StoryGuides-Making Comparative Effectiveness Useful for Vulnerable Patients

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DESCRIPTION (provided by applicant): StoryGuides: Making Comparative Effectiveness Useful for Vulnerable Patients will culturally adapt the AHRQ Comparative Effectiveness Patient Guides (the Guides) through storytelling (narrative communication), test their use in a randomized trial, and actively promote active, widespread dissemination. Although the Guides are clearly written and clinically sound, behavior change, especially within vulnerable populations, requires active and innovative dissemination, or their benefit will be missed. More specifically, we will adapt and deliver comparative-effectiveness content to African American patients with hypertension (HTN) and diabetes (DM) treated in the Cooper Green Health System (CGHS), an inner-city, safety-net setting in Birmingham Alabama. Relevant Guides include those focused on cardiovascular risk, such as HTN, DM, and hyperlipidemia. Content from the Guides will be developed into storytelling episodes drawn from the community and presented on digital video discs (DVDs). Our previous work has shown that this approach is powerful and effective. Our specific aims are: (SA1) --- Drawing upon the principles of narrative communication theory and the Ashton Racial/Ethnic Model of Patient - Doctor Communication, engage patients and providers in formative work; (SA2) --- Evaluate the intervention in a randomized controlled trial within CGHS for African American patients with HTN and DM by randomizing 250 patients to an intervention group (storytelling DVDs) and 250 patients to a comparison group (Guides on DVDs without storytelling); (SA3) --- Develop and deploy an Internet Dissemination Depot (IDD) for patients, providers, health system leaders, and researchers. The IDD will allow intervention products to be easily downloaded. We will also produce an interactive, step-by-step guide for making similar products for other conditions, settings, and geographic regions. For secondary analyses, we will collect medication adherence, self efficacy, and intensity of intervention engagement, co-morbidity, medications, and laboratory values. Formal mediation analyses will elucidate the mechanisms through which the intervention works. An economic analysis will examine the cost of disseminating and producing new narrative interventions from different perspectives. Our team has been collaborating for over five years, with expertise that includes cultural competency, behavioral informatics, and the development and testing of interventions to reduce health disparities. We have: (1) established solid relationships with patients and provider-partners at CGHS, (2) maintained a pool of patients registered for their interest in participating in new studies, and (3) developed mechanisms for efficient data collection. By appealing to the universal human activity of storytelling, our innovative tools will accelerate the uptake of the Guides into routine practice. Storytelling is a flexible intervention, readily adaptable to new Guides and new patient populations and easily disseminated to broad audiences. PUBLIC HEALTH RELEVANCE: StoryGuides - Making Comparative Effectiveness Useful for Vulnerable Patients will develop interactive, culturally tailored, and literacy appropriate interventions to promote use of comparative effectiveness information to vulnerable populations. The intervention will be based on the effective and powerful technique of community-based storytelling, or narrative communication.