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

600万美国人患有房颤，这是一种心脏节律异常，是一种主要的危险因素 治疗中风。尽管如此，符合条件的房颤患者中只有一半接受了抗凝(AC)治疗。交流领域的鸿沟 非洲裔美国人的使用量更大，与白人和白人相比，他们的使用量减少了10%-22% 西班牙裔。讲故事是一个有希望的患者，面临着促进启蒙和坚持的干预 在非裔美国人的患者身上发现了AC。根据斯莱特的叙事传播模式，两个 结构促进了行为的改变。它们包括同源关系，或与 讲故事，叙述，运输，或吸收到一个故事情节中。使用这个模型，我们假设一个 非AC患者观看患者在犹豫或挫折后启动或恢复AC的故事 培养更准确的风险感知，增强对AC益处的信念，并降低感知到的障碍 使用交流。通过故事开发小组(焦点小组，旨在确定引人注目的故事和明星 讲故事者)，我们将为讲故事干预制作素材。然后我们 建议在非洲裔美国患者中进行讲故事干预的试点和可行性试验 那些不遵守AC的人。在试验中，我们将评估干预的保真度和交通，测量 招聘和保留，并跟踪AC的启动和持续趋势，这将为更大规模的试验提供参考。 明确的目标。目标1：(故事发展)符合改编的斯莱特和健康信念 模型，开发讲故事的干预措施，在非洲人中促进AC的发起和坚持 美国病人。目标1a：(评选讲故事者和故事)召集故事开发小组， 来自我们两个研究地点的患者(共33例)。在这些小组中，我们将询问患者使用 发起和坚持AC；通过这次调查，我们将确定发起/坚持挑战， 说明这些挑战的令人信服的故事，以及患者和 “明星”讲故事的人。目标1b：(拍摄故事)创建采访指南，重新激发最有说服力的人 每个明星讲故事的人(n=10)更详细的故事，然后进行单独的录像采访 每一颗恒星。目标1c：(视频分析和评级)对录制的采访进行专题分析 确定关键故事单元；患者咨询小组将对这些单元进行评级，以确定哪些单元将进入 最后的视频。目标2(随机试验)-将符合条件的患者按1：1的比例分配到干预组和对照组 视频(对比，没有故事的说教视频)。符合条件的患者包括非洲裔美国人患者 房颤不使用空调但建议在过去一年内使用空调(n=40；20名干预者和20名对照组 病人)。目标2a：(保真度和交通)衡量观看视频所花费的时间；在干预中 患者，使用已建立的仪器测量传输(吸收到故事中)。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仪器的繁重。还开发了一种 为未来R01的相对有效性准备的操作手册。目标2c：(视频测试 行为改变)测量在接下来的6个月中开始使用AC和持续使用AC的趋势 随机化。

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.