Defense Date
2026
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Psychology
First Advisor
Oswaldo Moreno
Abstract
Latinos continue to experience many logistical and systemic barriers to professional mental health services (Derr, 2016) despite being the second-largest racial-ethnic group in the United States (U.S.). With a community of 65 million people (U.S. Census Bureau, 2024), Latinos experience mental healthcare inequalities (Cook et al., 2019) due to structural, cultural, and systemic barriers. Although prior research has emphasized culturally responsive care as a pathway to reducing disparities (Nagy et al., 2025), much of the literature has focused on Western medical models, with limited attention to community-based perspective. Guided by the Knowledge, Attitude, and Practices (KAP) framework, the present study examined how community health workers (CHWs; n = 39) and healthcare providers (n = 22) conceptualize and respond to the underutilization of mental health services among Latino immigrants. Using a community-based participatory research approach, qualitative data was collected through focus group interviews and analyzed using thematic analysis (Braun & Clark, 2006). Findings revealed both shared and distinct perspectives across KAP domains. Within the knowledge domain, CHWs emphasized non-clinical and externally mediated pathways to recognizing psychological distress, including somatic symptoms, behavioral changes, and institutional involvement, whereas healthcare providers conceptualized distress through trauma-informed and clinical frameworks. Within the attitude domain, CHWs described mental health service utilization as reactive, crisis-driven, and requiring sustained relational support, while healthcare providers framed engagement as shaped by trust, cultural responsiveness, competing life demands, and sociopolitical vulnerability. Within the practice domain, CHWs reported implementing flexible, relationship-based, and community-grounded strategies that extend beyond formal roles, whereas healthcare providers emphasized adapting clinical care to improve engagement and retention within existing systems. Across domains, findings suggest that mental health service utilization among Latino immigrants is a dynamic, multi-stage process shaped by cultural values, structural constraints, and relational processes. Importantly, the study highlights a critical misalignment between how mental healthcare systems are structured and how engagement unfolds within Latino immigrant communities. By integrating CHWs’ community-based knowledge with healthcare providers’ clinical expertise, interdisciplinary approaches may enhance cultural responsiveness, improve engagement and retention, and better align mental health services with the lived realities of Latino immigrant communities.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-1-2026