Development of an Online Provider Intervention to Address Intersectional Stigma and Medical Mistrust in People Living with HIV
制定在线提供者干预措施,以解决艾滋病毒感染者的跨部门耻辱和医疗不信任问题
基本信息
- 批准号:10375585
- 负责人:
- 金额:$ 22.52万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-05-01 至 2024-03-31
- 项目状态:已结题
- 来源:
- 关键词:AIDS preventionAIDS/HIV problemAddressAdherenceAmericanBlack raceCaringClinicalCodeCognitive TherapyCommunitiesCompetenceControl GroupsCounselingDevelopmentDiscriminationDissemination and ImplementationFeedbackFundingHIVHIV InfectionsHealthHealth PersonnelHealth behavior outcomesHealthcareIncidenceIndividualInterventionKnowledgeLatinxMediatingMedicalMental disordersMethodsOutcomePatient CarePatientsPersonsPhysiciansPilot ProjectsProviderRandomizedRandomized Controlled TrialsReduce health disparitiesReportingResearchResearch PriorityRiskScienceScientific Advances and AccomplishmentsSexismStructureTestingTrainingTreatment outcomeTrustUnited States National Institutes of HealthViral Load resultWorkacceptability and feasibilityantiretroviral therapybasebehavior changeblack patientcare deliverycare providerscare systemsclinical practiceethnic health disparityethnic minorityevidence baseexperienceexplicit biasfeasibility testingfollow-uphealth disparityimplementation effortsimplicit biasimprovedintersectionalitymeetingsmenmotivational enhancement therapyonline interventionperceived discriminationpost interventionprevention serviceprocess evaluationprovider interventionpsychoeducationracial and ethnicracismrecruitresponseservice deliverysexual minoritysexual minority menskillsskills trainingsocial stigmasubstance usetherapy adherencetreatment adherencetreatment as usualusability
项目摘要
PROJECT SUMMARY/ABSTRACT
Intersectional stigma and discrimination are key contributors to health disparities, including in HIV care, in
Black and Latinx communities. As a result of historical and ongoing stigma and discrimination in the U.S.,
medical mistrust is highly prevalent in Black and Latinx communities, including those living with HIV, and
contributes to low care engagement, treatment nonadherence, and poor health outcomes. However, no
evidence-based provider intervention is available for providers to gain knowledge and skills to address
intersectional stigma and medical mistrust with patients. This study responds to the call in RFA-DA-21-001 to
“reduce the impact of intersectional stigma and strengthen the provision and utilization of HIV prevention or
care services,” by developing an intervention for HIV care providers working with individuals who experience
intersectional stigma and discrimination. The proposed intervention has the potential to improve providers’
competence to address the impact of intersectional stigma and medical mistrust with patients, which may in
turn improve patient’s healthcare engagement, treatment adherence, and health outcomes. Aim 1 involves
developing an online provider intervention for HIV care providers to gain knowledge and skills to address the
impact of experiencing intersectional stigma and discrimination, with particular focus on medical mistrust, using
input from key community stakeholders, including HIV providers and patients from Black and Latinx
communities. The intervention will include psychoeducation on the impact of intersectionality and medical
mistrust on patients as well as skills training to address these issues based on principles of motivational
interviewing (MI), cognitive behavior therapy (CBT), and the science of behavior change. We will engage
community stakeholders to provide feedback on the intervention content. The context of the intervention will be
online, and we will work with a provider training center partner to develop the online platform and conduct a
usability test in 10 HIV care physicians. Aim 2 involves conducting a pilot randomized controlled trial in 80
physicians providing care for patients at risk or living with HIV to test the intervention (n = 40) against a no-
treatment control group (n = 40). Provider training outcomes will include providers’ use of skills learned in the
intervention (e.g., MI-consistent statements) to address intersectional stigma and medical mistrust using
hypothetical patient scenarios, and provider-reported HIV service delivery outcomes. Outcomes will be
assessed at baseline, immediately post-intervention, and at 12-month follow-up. A mixed-method process
evaluation will be conducted at post-intervention to assess acceptability, feasibility, and appropriateness of the
online intervention. Results from this study have the potential to significantly advance scientific knowledge and
clinical practice regarding addressing intersectional stigma and medical mistrust at the provider-level with
patients from Black and Latinx communities as a way to reduce HIV-related disparities.
项目摘要/摘要
跨部门的耻辱和歧视是造成健康差距的关键因素,包括在#年艾滋病毒护理方面
黑人和拉丁裔社区。由于美国历史上和正在进行的污名和歧视,
医疗不信任在黑人和拉丁裔社区非常普遍,包括那些感染艾滋病毒的社区,以及
导致护理参与度低、治疗不依从性和健康结果差。然而,没有
以证据为基础的提供者干预可供提供者获取知识和技能来解决
对患者的跨部门污名和医疗不信任。这项研究响应了RFA-DA-21-001中的呼吁
“减少跨部门污名的影响,加强提供和利用艾滋病毒预防或
护理服务,通过为艾滋病毒护理提供者开发干预措施,帮助那些经历过
跨部门的污名和歧视。拟议的干预措施有可能改善供应商的
处理跨部门耻辱和对患者的医疗不信任的影响的能力,这可能在
进而提高患者的医疗参与度、治疗依从性和健康结果。目标1涉及
为艾滋病毒护理人员开发在线干预服务,以获取知识和技能来解决
经历跨部门污名和歧视的影响,特别侧重于医疗不信任,使用
来自主要社区利益攸关方的意见,包括艾滋病毒提供者和来自黑人和拉丁裔的患者
社区。干预将包括关于交叉性的影响的心理教育和医学
对病人的不信任以及基于激励原则解决这些问题的技能培训
访谈(MI)、认知行为疗法(CBT)和行为改变科学。我们将与
社区利益相关者就干预内容提供反馈。干预的背景将是
在线,我们将与提供商培训中心合作伙伴合作开发在线平台并进行
在10名HIV护理医生中进行可用性测试。目标2涉及在80个月内进行一项试点随机对照试验
为高危患者或艾滋病毒携带者提供护理的医生测试干预措施(n=40),以防止
治疗对照组40例。提供商培训结果将包括提供商使用在
干预(例如,MI一致的声明),以解决跨部门污名和医疗不信任问题
假想的患者情景,以及提供者报告的艾滋病毒服务交付结果。结果将是
在基线、干预后即刻和12个月随访时进行评估。一种混合方法过程
将在干预后进行评估,以评估可接受性、可行性和适当性
在线干预。这项研究的结果有可能显著提高科学知识和
关于在提供者层面解决跨部门污名和医疗不信任的临床实践
来自黑人和拉丁裔社区的患者,以此作为减少艾滋病毒相关差异的一种方式。
项目成果
期刊论文数量(0)
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{{ truncateString('Lu Dong', 18)}}的其他基金
Development of an Online Provider Intervention to Address Intersectional Stigma and Medical Mistrust in People Living with HIV
制定在线提供者干预措施,以解决艾滋病毒感染者的跨部门耻辱和医疗不信任问题
- 批准号:
10584495 - 财政年份:2021
- 资助金额:
$ 22.52万 - 项目类别: