Mechanisms of Action in AWARE: A Culturally Informed Intervention for 1.5- and 2nd-Generation Asian American Women

Young Asian American women have high rates of depression and suicidality; however, few interventions address the urgent need for culturally informed care. Asian Women's Action for Resilience and Empowerment (AWARE) aims to be the first gender and culturally specific group psychotherapy intervention designed to improve mental and sexual health in Asian American women with trauma. This article specifically focuses on identifying the mechanisms of action that were responsible for improving mental health and well-being among those who participated in AWARE randomized controlled trial. Of the 435 women screened for the study, 63 Chinese, Korean, and Vietnamese women with histories of interpersonal violence were randomized into either the intervention (n = 32) or waitlist control groups (n = 31). Data from 16 posttrial focus group sessions were then thematically analyzed to explore the key themes and mechanisms of action of the AWARE intervention. Analysis revealed four cultural mechanisms that facilitated mental health improvements: psychoeducation on disempowering parenting, the reduction of mental illness-related stigma, community and relational building, and a heightened sense of empowerment. Results suggest that the AWARE intervention fosters Asian American women's well-being on an individual level and encourages social engagement through culturally salient messages. Women in the study were able to expand their social support network, engage in activism, and develop an empowered connection to their community. Public Policy Relevance Statement Young Asian American women are at high risk for depression and suicide, but few have access to culturally informed treatments. This efficacy study of the AWARE intervention suggests that positive outcomes may be mediated by cultural factors like destigmatization, cultural psychoeducation, community building, and empowerment.