Table 1.

Study Design and Intervention Adaptations

Recruitment and Attrition Adaptations	Recruitment from community-based public primary care clinics Use of Spanish-speaking recruiters and study interviewers Telephone data collection Flexible scheduling of outcome interviews, including evening and weekend hours Study and intervention materials adapted for literacy, idiomatic, and cultural content Multiple (including evening and weekend) attempts to reach patient by study recruiters and interviewers Patient reimbursement for completing outcome interviews Transportation expenses covered when need indicated.
Provider and System Level Adaptations	Use of bilingual therapists with a master’s degree in social work as Depression Diabetes Care Specialist (DDCS) Brief training in cultural competency to all intervention staff via a self-administered cultural competence training manual Engagement of clinic medical and nursing staff in decision making about individual clinic needs and preferences Medical staff (e.g., primary care physicians, nursing staff, and diabetes nurses) received depression treatment training conducted by study psychiatrist and research staff Communication methods with intervention staff determined by PCPs Weekly clinical telephone conferences with study psychiatrist and DDCS Standardized depression measures (e.g., PHQ-9) used to monitor and guide treatment decisions Use of a clinical decision-making algorithm based on practice guidelines Supplemental patient navigation intervention to address known barriers to both diabetes and depression treatments and to facilitate receipt of supportive services Intense in person and/or telephone follow-up through remission and maintenance Provision of culturally competent PST Open-ended PST support group in English and Spanish during maintenance phase Computerized encrypted patient tracking system available to DDCS, PN, and psychiatrist
Patient Level Adaptations	Honored patients’ treatment preference for first line depression treatment Pre-therapy psycho-education sessions to dispel misconceptions about treatment, reduce stigma, and enhance therapeutic alliance Inclusion of family members in treatment if preferred by patient Health promotion messages linking depression to diabetes throughout treatments Individualized relapse prevention plan Linking PST problem-solving skills training to enhance diabetes and depression self-management and address socioeconomic stress All PST homework and educational materials consistent with literacy and idiomatic patient need