StoryGuides-Making Comparative Effectiveness Useful for Vulnerable Patients

描述（由申请人提供）：StoryGuides：Making Comparative Effectiveness Useful for Vulnerable Patients将通过讲故事（叙述性沟通）在文化上适应AHRQ Comparative Effectiveness Patient Guides（指南），在随机试验中测试其使用，并积极促进积极，广泛的传播。虽然这些指南写得很清楚，在临床上也很合理，但行为改变，特别是在弱势群体中，需要积极和创新的传播，否则就会失去其好处。更具体地说，我们将调整和提供比较有效的内容，以非洲裔美国人的高血压（HTN）和糖尿病（DM）在库珀绿色卫生系统（CGHS），在伯明翰亚拉巴马市中心，安全网设置治疗。相关指南包括关注心血管风险的指南，如HTN、DM和高脂血症。《指南》的内容将发展成从社区中抽取的讲故事情节，并在数字视频光盘（DVD）上呈现。我们以前的工作表明，这种方法是强大和有效的。我们的具体目标是：（SA 1）-借鉴叙事沟通理论和阿什顿种族/民族模式的病人-医生沟通的原则，让病人和提供者参与形成性工作;（SA 2）-通过将250例患者随机分配至干预组，评价CGHS中针对非裔美国HTN和DM患者的随机对照试验中的干预措施（讲故事的DVD）和250名患者作为对照组（没有讲故事的DVD指南）;（SA 3）-为患者、提供者、卫生系统领导者和研究人员开发和部署互联网传播库（IDD）。IDD将使干预产品易于下载。我们还将制作一个交互式的分步指南，用于为其他条件，设置和地理区域制作类似产品。对于次要分析，我们将收集药物依从性、自我效能和干预参与强度、合并症、药物和实验室检查值。正式的调解分析将阐明干预工作的机制。一项经济分析将从不同角度审查传播和制作新的叙述性干预措施的成本。我们的团队已经合作了五年多，专业知识包括文化能力，行为信息学以及干预措施的开发和测试，以减少健康差距。我们拥有：（1）与CGHS的患者和提供者合作伙伴建立了牢固的关系，（2）维持了一个登记参与新研究的患者库，（3）开发了有效的数据收集机制。通过吸引人类普遍的讲故事活动，我们的创新工具将加速将指南纳入日常实践。讲故事是一种灵活的干预措施，易于适应新的指南和新的患者人群，并易于传播给广泛的受众。 公共卫生相关性：StoryGuides -使比较有效性对弱势患者有用将开发互动的，文化上定制的和扫盲适当的干预措施，以促进弱势群体使用比较有效性信息。干预将基于有效和强大的技术，以社区为基础的讲故事，或叙事沟通。

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.