Continuing the Conversation: A Multi-site RCT Using Narrative Communication to Support Hypertension Self-Management among African-American Veterans

继续对话：利用叙事沟通支持非裔美国退伍军人高血压自我管理的多中心随机对照试验

• 批准号: 10800641
• 负责人: Sarah LeLeiko Cutrona
• 金额: --
• 依托单位: EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2023-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10800641
• 关键词: Address; Adoption; African American; African American population; Area; Back; Behavior; Behavioral; Blood Pressure; Cardiovascular system; Characteristics; Clinic Visits; Clinical; Cognitive; Collaborations; Communication; Complication; Cost Analysis; Decision Making; Development; Diastolic blood pressure; Disparity; Education; Effectiveness; Electronic Health Record; Emotional; Enrollment; Equitable healthcare; Ethnic Population; Funding; Gender; Goals; Healthcare; High Prevalence; Hypertension; Intention; Intervention; Leadership; Life; Life Style; Light; Literature; Maintenance; Massachusetts; Measures; Mediating; Medical; Methods; Morbidity - disease rate; Motivation; Not Hispanic or Latino; Outcome; Participant; Periodicals; Persons; Positioning Attribute; Prevalence; Process; Proliferating; Provider; Race; Randomized; Randomized, Controlled Trials; Research; Risk; Sampling; Self Efficacy; Self Management; Site; Stratification; System; Technology; Testing; Text; Text Messaging; Touch sensation; Transcript; Translating; United States National Institutes of Health; Universities; Veterans; Video Recording; Vulnerable Populations; Work; comparison control; comparison group; comparison intervention; connected care; design; early onset; experience; follow-up; group intervention; health communication; health disparity; health equity; high risk; hypertension control; hypertensive; improved; informatics tool; innovation; intervention cost; mortality; novel; participant enrollment; patient engagement; peer; primary outcome; racial population; randomized trial; recruit; response; theories; tool

Background: In response to the VA HSR&D Healthcare Equity and Health Disparities major priority domain, we propose Continuing the Conversation, an RCT testing use of narrative communication to support and sustain hypertension (HTN) self-management among African-American Veterans. Compared to other racial and ethnic groups, non-Hispanic African Americans have an earlier onset and higher prevalence of HTN as well as a disproportionately higher risk of complications, leading to higher rates of cardiovascular morbidity and mortality. In previous work, we used storytelling in African Americans outside the VA, yielding significant improvements in blood pressure. We translated these findings to the VA, developing and testing video-recorded Veteran narratives which we showed to African- American Veterans. We demonstrated significant differences in intention to change HTN management behavior immediately after video viewing; however, effects on blood pressure were not sustained, and six-month outcomes revealed only modest benefit over control (p = 0.06). Our findings highlight the need for longitudinal support to sustain the storytelling effect. Our proposed study provides longitudinal support via text messages, incorporating content from the participant’s chosen peer narrative as a means of sustaining motivation and engagement in HTN self-management. Innovativeness: Despite the proliferation of texting studies in the medical literature, very few have been rigorous randomized trials. African-Americans have been under-represented in technology-assisted interventions, and trials using texting for HTN self-management in Veterans have not been conducted. Our proposal, “Continuing the Conversation,” is a novel integration of peer narrative communication into technology. While use of an informatics tools (texting) as a channel to support self-management is not novel per se, the extension of a narrative via longitudinal texting is an innovative mechanism for supporting and sustaining HTN self-management behaviors. Our Specific aims include: Aim 1. Refine and Pilot the Continuing the Conversation (CTC) intervention. Previously, we created video-recorded stories told by African-American Veterans with HTN, describing their self-management strategies. We will refine CTC by adapting content from these videos to create narrative-aligned texts and we will pilot CTC. Aim 2. Test CTC by conducting a randomized controlled trial. CTC ‘begins the conversation’ by showing Veteran Story videos to participants, then inviting participants to select a preferred narrative. We then ‘continue the conversation,’ offering longitudinal support via 6 months of narrative-aligned text messages. Messages cover key HTN content, providing education, reminders and weekly assessments, and include quotations derived from the chosen narrative. Control participants receive weekly assessment texts addressing the same key HTN self-management behaviors. Aim 3. Evaluate CTC effectiveness, and mediating factors, and conduct a cost analysis. We hypothesize that, for the CTC Intervention group as compared to the control: (H1)the difference in blood pressure from baseline to 6 months (primary outcome) will favor CTC intervention compared with the change in control. (H2): Self-efficacy and HTN management behaviors during 6-month follow-up will be greater for those in the CTC intervention group than control. Methods: In a randomized controlled trial, 600 African-American Veterans with poorly controlled HTN will be recruited from 2 VA healthcare sites with known disparities in HTN control. We will use within-site randomization (CTC vs. Control). Outcomes will include blood pressure, self-efficacy and HTN management behaviors. Longitudinal texts are designed to bring the storyteller back into the Veteran’s everyday life, reminding and reinforcing as our Veterans engage in the numerous daily decisions that will impact their blood pressure and their lives. Incorporating peer content into text messages in this way is highly innovative and offers a promising approach to supporting our Veterans. Next Steps: During and following this trial, we will provide materials to our operational partner, the Office of Connected Care (OCC), for presentations to National Leadership Council including to VISN Directors and also explore other avenues for dissemination. We will work with OCC to create an Electronic Health Record-based referral tool to encourage clinical teams to enroll patients and will explore mechanisms by which Veterans can initiate the request for enrollment.

背景：响应VA HSR＆D Healthcare公平与健康差异主要优先领域，我们 提案继续对话，RCT测试叙事交流以支持和维持 非裔美国退伍军人之间的高血压（HTN）自我管理。与其他种族和种族相比 非西班牙裔美国人的发病率和较高的HTN患病率和不成比例 并发症的风险更高，导致心血管发病率和死亡率较高。在以前的工作中，我们使用了 弗吉尼亚州以外的非洲裔美国人讲故事，使血压有了重大改善。我们翻译了 这些发现向VA，开发和测试了我们向非洲展示的视频录制的资深叙事 - 美国退伍军人。我们在改变HTN管理行为的意图上表现出显着差异 视频观看后立即进行；但是，对血压的影响尚未持续，六个月的结果 仅揭示了对控制的适度益处（p = 0.06）。我们的发现凸显了需要纵向支持以维持 讲故事的效果。我们提出的研究通过文本消息提供了纵向支持，并结合了 参加者选择的同伴叙事是维持HTN自我管理中动机和参与的一种手段。 创新性：尽管医学文献中发短信研究的泛滥，但很少有严格 随机试验。非裔美国人在技术辅助干预措施中的代表性不足，并使用 尚未进行HTN自我管理的短信。我们的建议“继续对话”是 同伴叙事交流与技术的新颖集成。在使用信息工具（短信）的同时 支持自我管理的渠道本身并不是新颖的，通过纵向发短信的叙事延伸是一个 支持和维持HTN自我管理行为的创新机制。我们的具体目的包括： 目标1。完善并驾驶继续对话（CTC）干预。以前，我们创建了视频记录 非裔美国退伍军人用HTN讲述的故事，描述了他们的自我管理策略。我们将通过 从这些视频中调整内容以创建与叙事统一的文本，我们将驾驶CTC。 AIM 2。通过进行随机对照试验测试CTC。 CTC通过展示退伍军人的故事来“开始对话” 给参与者的视频，然后邀请参与者选择首选叙述。然后我们“继续对话” 通过6个月的叙事一致文本消息提供纵向支持。消息涵盖密钥HTN内容， 提供教育，提醒和每周评估，并包括从所选叙述中得出的引文。 控制参与者每周收到针对相同关键HTN自我管理行为的评估文本。 目标3。评估CTC有效性和中介因素，并进行成本分析。我们假设这是CTC 干预组与对照组相比：（H1）基线到6个月的血压差异（主要 与控制变化相比，结果将有利于CTC干预。 （H2）：自我效能和HTN管理 对于CTC干预组中的6个月随访期间的行为将比对照组更大。 方法：在一项随机对照试验中，将招募600名非裔美国退伍军人的退伍军人 来自HTN控制中已知差异的2个VA医疗保健站点。我们将使用现场随机化（CTC VS。 控制）。结果将包括血压，自我效能感和HTN管理行为。纵向文本是 旨在将讲故事的人带回退伍军人的日常生活中，在我们的退伍军人互动时提醒和加强 在众多日常决定中，会影响他们的血压和生活。将同伴内容纳入文本 以这种方式的消息具有很高的创新性，并为支持我们的退伍军人提供了有希望的方法。 下一步：在此试验期间和之后，我们将向我们的运营合作伙伴，连接办公室提供材料 护理（OCC），向包括VISN董事在内的国家领导委员会介绍，并探索其他途径 进行传播。我们将与OCC合作创建一个基于电子健康记录的推荐工具，以鼓励临床 参加患者的团队，并将探索退伍军人可以发起入学请求的机制。

项目成果

Incorporating African American Veterans' Success Stories for Hypertension Management: Developing a Behavioral Support Texting Protocol.

• DOI: 10.2196/29423
• 发表时间: 2021-12-01
• 期刊: JMIR research protocols
• 影响因子: 1.7
• 作者: DeLaughter KL;Fix GM;McDannold SE;Pope C;Bokhour BG;Shimada SL;Calloway R;Gordon HS;Long JA;Miano DA;Cutrona SL
• 通讯作者: Cutrona SL