Multiethnic Perspectives of Shared Decision Making in Hypertension

高血压共同决策的多种族观点

• 批准号: 10535421
• 负责人: Sabrina Elias
• 金额: $ 4.68万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-01 至 2022-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10535421
• 关键词: Address; Adherence; Adult; Advocate; Antihypertensive Agents; Area; Attitude; Black Populations; Black race; Blood Pressure; Cardiovascular system; Caring; Cessation of life; Characteristics; Clinic; Clinical; Communication; Data; Decision Making; Development; Ethnic Origin; Ethnic group; Failure; Foundations; Grant; Guidelines; Health; Health Promotion; Health system; Heart Diseases; High Prevalence; Hispanic; Hispanic Populations; Hypertension; Individual; Interdisciplinary Study; Intervention; Interview; Knowledge; Lead; Medical; Methods; Mid-Atlantic Region; National Institute of Nursing Research; Nurses; Outcome; Parents; Participant; Patient Preferences; Patient Self-Report; Patient-Centered Care; Patients; Perception; Pharmaceutical Preparations; Phase; Population; Prevalence; Prevention; Primary Health Care; Process; Provider; Public Health; Publications; Race; Recommendation; Reporting; Research; Research Methodology; Resources; Risk Factors; Risk Management; Role; Sampling; Scientist; Stroke; Structure; Training; Trust; United States; United States National Institutes of Health; base; blood pressure control; cardiovascular risk factor; career; comparative effectiveness study; contextual factors; cost; depressive symptoms; design; ethnic diversity; experience; follow-up; group intervention; health disparity; hypertension control; improved; innovation; knowledge base; multi-ethnic; patient oriented; preference; prevent; racial and ethnic; racial and ethnic disparities; satisfaction; shared decision making; skills; sociodemographics

Project Summary/Abstract Hypertension (HTN) is a major risk factor for heart disease and stroke, contributing to about 1,000 deaths a day with persistent racial/ethnic disparities. Higher prevalence and poor HTN control rates are common among Blacks (57%, 37%) and Hispanics (45%, 42%), compared to Whites (44%, 46%) in the US. Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence, along with patients' preferences and values, and is a possible strategy to improve HTN control. Little is known about the influence of race/ethnicity on SDM practices or the impact of SDM on HTN control in ethnically diverse groups. To address this gap, the applicant proposes to conduct a mixed methods explanatory sequential study to examine SDM in HTN management from the perspectives of multiethnic patients with HTN. This dissertation study will be conducted within the Parent Study, the RICH LIFE Project. Specific aims include: 1) Examine the relationship between SDM, change in level of blood pressure (BP), and self-reported race and ethnicity in patients with HTN; 2) Examine baseline determinants of decision that predict SDM at 12 months, including sociodemographic and clinical characteristics, perception of the decision (i.e., HTN knowledge), perception of important others (i.e., satisfaction and trust in providers), and resources to make and implement decisions; 3) Explore SDM in BP management from the perspective of HTN patients with high/low SDM scores, and improvement/no improvement over 12 months in level of BP; 4) Describe SDM in the BP management context in relation to SDM score and BP level. This study will be carried out in three phases. During Phase 1, quantitative data collected in the Parent Study at baseline and 12 month follow up will be analyzed. These results will then guide purposeful sampling of Parent Study participants for participation in semi-structured interviews to obtain qualitative data in Phase 2. Qualitative data will be used to help explain the findings from Phase 1. In Phase 3, quantitative and qualitative data will be integrated. The study will follow a fixed-design approach since the methods are predetermined during the planning phase with a specific intent to mix qualitative and quantitative approaches. The application of mixed methods to enhance understanding of the cultural and contextual factors influencing SDM in HTN is innovative and will inform the development of culturally congruent interventions to promote HTN control and reduce racial/ethnic disparities. This study and proposed training plan will provide foundational experience and skills in mixed methods research among multiethnic populations experiencing health disparities. The proposed study and training plan will allow the applicant to develop into a nurse scientist who will lead interdisciplinary research to improve cardiovascular risk management through SDM. The proposed study addresses the National Institute of Nursing Research's “Wellness: Promoting Health and Preventing Illness” area of scientific focus and will add to the scientific knowledge base on the impact of race, ethnicity, and other factors on SDM and the relationship between SDM and HTN control.

项目概要/摘要 高血压 (HTN) 是心脏病和中风的主要危险因素，每天导致约 1,000 人死亡 持续存在的种族/民族差异。较高的患病率和较差的高血压控制率在以下人群中很常见 在美国，黑人（57%、37%）和西班牙裔（45%、42%）与白人（44%、46%）相比。共同决定 制定 (SDM) 是一种临床医生和患者使用最佳可用信息共同做出决策的方法 证据以及患者的偏好和价值观，是改善高血压控制的可能策略。小的 了解种族/民族对 SDM 实践的影响或 SDM 对种族 HTN 控制的影响 不同的群体。为了解决这一差距，申请人建议进行混合方法解释顺序 这项研究从多种族高血压患者的角度审视 SDM 在高血压管理中的作用。这 论文研究将在家长研究（RICH LIFE 项目）内进行。具体目标包括：1) 检查 SDM、血压 (BP) 水平变化和自我报告的种族之间的关系 高血压患者的种族； 2) 检查预测 12 个月时 SDM 的决策的基线决定因素， 包括社会人口统计学和临床​​特征、对决策的看法（即 HTN 知识）、 对重要他人的看法（即对提供者的满意度和信任）以及制定和实施的资源 决定； 3）从SDM评分高/低的高血压患者角度探讨SDM在血压管理中的应用， 12 个月内血压水平有改善/无改善； 4）描述BP管理中的SDM 与 SDM 评分和血压水平相关的背景。这项研究将分三个阶段进行。在第一阶段， 将分析在父母研究中收集的基线和 12 个月随访的定量数据。这些结果 然后将指导有目的地对家长研究参与者进行抽样，以参与半结构化访谈，以 在第 2 阶段获取定性数据。定性数据将用于帮助解释第 1 阶段的发现。 第三阶段，定量和定性数据将被整合。该研究将遵循固定设计方法，因为 这些方法是在规划阶段预先确定的，其具体目的是混合定性和定量 接近。应用混合方法来增强对文化和背景因素的理解 影响 HTN 中的 SDM 具有创新性，并将有助于制定文化一致的干预措施，以 促进高血压控制并减少种族/民族差异。这项研究和拟议的培训计划将提供 在多种族人群中进行混合方法研究的基础经验和技能 健康差异。拟议的学习和培训计划将使申请人发展成为一名护士科学家 他将领导跨学科研究，通过 SDM 改善心血管风险管理。拟议的 研究涉及国家护理研究所的“健康：促进健康和预防 疾病”领域的科学重点，并将增加关于种族、民族和文化影响的科学知识库。 其他因素对SDM的影响以及SDM与HTN控制之间的关系。