DO TELL - Digitized Stories to Bridge the Gap Between Patient and Provider Perceptions of Disease Self-Management Challenges

项目摘要 老年非裔美国人在慢性病自我管理(CCSM)方面的差异导致 很大程度上是由于他们在CCSM中面临的复杂挑战，以及医生对和/或理解不足 对这些挑战的同理心。为了帮助年长的非裔美国人优化CCSM，他们必须 至少对患者面临的复杂而独特的CCSM挑战有更好的理解。 病人的故事越来越多地被用来促进知识共享、理解和反思 在不同群体中倾听，以及在CCSM患者中培养成功的行为改变。 然而，病人的故事还没有被用来促进医生对生活的理解 与CCSM抗争的老年非裔美国患者的情况。要发展出一个有效的故事 然而，对于大规模使用的方法，我们首先需要更好地了解CCSM在 老年非裔美国人，如何将这种经历转化为医学教育的故事，以及如何 这样的故事对增进医生的理解和改善护理有没有作用。这些步骤是必要的 改进老年非裔美国患者的CCSM实践。拟议研究的长期目标 目的是(1)通过创建和管理一个经过验证的数字CCSM故事库来解决这些知识差距 有效地加强了医生之间的理解和护理互动；以及(2) 在CCSM和少数族裔老龄化的交汇点上保持对相关研究的参与 职业治疗专业本科生和教职员工。拟议的R15研究的具体目标是 (1)收集和分析年长非裔美国人的个人故事，并将其转化为数字叙事 (视频)反映他们面临的最重要的CCSM挑战，以及(2)评估一致性 故事内容与医学生对故事的理解之间的关系。为了实现目标1，我们将进行 焦点小组(n=6，每个5-8人)收集老年非裔美国人对CCSM的叙事性描述 挑战。我们将对这些叙事数据进行分析，以确定其核心维度和修辞结构。 这一叙述内容和结构将由一个专家小组(包括年长的非裔美国人)验证。 然后翻译成由年长的非裔美国人上演的简短视频故事。为了实现目标2，我们将使用 对医学生进行问卷调查和认知访谈(观看视频后)以确定他们的 对故事内容的理解以及可能解释理解差异的因素。AIM 2分析 将重点考察故事和学生理解之间的符合率，以及相互关系 一致性和可以解释其差异的变量之间的关系，例如故事维度、学生 民族/种族，以及同理心得分。对问卷和认知访谈数据的开放式回答 将通过分析进一步了解医学生的理解模式及其潜在原因。

Project Summary Disparities in chronic condition self-management (CCSM) experienced by older African Americans stem, to a significant degree, from their complex challenges in CCSM and physicians' poor understanding of and/or empathy for those challenges. For physicians to assist older African Americans to optimize CCSM, they must have at least a better understanding of the complex and unique CCSM challenges faced by their patients. Patients' stories have been used increasingly to promote knowledge sharing, understanding, and reflective listening across diverse groups, as well as to foster successful behavior change among CCSM patients. However, patients' stories have not yet been used to promote physicians' understanding of the life circumstances of older African American patients who struggle with CCSM. To develop an effective story approach for large-scale use, however, we first need to better understand the experience of CCSM among older African Americans, how that experience can be translated into stories for medical education, and how such stories work or not to enhance physician understanding and improve care. Those steps are necessary to improve CCSM practice with older African American patients. The long-term goals of the proposed research are to (1) address these gaps in knowledge by creating and curating a library of validated digital CCSM stories of older African Americans that effectively enhance physicians' understanding and care interactions; and (2) sustain engagement in related research at the intersection of CCSM and minority aging by graduate and undergraduate occupational therapy students and faculty. The specific aims of the proposed R15 study are to (1) collect and analyze personal stories from older African Americans and transform them into digital narratives (videos) that reflect the most important CCSM challenges they face, and to (2) evaluate the concordance between story content and medical students' understanding of the stories. To address Aim 1 we will conduct focus groups (n = 6, 5-8 participants each) to collect older African Americans' narrative descriptions of CCSM challenges. We will analyze those narrative data to determine their core dimensions and rhetorical structure. That narrative content and structure will be validated by an expert panel (including older African Americans) and then translated into brief video stories enacted by older African Americans. To achieve Aim 2, we will use questionnaires and cognitive interviews with medical students (after video viewing) to determine their understanding of story content as well as factors that may explain variations in understanding. Aim 2 analysis will focus on examining rates of concordance between story and student understanding, and correlations between concordance and variables that could account for its variation, such as story dimensions, student ethnicity/race, and empathy scores. Open-ended responses on the questionnaire and cognitive interview data will be analyzed to further understand patterns in medical student understanding and their potential causes.