately from lower-income backgrounds, such as lack of access to insurance that covers mental healthcare sufficiently and the inability to find the time due to having multiple jobs, etc. Additionally, for people who are native Spanish speakers, there are very few providers who speak Spanish. Beyond the structural factors, there’s often stigma associated with seeking mental healthcare. This can be due to a lack of conceptualizing mental health and emotional challenges as a health problem, but instead due to other sources (e.g. religious, spiritual, faith based) and thus needing other solutions. Another reason for lower utilization of services may have to do with the way that many Latino communities provide support for each other in informal ways, be it at regular family gatherings or via community organizations and local churches.

Could you discuss some of the specific work you’ve done around utilizing digital technologies to improve health and mental health for this population?

Dr. Aguilera: MoodText is a low-tech way to reach people who may not have access to home computers or endless phone data and help them to make the most of their group Cognitive Behavioral Therapy (CBT) sessions for depression. After sessions, MoodText will send automated messages to track patients’ moods and remind them of lessons that they learned in their group CBT sessions. We have found that the addition of the texting program doubled the number of sessions that patients attended, which is essential since the dropout rate for CBT courses is high, especially among low-income patients who have competing life demands.

We are beginning work on another project to provide access to a CBT app for depression and anxiety for Spanish speakers and studying whether pairing them with a peer supporter can help them engage with the app and provide support to complete treatment and improve their symptoms. This project is specifically in response to the dearth of Spanish speaking mental health providers.

Could you speak to the intersection of cultural identity and effective mental health care?

Dr. Aguilera: Mental health care is rooted in verbal communication with clients, first in providing education around mental health and with psychotherapy, it is the core medium. Verbal communication is imbued with culture regarding the words we use and the way we use them being subject to the norms that exist within our own communities. For example, communication in Latin American cultures often begins with “small talk” to set the stage and make a connection. On the other hand, Euro-American cultural norms tend to be more direct and to the point. These two forms of communication can sometimes be at odds and ultimately get in the way of making a connection.

Additionally, there are other cultural norms that are often at odds. In Latin American cultures, there is an emphasis and expectation of sacrificing one’s self for the sake of one’s family or community. Euro-American cultural norms often prioritize individual needs first and a therapist from this background may suggest the same prioritization of the self for someone from a Latino background, but this may not always be appropriate or values aligned. The main point is that the requirements for being a “healthy” member of a social group vary and it’s important to understand the different ways that we can be well.

How do you hope to see technology better leveraged in the future to help provide better care to all communities?

Dr. Aguilera: Technology has the potential to increase dissemination of healthcare information and intervention. However, in order for it to be effective, it needs to meet the needs of all communities. This doesn’t always happen. Most often, designers of these technologies don’t have much contact with diverse communities or people from different lived experiences. Understanding these diverse cultural backgrounds is crucial to understand the motivations and barriers that exist for people in terms of living healthy lives.

What does National Hispanic Heritage Month mean to you?

Dr. Aguilera: It’s a time to recognize that many of us have different backgrounds and they contribute to the rich fabric of society in the United States. Personally, it reminds me of the deep sacrifices and hard work that my own parents and others have endured to improve opportunities for themselves and their families.

Want to learn more? Head herehere for more National Hispanic Heritage Month resources.

Related Links:

• Healthcare and research inequities in the Hispanic and Latinx community
• The complete checklist to prepare for your next doctor’s appointment
• Here’s how to get a second opinion (and when you should)
• 7 ways to best advocate for yourself at doctor’s appointments, according to an expert

References:

1. National Hispanic Heritage Month. Hispanic Heritage Month.gov. URL. Accessed October 3, 2022.
2. Mental Health Challenges and Support: Latinx Communities. National Alliance on Mental Illness. URL. Accessed October 3, 2022.
3. Perceived Unmet Need for Mental Health Services in Past Year: Among People Aged 18 or Older. SAMHSA.gov.URL. Accessed October 3, 2022.
4. MoodText Project. UC Berkeley School of Social Welfare. URL. Accessed October 3, 2022.