Re-thinking the role of Peers And Training Patients [RePeAT]

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PROJECT ABSTRACT This project involves training peer-health coaches to improve the shared-decision making behavior of patients with low-health literacy (LHL). Most patients want to be involved in important health decisions such as taking medications to prevent cardiovascular disease. Yet, patients with LHL often lack the knowledge, confidence, and skills to assume a more active role in these decisions. I am committed to conducting research that will support patients with LHL in becoming equal partners with their clinicians. My commitment is evidenced in this novel intervention that is designed to help LHL patients acquire the knowledge they need to engage in a shared-decision about reducing their cardiovascular disease (CVD) risk; and the agency and confidence they need to do so. This study will provide a foundation for advancing the science of SDM around the primary prevention of CVD with a focus on addressing LHL through trained peers. Moreover, this proposed K-award will springboard to the next steps in my path to an independent investigator. By the end of this award, I will develop expertise in understanding the scope of peers in the SDM process and how they can be used to improve cardiovascular disease outcomes for patients with LHL. This award will span 5 years and will involve a graduated career development plan that includes mentorship, coursework, analyses, publication, and an R-level grant submission. In order to achieve the goals of this research plan and transition to independence, I need formal training and mentorship in implementation science, health literacy & patient communication, and primary prevention of cardiovascular disease. This proposal includes an exceptional team of mentors to help me reach my goals. My primary mentor, Dr. Kevin Fiscella, is a nationally known expert in health care disparities, implementation science, and health care policy. He is experienced in conducting equity- focused primary prevention of cardiovascular disease implementation research in primary care. My Co- Mentor, Dr. Ronald Epstein, is an internationally known expert in patient-provider communication. He is a communication and health services researcher with a focus on pragmatic strategies for improving communication with patients. My goal at the end of this award is to submit an NHLBI grant application (such as in response to NHLBI PA-19-166 (Implementation of shared decision making for HLBS diseases and conditions) to further refine and test the proposed intervention in a broader population.