Using values affirmation to reduce the effects of perceived discrimination on hypertension disparities

利用价值观肯定来减少感知歧视对高血压差异的影响

• 批准号: 9330926
• 负责人: Stacie Luther Daugherty
• 金额: $ 75.14万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-15 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9330926
• 关键词: Adherence; Adoption; African American; Antihypertensive Agents; Attitude; Behavior; Behavior Control; Blood Pressure; Cardiovascular system; Caring; Characteristics; Clinic; Clinic Visits; Clinical; Colorado; Communication; Control Groups; Discrimination; District of Columbia; Effectiveness; Emotions; Exercise; Family; Foundations; Frequencies; Fright; Goals; Health; Health system; Healthcare; High Prevalence; Hypertension; Individual; Integrated Health Care Systems; Intervention; Link; Maintenance; Maryland; Measures; Mediating; Medical; Minority; Outcome; Patients; Perception; Pharmaceutical Preparations; Pilot Projects; Population; Primary Health Care; Provider; Race; Randomized; Randomized Controlled Trials; Religion; Reporting; Research; Resources; Self Efficacy; Source; Training; Visit; Work; Writing; base; blood pressure regulation; caucasian American; compliance behavior; disability; disparity reduction; experience; health care disparity; health disparity; improved; innovation; intervention effect; medication compliance; novel; primary outcome; racial bias; racial discrimination; racial disparity; secondary outcome; social norm; socioeconomics; theories; trial comparing

PROJECT SUMMARY / ABSTRACT Over 80% of African Americans report experiences of discrimination in the past year; perceived discrimination is linked to health disparities including poor adherence. Poor adherence may contribute to the high prevalence of uncontrolled hypertension in African Americans. We propose an innovative approach using values affirmation to overcome the threat of discrimination to increase patient activation, improve adherence and thereby reduce disparities in hypertension outcomes. Our proposal is based upon our pilot study demonstrating a brief values affirmation exercise done immediately before a clinic visit resulted in improved communication between African American patients and providers during the visit and suggested improved medication adherence 6-months after the visit. We propose to advance our prior work and fill gaps in the evidence by conducting a randomized controlled trial comparing a values affirmation exercise to a control exercise among 1100 patients with hypertension from three health systems. The primary outcome is 6-month change in adherence to antihypertensive therapies with the secondary outcome of change in blood pressure. We will also explore possible mechanisms of the intervention effect and formally evaluate for dissemination.  In aim 1, we will compare the effects of the values affirmation exercise to a control exercise on antihypertensive medication adherence in African American patients across three clinical settings. We hypothesize patients randomized to values affirmation will have greater adherence change at 6-months compared to controls and the effect will be partially moderated by patient factors (prior experiences of discrimination), independent of provider factors (implicit racial bias, past disparities training, self- efficacy caring for minority patients) and mediated by patient activation.  In aim 2, we will compare the effects of values affirmation exercise in African American patients to its effects in white patients with hypertension. We hypothesize that values affirmation will improve adherence to a greater degree in African American patients suggesting the intervention is targeting perceived discrimination related to race.  In aim 3, we will formally evaluate the intervention for widespread dissemination using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. We hypothesize the intervention will have favorable characteristics for widespread dissemination within primary care. The project is innovative, as it will use a novel intervention that has not been widely applied in the healthcare setting. Since values affirmation is not specific to hypertension or African Americans, this study will be the first to provide evidence for a low-resource intervention that has the potential to reduce healthcare disparities across a wide range of health care conditions and populations.

项目概要/摘要 超过 80% 的非裔美国人表示在过去一年中遭受过歧视； 歧视与健康差异有关，包括依从性差可能会导致健康差异。 非洲裔美国人未控制的高血压患病率很高，我们提出了一种创新方法。 价值观肯定，克服歧视的威胁，增加患者的积极性，提高依从性 从而减少高血压结果的差异。我们的建议是基于我们的试点研究。 展示在就诊前立即进行的简短价值观肯定练习，结果有所改善 非裔美国患者和医疗服务提供者在访问期间进行沟通并提出改进建议 访视后 6 个月的药物依从性 我们建议推进我们之前的工作并填补之前的空白。 通过进行随机对照试验将价值观肯定练习与对照进行比较来提供证据 对来自三个卫生系统的 1100 名高血压患者进行了锻炼，主要结果是 6 个月。 抗高血压治疗依从性的改变以及血压变化的次要结果。 我们还将探讨干预效果的可能机制并正式评估以进行传播。  在目标 1 中，我们将比较价值观肯定练习与控制练习的效果 我们在三种临床环境中观察非裔美国患者的抗高血压药物依从性。 随机接受价值观肯定的患者在 6 个月时会有更大的依从性变化 与对照组相比，效果将部分受到患者因素的调节（患者的先前经验） 歧视），独立于提供者因素（隐性种族偏见、过去的差异培训、自我 功效护理少数民族患者）并由患者激活介导。  在目标 2 中，我们将比较非裔美国患者的价值观肯定运动及其效果 我们勇敢地承认价值观肯定会改善白人高血压患者的效果。 非裔美国患者的依从性更高，表明干预措施的目标是 感知到的与种族有关的歧视。  在目标 3 中，我们将使用 RE-AIM 正式评估干预措施以进行广泛传播 （范围、有效性、采用、实施和维护）框架。 干预措施将具有在初级保健中广泛传播的有利特征。 该项目具有创新性，因为它将使用一种尚未广泛应用的新颖干预措施 由于价值观肯定并非针对高血压或非裔美国人，因此本研究将 成为第一个为有可能减少医疗保健的低资源干预提供证据的人 各种医疗保健条件和人群之间存在差异。