Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial
Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial
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DOI：
10.2196/12498
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发表时间：
2019-03-01
影响因子：
1.7
通讯作者：
Havranek, Edward P.
中科院分区：
文献类型：
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作者：
Daugherty, Stacie L.;Vupputuri, Suma;Havranek, Edward P.
背景：药物不依从是导致高血压未得到控制的一个重要且可改变的因素。刻板印象威胁可能通过阻碍患者在临床诊疗过程中积极参与的能力，导致依从性的种族差异，从而降低患者坚持按规定治疗的积极性。
目的：高血压与价值观（HYVALUE）试验旨在检验一种价值观肯定干预措施是否通过针对种族刻板印象威胁来提高药物依从性（主要结局）。
方法：HYVALUE试验是一项患者层面的、设盲的随机对照试验，在患有未控制高血压的黑人和白人患者中，比较一种简短的价值观肯定写作练习与一种对照写作练习。我们正在从美国的3个大型医疗系统招募患者。主要结局是患者对降压药物的依从性，次要结局包括随时间推移的收缩压和舒张压、血压得到控制的时间以及治疗强化情况。我们正在比较该干预措施在黑人和白人中的效果，探索干预对结局影响的可能调节因素（即患者先前的歧视经历和临床医生的种族偏见）和中介因素（即患者的积极性）。
结果：本研究由美国国家心肺血液研究所资助。招募和随访正在进行中，预计2020年末开始数据分析。计划招募1130名患者。基于在教育环境中支持价值观肯定有效性的证据以及我们的初步研究表明患者 - 临床医生沟通得到改善，我们假设价值观肯定会打破刻板印象威胁对临床互动的负面影响，并能减少药物依从性和后续健康结局方面的种族差异。
结论：HYVALUE研究超越了对基于种族的健康差异的记录，转向对一种干预措施进行检验。我们关注一种疾病——高血压，它可以说是导致黑人患者死亡率差异的最大因素。如果成功，这项研究将首次为一种低资源干预措施提供证据，该措施有可能在广泛的医疗状况和人群中大幅减少医疗保健差异。
Background: Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient's ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies.Objective: The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat.Methods: The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients' adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients' prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes.Results: This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes.Conclusions: The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition-hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations.