Improving primary care providers ability to communicate about patients experiences of racism to improve cardiovascular health: a feasibilitystudy

项目总结/摘要 非裔美国人（AAs）的主要心血管疾病的年龄调整死亡率最高 种族群体。许多与种族有关的因素导致AA的高CVD率。例如暴露于 人际和结构性种族主义导致长期压力、消极情绪状态和健康状况不佳 行为，这反过来又会导致不良的心血管结果。与种族不一致的供应商的AA 经历较差的人际护理过程（较少分享决策和心理社会谈话）， 报告比具有相同竞赛提供者的AA更低的信任级别。候选人的长期假设是：邀请 AA患者讨论他们的种族主义访问的经验将加强治疗关系，从而 改善AA心血管结局。根据社会认知理论和接触理论， 建议开发和测试一种可行的和可接受的方法，供医疗保健提供者交流 关于种族歧视的事我们专注于美国出生的非西班牙裔AA患者，因为他们有最糟糕的 心血管健康结果，以及作为一个群体，长期暴露于种族主义。对于供应商，我们专注于 白色居民，因为（1）大多数医疗保健提供者是白色;（2）文献表明，种族不一致 关系有较差的人际护理过程;（3）居民正在积极建立自己的 沟通技巧和对不同人群的反应能力，以及（4）居民可能没有那么根深蒂固 比执业医师的行为。在目标1中，候选人将与AA患者进行焦点小组讨论， 白色住院医师接受内科、医学儿科和家庭医学培训，以确定对 讨论种族主义的障碍。然后，在目标2中，候选人将制定一项干预措施， 种族主义，提高居民的自我效能和结果的预期，在试点测试的干预， 目标3.社区咨询委员会将在整个研究过程中为候选人提供建议。的 候选人的长期职业目标是成为一名独立调查员，通过以下方式减少种族差异： 制定创新的循证干预措施，以解决种族主义 对健康有不利影响。职业发展计划包括高级定性和 量化方法，社区参与的研究和概念绘图，关于种族主义的沟通， 实施科学和临床研究。候选人拥有一支由导师和顾问组成的优秀团队 他们是上述领域的杰出学者。候选人完全有能力进行这项工作 研究，这将使她过渡到独立作为一个调查员，并奠定了基础，大规模的 随机试验她有机会获得丰富的学术环境，其中包括一个部门与强大的 出版物和校外资金的记录，公共卫生的优秀学校，临床和翻译 科学研究所，投资于初级教师，和一个国家的最先进的模拟中心。

PROJECT SUMMARY / ABSTRACT African Americans (AAs) have the highest age-adjusted death rates from major cardiovascular diseases of all racial groups. Many race-related factors contribute to AAs' high rates of CVD. For example, exposure to interpersonal and structural racism contributes to chronic stress, negative emotional states, and poor health behaviors, which, in turn, lead to adverse cardiovascular outcomes. AAs with racially discordant providers experience poorer interpersonal processes of care (less shared decision-making and psychosocial talk) and report lower levels of trust than AAs with same race providers. The candidate's long-term hypothesis is: inviting AA patients to discuss their experiences of racism visit will strengthen the therapeutic relationship and thereby improve AAs' cardiovascular outcomes. Drawing on social cognitive theory and contact theory, the candidate proposes to develop and test a feasible and acceptable method for health care providers to communicate about racism with AA patients. We focus on US born, non-Hispanic, AA patients, because they have the worst cardiovascular health outcomes, and, as a group, longstanding exposure to racism. For providers, we focus on White residents because (1) most health care providers are White; (2) the literature shows that race-discordant relationships have poorer interpersonal processes of care; (3) residents are actively building their communication skills and responsiveness to diverse populations, and (4) residents may have less entrenched behaviors than practicing physicians. In Aim 1, the candidate will conduct focus groups with AA patients and White residents training in Internal Medicine, Med-Peds, and Family Medicine to identify attitudes about and barriers to discussing racism. Then, in Aim 2, the candidate will develop an intervention to communicate about racism that improves residents' self-efficacy and outcome expectancies, prior to pilot testing the intervention in Aim 3. A community advisory board will advise the candidate throughout the research process. The candidate's long-term career goal is to become an independent investigator who reduces racial disparities by developing innovative evidence-based interventions to address the multiple mechanisms through which racism adversely affects health. The career development plan includes training in advanced qualitative and quantitative methods, community engaged research and concept mapping, communication about racism, implementation science, and clinical research. The candidate has an exceptional team of mentors and advisors who are distinguished scholars in the aforementioned areas. The candidate is well-positioned to conduct this research, which will transition her to independence as an investigator and lay the foundation for a large-scale randomized trial. She has access to a rich academic environment, which includes a department with a strong record of publications and extramural funding, an excellent School of Public Health, a Clinical and Translational Science Institute that invests in junior faculty, and a state-of-the art Simulation Center.