Still Climbin': A Randomized Controlled Trial of an Intervention to Improve Coping with Discrimination, Address Medical Mistrust, and Reduce Health Disparities among Black Sexual Minority Men

仍在攀登：一项旨在改善应对歧视、解决医疗不信任并减少黑人性少数群体健康差异的干预措施的随机对照试验

• 批准号: 10307134
• 负责人: Laura M Bogart
• 金额: $ 62.97万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-10 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10307134
• 关键词: Address; Age; Ambulatory Care; Black race; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Cognitive Therapy; Communities; Community prevention programs; Control Groups; Coping Skills; Discrimination; Disease; Effectiveness; Face; Goals; HIV; Health; Health Services Accessibility; Health behavior; Healthcare; Healthcare Systems; Healthy People 2020; Hypertension; Individual; Intervention; Intervention Trial; Knowledge; Lead; Mediator of activation protein; Medical; Medical Records; Minority Groups; Modeling; Names; Outcome; Participant; Premature Mortality; Prevention; Preventive care; Problem Solving; Provider; Race; Randomized; Randomized Controlled Trials; Recommendation; Reduce health disparities; Research; Sexually Transmitted Diseases; Social Identification; Societies; Stigmatization; Stress and Coping; Subgroup; Support Groups; Surveys; Testing; Treatment/Psychosocial Effects; Visit; Waiting Lists; Weather; Woman; Work; arm; barrier to care; base; biological adaptation to stress; biopsychosocial; black men; care outcomes; community setting; coping; design; ethnic minority; evidence base; flexibility; group intervention; health care disparity; health disparity; high risk men; improved; innovation; intervention effect; men; mortality; negative affect; perceived discrimination; physical conditioning; primary outcome; programs; racial and ethnic; recruit; resilience; response; sexual minority; sexual minority group; sexual minority health disparity; sexual minority men; social stigma; theories; unethical; willingness

PROJECT SUMMARY Black men, especially Black sexual minority men (SMM), are negatively affected by health and healthcare disparities: They show worse outcomes for preventable conditions and preventable complications from chronic conditions, and are less likely to engage with healthcare than are White men and women. Moreover, Black SMM display strikingly high rates of HIV and other sexually transmitted infections. Based on evidence-based theory that discrimination contributes meaningfully to disparities, we propose to conduct a randomized controlled trial (RCT) of an 8-session culturally congruent cognitive behavior therapy group intervention, Still Climbin’, which aims to increase effective coping responses to discrimination (from intersectional race and sexual minority identities) and reduce medical mistrust among Black SMM, with the goal of improving healthcare engagement and receipt of evidence-based preventive care. Still Climbin’ has a strong scientific basis in our prior pilot work, which found that the proposed intervention is acceptable to key stakeholders, feasible to conduct, and associated with improved effective coping. The specific aims are: (1) To conduct a randomized controlled trial to test the effects of Still Climbin', a culturally congruent cognitive behavior therapy group intervention, on healthcare engagement (e.g., at least one ambulatory visit in the past 6 months) and receipt of evidence-based preventive care (e.g., chronic disease screenings) among Black sexually minority men; (2) To examine mechanisms of the intervention’s effects on improved healthcare engagement and receipt of evidence-based preventive care, including more effective coping skills and reduced medical mistrust; and (3) To examine potential moderators of the intervention’s effects (e.g., age, HIV-serostatus and other health conditions). In the context of established community-academic partnerships, we will conduct the RCT with 300 Black SMM, randomizing 150 to the intervention group and 150 to a wait-list control group. Participants will complete surveys at baseline and 3-, 6-, and 12-months post-baseline to assess the primary outcomes, and potential mediators, covariates, and moderators. Healthcare engagement, receipt of evidence-based care, and health conditions will be verified with medical records. With the exception of our own work, we are not aware of any interventions that address coping with discrimination from intersectional identities in order to improve health outcomes among Black SMM. Our research is consistent with Healthy People 2020, which recommends developing interventions to address effects of discrimination among sexual minority individuals. Although structural-level interventions are critical for reducing societal discrimination as a long-term strategy, individual- level interventions—such as Still Climbin’—are needed in tandem to reduce discrimination’s immediate health effects.

项目概要 黑人男性，尤其是黑人性少数男性 (SMM)，受到健康和医疗保健的负面影响 差异：他们在可预防的疾病和可预防的慢性并发症方面表现出更差的结果 与白人男性和女性相比，他们不太可能参与医疗保健。 基于证据，SMM 显示艾滋病毒和其他性传播感染的发病率惊人地高。 理论认为歧视对差异有重大贡献，我们建议进行随机 为期 8 次的文化一致性认知行为治疗小组干预的对照试验 (RCT)，Still Climbin’，旨在提高对歧视（来自交叉种族和歧视）的有效应对反应 性少数群体身份）并减少黑人 SMM 之间的医疗不信任，目标是改善 Still Climbin 的医疗保健参与和基于证据的预防性护理具有很强的科学性。 我们之前的试点工作的基础，发现拟议的干预措施可以为主要利益相关者所接受， 可行且与改进有效应对措施相关的具体目标是： (1) 开展 随机对照试验测试 Still Climbin' 的效果，这是一种文化一致的认知行为疗法 团体干预、医疗保健参与（例如，过去 6 个月内至少一次门诊就诊）以及 黑人性少数群体接受循证预防性护理（例如慢性病筛查） 男性；(2) 研究干预措施对改善医疗保健参与和接受的影响机制 基于证据的预防性护理，包括更有效的应对技巧和减少医疗不信任；以及 (3) 检查干预效果的潜在调节因素（例如年龄、HIV 血清状态和其他健康状况） 在已建立的社区学术伙伴关系的背景下，我们将与 300 人进行随机对照试验。 Black SMM，将 150 名参与者随机分配到干预组，将 150 名参与者随机分配到候补名单对照组。 完成基线以及基线后 3、6 和 12 个月的调查，以评估主要结果，以及 潜在的中介变量、协变量和调节变量。医疗保健参与、接受循证护理以及 健康状况将通过医疗记录进行核实，除了我们自己的工作外，我们不知道。 任何旨在应对交叉身份歧视的干预措施，以改善 我们的研究与健康人群 2020 的建议一致。 制定干预措施以解决性少数群体中歧视的影响。 作为一项长期战略，结构层面的干预措施对于减少社会歧视至关重要。 需要同时采取各种水平的干预措施，例如“Still Climbin”，以减少歧视的直接健康 影响。