Providing Mental Health Care Across Cultures: A Qualitative Study to Understand Perspectives and Experiences of PEARLS Coaches Delivering Late-Life Depression Care

Abstract

Around 31.74% of older adults experience late-life depression. PEARLS is an evidence-based coaching intervention effective in reducing depression symptoms in older adults. Due to racial/ethnic diversity in the United States, culturally responsive care is essential for effective treatment. Evidence is inconclusive regarding whether racial/ethnic cultural match and cultural mismatch of coach and client influences intervention engagement and mental health outcomes. This study aims to highlight the experiences of PEARLS coaches providing cross-cultural care. Participants were recruited using quota and snowball sampling technique. Sixteen PEARLS coaches were interviewed virtually using a semi-structured interview approach. Data was analyzed using a hybrid deductive and inductive approach and thematic analysis was conducted to identify salient findings. Six themes were identified through thematic analysis. These six themes were nested within two overarching themes. They illustrated that while cultural match promotes establishing therapeutic relationships, it comes with challenges such as blurred professional boundaries and more evident mental health stigma. On the contrary, cultural mismatch can lead to initial hesitancy to engage with PEARLS, however, this challenge can be overcome by building rapport using effective interpersonal skills and focusing on shared humanity of clients. In conclusion experiences of PEARLS coaches highlight challenges in delivering cross-cultural care. The findings illustrate the need for additional training and on-going support to ensure cultural responsiveness and further health equity.