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

项目摘要 黑人男性，特别是黑人性少数群体男性（SMM），受到健康和医疗保健的负面影响 差异：他们显示出可预防的疾病和可预防的慢性并发症的结果更差。 条件，并且不太可能比白色男性和女性参与医疗保健。而且黑 SMM显示出艾滋病毒和其他性传播感染的高比率。基于循证 理论认为，歧视有助于有意义的差距，我们建议进行随机 一项为期8个疗程的文化一致性认知行为治疗组干预的对照试验（RCT）， 攀登“，旨在提高对歧视的有效应对措施（来自交叉种族和 性少数群体身份），并减少黑人SMM之间的医疗不信任，目的是改善 保健参与和接受循证预防保健。仍然攀登有很强的科学性 在我们先前试点工作的基础上，发现拟议的干预措施是关键利益攸关方可以接受的， 可行的，并与改善有效的应对。具体目标是：（1）开展 一项随机对照试验，以测试“仍然攀登”的效果，一种文化一致的认知行为疗法 小组干预，对医疗保健的参与（例如，在过去6个月内至少有一次门诊访视），以及 接受循证预防护理（例如，慢性疾病筛查） 男性;（2）检查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能和减少医疗不信任;以及（3） 检查干预效果的潜在调节因素（例如，年龄、艾滋病毒血清状况和其他健康状况 条件）。在已建立的社区-学术伙伴关系的背景下，我们将与300名 黑色SMM，随机分配150人到干预组，150人到等待名单对照组。参与者将 在基线和基线后3个月、6个月和12个月完成调查，以评估主要结局，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 将通过医疗记录核实健康状况。除了我们自己的工作，我们不知道 采取任何干预措施，解决来自交叉身份的歧视，以改善 黑人SMM的健康状况。我们的研究与《健康人群2020》一致，该研究建议 制定干预措施，以解决性少数群体中歧视的影响。虽然 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， 为了减少歧视的直接健康，需要同时进行水平干预，如“仍在攀登” 方面的影响.

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.