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

讲故事以减少患有心房颤动的非洲裔美国人使用交流电的差距

• 批准号: 10667019
• 负责人: Alok Kapoor
• 金额: $ 22.37万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-13 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10667019
• 关键词: Address; Adherence; African American; African American population; American; Anticoagulation; Atrial Fibrillation; Awareness; Belief; Cardiology; Collaborations; Communication; Communities; Complex; Coping Skills; Development; Eligibility Determination; Exploratory/Developmental Grant; Film; Focus Groups; Future; Guidelines; Health system; Hemorrhage; Hispanic Populations; Individual; Institution; Intervention; Interview; Learning; Manuals; Massachusetts; Measures; Michigan; Modeling; National Institute on Minority Health and Health Disparities; Oral; Participant; Patients; Phase; Professional Organizations; Protocols documentation; Provider; Randomized; Recommendation; Recording of previous events; Reporting; Research; Research Project Grants; Risk Factors; Self Efficacy; Site; Specialist; Stroke; Testing; Time; Transportation; Trust; Universities; Videotape; Work; absorption; behavior change; comparative effectiveness; disability; experience; falls; feasibility trial; health belief; heart rhythm; hypertension control; improved; instrument; meetings; operation; pilot trial; randomized trial; recruit; retention rate; risk perception; satisfaction; stroke risk; trend; usability; web site

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.

600万美国人患有心房颤动（AF），这是一种心律异常，是一个主要的风险因素 治疗中风尽管如此，只有一半合格的AF患者接受抗凝（AC）治疗。AC中的差距 非洲裔美国人的使用量甚至更大，与白人相比，他们的使用量少10-22%， 西班牙裔讲故事是一个有前途的病人面临的干预，以促进启动和持久性 非裔美国人的AC根据斯莱特的叙事传播模式， 结构促进行为改变。它们包括同质性，或认同的字符在一个 讲故事的叙述，和运输，或吸收到一个故事线。利用这个模型，我们证明， 未接受AC治疗的患者观察患者在犹豫或挫折后开始或恢复AC的故事， 发展更准确的风险认知，增加对AC益处的信念，并减少感知障碍， 使用AC。通过故事发展小组（焦点小组，旨在确定引人注目的故事和星星 讲故事的人）的非裔美国人的病人，我们将产生的材料讲故事的干预。然后我们 我提议对非裔美国人进行一项讲故事干预的试点和可行性试验 不遵守AC的人。在试验中，我们将评估干预保真度和运输，测量 招募和保留，并遵循AC的启动和持续趋势，这将为更大规模的试验提供信息。 具体目标。目标1：（故事发展）与适应的斯莱特和健康信念相一致 模型，制定一个讲故事的干预措施，以促进非洲人开始和坚持AC 美国患者目标1a：（故事讲述者和故事的选择）召集故事开发小组， 来自我们两个研究中心的患者（共n=33）。在这些小组中，我们将询问患者的经验， AC的启动和持续性;通过本次调查，我们将确定启动/持续性挑战， 说明这些挑战的令人信服的故事，以及患者使用的适应性应对策略， “星星”讲故事的人。目标1b：（拍摄故事）创建一个采访指南，重新引出最引人注目的 从每个星星讲故事的人（n=10）更详细的故事，然后进行个人录像采访 每一颗星星。目标1c：（录像分析和评级）对录像访谈进行主题分析 确定关键的故事单元;一个病人咨询小组将对这些单元进行评级，以确定哪些单元将成为 最终视频目的2（随机试验）-以1：1的比例分配合格患者观察干预与对照 视频（比较，没有故事的教学视频）。符合条件的患者包括非裔美国患者， 在过去一年内未使用AC但建议使用AC的AF（n=40; 20例干预和20例对照 患者）。目标2a：（保真度和传输）测量观看视频所花费的时间;干预 患者，测量运输（吸收到故事）使用一个既定的仪器。目标2b： （可行性、可接受性;操作手册）衡量招聘和保留率;衡量 视频网站的可用性和完成研究工具的负担。也发展一个 操作手册，为将来具有比较效力的R 01做准备。目标2c：（视频测试 行为改变）测量AC开始和AC持续6个月后的趋势 随机化