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

仍在攀登：一项旨在改善应对歧视、解决医疗不信任并减少黑人性少数群体健康差异的干预措施的随机对照试验

• 批准号: 10524016
• 负责人: Laura M Bogart
• 金额: $ 40.76万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-10 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10524016
• 关键词: Address; Age; Ambulatory Care; Black race; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Cognitive Therapy; Communication; Communities; Community prevention programs; Control Groups; Coping Skills; Discrimination; Disease; Disparity; Effectiveness; Ethnic Population; Face; Goals; HIV; Health; Health Services Accessibility; Health behavior; Healthcare; Healthcare Systems; Healthy People 2020; Hypertension; Individual; Intervention; Intervention Trial; Knowledge; Mediator; Medical; Medical Records; Minority Groups; Modeling; Names; Outcome; Participant; Premature Mortality; Prevention; Preventive care; Problem Solving; Provider; Race; Randomized; Randomized, Controlled Trials; Recommendation; Reduce health disparities; Research; Sexually Transmitted Diseases; Social Identification; Societies; Stigmatization; Stress and Coping; Support Groups; Surveys; Testing; Treatment/Psychosocial Effects; Visit; Waiting Lists; Weather; Woman; Work; arm; barrier to care; biological adaptation to stress; biopsychosocial; black men; care outcomes; community setting; coping; design; ethnic minority; evidence base; flexibility; group intervention; health assessment; health care disparity; health disparity; high risk men; improved; innovation; intervention effect; men; mortality; negative affect; perceived discrimination; physical conditioning; poor health outcome; primary outcome; programs; racial minority; recruit; resilience; response; screening; sexual minority; sexual minority group; sexual minority health; sexual minority men; social stigma; theories; unethical; willingness

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.

项目总结 黑人男性，特别是黑人性少数男性(SMM)，受到健康和医疗保健的负面影响 差异：对于可预防的疾病和慢性疾病的可预防并发症，它们显示出更差的结果 与白人男性和女性相比，他们更不可能从事医疗保健工作。此外，布莱克 SMM显示艾滋病毒和其他性传播感染的比率惊人地高。以循证为基础 歧视对差异有意义的理论，我们建议进行一项随机的 文化一致性认知行为疗法团体干预的8个疗程的对照试验 《攀登》，其目的是增加对歧视的有效应对反应(来自跨部门种族和 性少数认同)，减少黑人SMM在医疗方面的不信任，目的是改善 医疗保健参与度和接受循证预防护理。尽管如此，科尔宾还是有很强的科学性 在我们之前的试点工作的基础上，我们发现拟议的干预措施是主要利益攸关方可以接受的， 可行的，并与改进的有效应对相关联。具体目标是：(1)开展一项 一种文化上一致的认知行为疗法--静止登山术的疗效的随机对照试验 团体干预，保健参与(例如，在过去6个月中至少进行了一次门诊访问)和 在性少数黑人中接受循证预防护理(例如慢性病筛查) 男性；(2)检查干预对改善医疗服务参与度和接受度的影响机制 基于证据的预防护理，包括更有效的应对技能和减少医疗不信任；和(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人进行区域合作 黑人SMM，随机将150人分配给干预组，150人分配给等待名单对照组。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，以评估主要结果；以及 潜在的中介者、协变量和协调者。医疗保健参与度、接受循证护理，以及 健康状况将通过医疗记录进行核实。除了我们自己的工作，我们不知道 任何应对跨界别身份歧视的干预措施，以改善 黑人SMM的健康状况。我们的研究与《健康人2020》是一致的，它建议 制定干预措施，以解决性别少数个人中歧视的影响。虽然 作为一项长期战略，结构性干预对于减少社会歧视至关重要，个人-- 需要采取措施--如“静止的攀登”--来减少歧视的直接健康 效果。