Storytelling for Reducing Gap in AC Use in African Americans with Atrial Fibrillation

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Six million Americans suffer from atrial fibrillation (AF), a heart rhythm abnormality that is a major risk factor for stroke. Despite this, only half of eligible AF patients receive anticoagulation (AC) treatment. The gap in AC use is even larger for African-Americans with their use ranging 10-22% less compared to Whites and Hispanics. Storytelling is one promising patient facing intervention to promoting initiation of and persistence with AC in African-American patients. According to the Slater Model of Narrative Communication, two constructs facilitate behavior change. They include homophily, or identification with the characters in a storytelling narrative, and transportation, or absorption into a story line. Using this model, we posit that a patient not on AC watching stories of patients who initiated or resumed AC after hesitancy or setback will develop more accurate risk perception, increased belief in AC benefit, and decreased perceived barriers to using AC. Through story development groups (focus groups geared to identify compelling stories and star storytellers) of African-American patients, we will generate material for a storytelling intervention. We then propose to conduct a pilot and feasibility trial of the storytelling intervention with African-American patients who are not adherent to AC. In the trial, we will assess intervention fidelity and transportation, measure recruitment and retention, and follow trends in initiation and persistence with AC that will inform a larger trial. Specific Aims. Aim 1: (Story Development) In accordance with the Adapted Slater and Health Belief models, develop a storytelling intervention for promoting initiation of and persistence with AC among African American patients. Aim 1a: (Selection of Storytellers and Stories) Convene story development groups with patients from our two study sites (n=33 total). In these groups, we will inquire about patients’ experiences with initiation of and persistence with AC; through this inquiry, we will identify initiation/persistence challenges, compelling stories which illustrate these challenges, and adaptive coping strategies used by patients and “star” storytellers. Aim 1b: (Filming Stories) Create an interview guide to re-elicit the most compelling stories from each star storyteller (n=10) in greater detail and then conduct individual videotaped interviews with each star. Aim 1c: (Video analysis and rating) Conduct thematic analysis of the videotaped interview to identify key story units; a patient advisory panel will rate the units to identify those which will make it into final videos. Aim 2 (Randomized trial) – Assign eligible patients in 1:1 ratio to watch intervention vs. control videos (comparison, didactic videos without stories). Eligible patients include African-American patients with AF not on AC but recommended to use AC in the past one year (n=40; 20 intervention and 20 control patients). Aims 2a: (Fidelity and transportation) Measure time spent viewing videos; in intervention patients, measure transportation (absorption into story) using an established instrument. Aim 2b: (Feasibility, acceptability; manual of operations) Measure recruitment and retention rates; measure usability of video website and burdensomeness of completing research instruments. Also develop of a manual of operations preparing for future R01 of comparative effectiveness. Aim 2c: (Video testing on behavior change) Measure trends in the initiation of AC and persistence with AC in the 6 months following randomization.