Using the PDCA cycle to uncover sources of mental health disparities for Hispanics

The Hispanic population is growing rapidly in U.S. rural states, yet limitations in Spanish-speaking behavioural health providers are a barrier to accessing care. In Montana, a new immigrant destination, mental health disparities may not yet be fully understood. We describe an interprofessional approach of nurses and engineers using the Plan-Do-Check-Act (PDCA) cycle to identify disparities in mental health access in a Hispanic community in a rural state. We recruited a community advisory board to inform researchers about potential disparities and to design interventions. The Plan phase consisted of naming the problem and its root causes. Researchers and a community advisory board created flowsheets and diagrams to uncover personal, environmental, political, and procedural contributors to poor mental health outcomes. The Do phase included implementation of a community screening for depression and anxiety. The Check phase revealed 43 mental health screenings where 21% screened positive for depression and 16% screened positive for anxiety. We made 16 referrals to a mental health intervention study. The Act phase led to plans for regular implementation of the health fairs and a study designed to provide Spanish-language mental health services. The success of our interprofessional work provides an example of how the PDCA cycle can be used to uncover potential causes for poor health outcomes and design and evaluate interventions targeted to mitigate those outcomes.