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.

项目摘要 黑人，尤其是黑人性少数民族（SMM），受健康和医疗保健的负面影响 差异：对于可预防的条件和可预防的并发症，它们的结果较差 与白人男人和女人相比，条件，与医疗保健互动的可能性较小。而且，黑色 SMM表现出惊人的艾滋病毒和其他性传播感染率。基于证据 歧视对差异有意义的理论，我们建议进行随机的 8条经验文化的对照试验（RCT） 攀登’，旨在增加对歧视的有效应对响应（从交叉种族和 性少数人身份）并减少黑人SMM中的医疗不信任，目的是改善 医疗保健参与并获得基于证据的预防保健。仍然攀爬有很强的科学 在我们先前的飞行员工作中的基础，发现拟议的干预措施是主要利益相关者可以接受的 可行的行为，并与改善有效应对有关。具体目的是：（1）进行 随机对照试验测试静态攀岩的影响，这是一种文化上一致的认知行为疗法 小组干预，医疗保健参与（例如，在过去6个月中至少进行一次卧床访问）和 在黑人性少数群体中，接收基于证据的预防保健（例如，慢性病筛查） 男人（2）检查干预措施对改善医疗保健参与和收据的影响的机制 基于证据的预防性护理，包括更有效的应对技巧和减少医疗不信任； （3） 检查干预效果的潜在主持人（例如，年龄，HIV-Serostatus和其他健康状况 状况）。在建立的社区学术伙伴关系的背景下，我们将与300 黑色SMM，将150随机分配给干预组，150个将候补名单对照组。参与者会 在基线以及3个月和12个月后的基线调查以评估主要结果，以及 潜在的介体，协变量和主持人。医疗保健参与，获得基于证据的护理以及 健康状况将通过病历验证。除我们自己的工作外，我们不知道 为了改善交叉身份的歧视的任何干预措施 黑色SMM中的健康成果。我们的研究与2020年健康的人一致，建议 制定干预措施来解决性少数群体之间歧视的影响。虽然 结构水平的干预措施对于减少社会歧视作为长期战略至关重要 水平干预措施（例如仍在攀爬）需要同时减少歧视的直接健康状况 效果。