An Intervention to Address Racial Bias in non-Physician Healthcare Staff

描述(申请人提供)：非洲裔美国人与欧洲裔美国人相比，高血压患病率更高，血压控制更差。高血压需要与医疗系统互动进行诊断和治疗，但少数族裔使用医疗服务的比例低于占多数的欧洲裔美国人。少数族裔患者的医疗服务利用率较低，人们对此知之甚少，但这被归因于种族偏见等因素。社会规范已经进步，公开的歧视行为，特别是在医疗保健方面的歧视行为是不可接受的。然而，研究表明，种族偏见是隐含的，在没有意图或意识的情况下发生，也有显性的。到目前为止，干预措施的重点是解决医生中的种族偏见。在我们由NHLBI资助的工作中，我们发现许多导致患者感知到的歧视的行为不是来自医生，而是来自非医生的医护人员，如接待员、医疗助理和有执照的执业护士。我们不知道有任何旨在提高非医生医护人员的文化能力或解决种族偏见的干预措施。解决非医生医护人员中的种族偏见可能有助于创造一种环境，提高员工的文化能力，减少患者对歧视的看法，并提高就诊依从性。这个应用程序的目标是开发和试点一种互联网促进的干预措施，以解决非医生医护人员中的种族偏见，该干预措施将使用未来的资金进行严格的测试，如果被发现有效，可以传播用于初级保健和其他医疗环境。这一试点项目的具体目标是：1)聘请非医生医护人员的咨询小组，并使用参与性研究方法开发以理论为导向、通过互联网促进的干预措施，以解决种族偏见问题；2)试行非医生医护人员参与随机试验的测试策略；3)在10组非医生医护人员中试行干预措施，以评估可行性和可接受性，并试行对员工文化能力、患者报告的歧视和诊所报告的就诊依从性的评估。指导这项创新研究的是一个特别适合 这项任务在社区干预、医疗保健差距、社会科学和互联网干预方面的知识为指导和制定有效的干预措施提供了必要的专业知识。这一应用的主要产品将是互联网促进的干预。这项试点研究将为R01资助的团体随机对照试验产生所需的可行性数据，该试验将能够评估干预措施在提高员工文化能力、减少患者对歧视的看法以及改善就诊依从性方面的有效性。如果成功，这项工作有可能通过减少医疗保健中的种族偏见和增加少数族裔对医疗保健服务的使用来减少健康结果中的种族差异。

DESCRIPTION (provided by applicant): African Americans, compared to European Americans, have a higher prevalence of hypertension and worse blood pressure control. Hypertension requires interaction with the healthcare system for both diagnosis and treatment, yet racial/ethnic minorities use health services less than the European-American majority. Lower use of health services in minority patients is poorly understood, but it has been attributed to factors such racial bias. Social norms have progressed such that overt discriminatory acts, especially in health care, are unacceptable. However, research reveals that racial biases occur implicitly, without intention or awareness, as well as explicitly. To date, interventions have focused on addressing racial bias in physicians. In our NHLBI- funded work, we found that many behaviors contributing to patients' perceived discrimination come, not from the physician, but from non-physician healthcare staff, such as receptionists, medical assistants, and licensed practical nurses. We are unaware of any interventions that aim to increase cultural competency or address racial bias among non-physician healthcare staff. Addressing racial bias in non-physician healthcare staff may help create an environment that increases the staff's cultural competency, reduces patients' perception of discrimination, and improves visit adherence. The goal of this application is to develop and pilot test an internet- facilitated intervention to addrss racial bias in non-physician healthcare staff that will be rigorously tested using future funding, and that, if found effective, can be disseminated for use in primary care and other medical settings. The specific aims for this pilot project are: 1) To engage an advisory group of non-physician healthcare staff and use participatory research methods to develop a theory-driven, internet-facilitated intervention to address racial bias; 2) To pilot test strategies for recruitin non-physician healthcare staff to participate in a randomized trial; 3) To pilot test the intervention in 10 groups of non-physician healthcare staff to assess feasibility and acceptability and to pilot assessments of staff cultural competency, patient-reported perceived discrimination, and clinic-reported visit adherence. Guiding this innovative study is a team particularly suited to the task, whose knowledge in community-based interventions, healthcare disparities, social science, and internet interventions provide the necessary expertise to guide and develop an effective intervention. The primary product from this application will be the internet-facilitated intervention. This pilot study will generate the required feasibility data for a R01-funded, group randomized controlled trial, which will be able to assess the effectiveness of the intervention in improving staff cultural competency, reducing patients' perception of discrimination, and improving visit adherence. If successful, this work has the potential to decrease racial disparitie in health outcomes by reducing racial bias in health care and increasing the use of healthcare services by racial/ethnic minorities.