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

描述（由申请人提供）：与欧洲裔美国人相比，非洲裔美国人的高血压患病率较高，血压控制较差。高血压的诊断和治疗都需要与医疗保健系统进行互动，但少数种族/民族使用的医疗服务少于欧美多数人。少数民族患者较少使用卫生服务的情况知之甚少，但这被归因于种族偏见等因素。社会规范已经发展到不能接受公开的歧视行为，特别是在保健方面。然而，研究表明，种族偏见既有显性的，也有隐性的，没有意图或意识。迄今为止，干预措施的重点是解决医生的种族偏见。在我们的NHLBI资助的工作中，我们发现许多导致患者感知歧视的行为不是来自医生，而是来自非医生的医疗保健人员，如接待员，医疗助理和有执照的实习护士。我们不知道任何旨在提高文化能力或解决非医生医护人员种族偏见的干预措施。解决非医生医疗保健人员的种族偏见可能有助于创造一个环境，提高工作人员的文化能力，减少患者的歧视感，并提高就诊依从性。本申请的目标是开发和试点测试一种互联网促进的干预措施，以解决非医生医疗保健人员的种族偏见，将使用未来的资金进行严格的测试，如果发现有效，可以在初级保健和其他医疗环境中推广使用。该试点项目的具体目标是：1）聘请一个由非医生医护人员组成的咨询小组，并使用参与式研究方法，开发一种理论驱动的、互联网促进的干预措施，以解决种族偏见问题; 2）试点测试招募非医生医护人员参与随机试验的策略; 3）在10组非医生医疗保健人员中进行试点测试，以评估可行性和可接受性，并对工作人员的文化能力，患者报告的感知歧视和诊所报告的就诊依从性进行试点评估。指导这项创新研究的是一个特别适合 该任务，其在基于社区的干预措施，医疗保健差距，社会科学和互联网干预措施方面的知识提供了必要的专业知识，以指导和制定有效的干预措施。该应用程序的主要产品将是互联网促进的干预。这项试点研究将为R 01资助的分组随机对照试验提供所需的可行性数据，该试验将能够评估干预措施在提高工作人员文化能力、减少患者对歧视的感知以及提高访视依从性方面的有效性。如果成功的话，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种族/族裔对医疗保健服务的使用来减少健康结果中的种族歧视。

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.