Testing the Right Question Project (RQP) Health Education Strategy in a Mental Health Setting

Recent research has demonstrated positive outcomes for patients who take an active role in
their mental health care (Linhorst & Eckert, 2003). Patients who participate in the
decision-making process are more satisfied with services, have a greater sense of
self-efficacy and confidence, an increased ability to cope with daily life, and are more
likely to achieve their treatment goals (Linhorst & Eckert, 2003). As defined by Chamberlin
and Schene (1997), empowerment in mental health care requires having access to information
and resources, having a range of options from which to make choices, learning to think
critically, and having the power to make decisions. Cooper-Patrick et al. (1999) indicate
that minority patients are less likely to have a collaborative relationship with providers
than are otherwise similar white patients. Thus, there is a need for minority patients to
learn to take a more active role in their care. One way to address the need for increased
empowerment and activation among minority mental health patients is to provide them with
training to enhance their communication and decision-making skills. The Right Question
Project (RQP) is a consumer educational technique designed for this purpose and developed
for use in multiple settings. The proposed study will examine the effectiveness of RQP with
a Latino population.

The Right Question Project (RQP) is a non-profit organization that works primarily with low-
and moderate-income communities with a history of disengagement from education, health care,
and other social services. The RQP approach differs from traditional models of client
empowerment in that instead of supplying clients with solutions to problems, the RQP gives
them a means to develop their own solutions. RQP teaches clients to identify important
issues, formulate questions, and devise plans to communicate and act in effective ways that
address factors impacting their health. The RQP methodology involves:

- establishing a set of beliefs, principles, and values about client involvement;

- teaching a skill-building technique that helps clients to think critically and ask the
"right" questions, leading to the answers they need; and

- giving clients a framework to create action plans and use their question-formulation
skills.

The RQP methodology is designed to build a permanent skill that clients can apply in health
care, as well as in other contexts that involve self-advocacy (e.g., getting better child
care). Thus far, implementation of the Right Question Project has shown that clients of any
education or literacy level can easily participate and benefit from the methodology's
three-step approach. RQP has been particularly successful in educational settings (Cohen,
1995).

The focus of the RQP health education module is to help patients learn how to formulate and
ask questions of their health care providers, in order to improve the quality of their care.
The Right Question Project, Inc. developed this protocol and trained staff at the Cambridge
Health Alliance (CHA) to conduct health education modules with psychiatry outpatients. The
pilot study uses a pre-post test design with two groups of 100 patients each from two
clinics that serve primarily Latino patients. The group at the CHA clinic will serve as the
"treatment" group. This group will receive the training modules and will be interviewed
about their experience in care. The group at the clinic at Massachusetts General Hospital
will serve as the "control" group. This group will be interviewed without first receiving
the training. Outcomes for the groups will be compared to look for an effect. If the RQP
training appears to have a positive affect on patients at CHA, then MGH patients will be
offered the RQP training. By testing the effectiveness of this educational module, we hope
to establish its usefulness as a means for the Cambridge Health Alliance to become even more
patient-centered and to assist in the integration and institutionalization of patient
empowerment/activation.

Inclusion Criteria:

- Must be a mental health outpatient at selected clinics

Exclusion Criteria:

- Unable to verbalize or take verbal direction

- Unable to sit still in one place to participate in education modules

- Potentially violent towards others