Multiethnic Perspectives of Shared Decision Making in Hypertension

高血压共同决策的多种族观点

• 批准号: 10569062
• 负责人: Sabrina Elias
• 金额: $ 0.26万
• 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 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10569062
• 关键词: Address; Adherence; Adult; Advocate; Antihypertensive Agents; Area; Attitude; Black Populations; Black race; Blood Pressure; Cardiovascular system; Caring; Cessation of life; Characteristics; Clinical; Communication; Data; Decision Making; Development; Disparity; Ethnic Origin; Ethnic Population; 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; Prevalence; Prevention; 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; blood pressure control; cardiovascular risk factor; career; comparative effectiveness study; contextual factors; cost; depressive symptoms; design; ethnic disparity; ethnic diversity; experience; follow-up; group intervention; health disparity; hypertension control; improved; innovation; knowledge base; multi-ethnic; patient engagement; patient oriented; preference; prevent; primary care clinic; racial disparity; 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.

项目摘要/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1000人死亡 持续存在的种族/民族差异。较高的感染率和较差的HTN控制率在 黑人(57%，37%)和西班牙裔(45%，42%)，而美国白人(44%，46%)。共同决策 决策(SDM)是一种临床医生和患者共同使用可用的最佳方法进行决策的方法 证据，以及患者的喜好和价值观，是改善HTN控制的可能策略。一点儿 已知种族/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的解释顺序 从多民族HTN患者的角度探讨SDM在HTN管理中的作用。这 论文研究将在家长研究的范围内进行，丰富生活项目。具体目标包括：1) 检查SDM、血压水平的变化和自我报告的种族和 HTN患者的种族；2)检查预测12个月后SDM的基线决策决定因素， 包括社会人口学和临床特征、对决策的感知(即HTN知识)、 感知重要的其他人(例如，对提供商的满意度和信任)，以及要制定和实施的资源 3)从高、低SDM评分的HTN患者的角度，探讨SDM在血压管理中的应用。 以及在过去12个月中BP水平改善/没有改善；4)描述BP管理中的SDM 与SDM评分和BP水平相关的上下文。这项研究将分三个阶段进行。在第一阶段， 在家长研究中收集的基线和12个月随访的定量数据将被分析。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，以便参与半结构化访谈 在第二阶段获取定性数据。定性数据将用于帮助解释第一阶段的调查结果。 第三阶段，将整合定量和定性数据。这项研究将遵循固定设计方法，因为 这些方法是在计划阶段预先确定的，具体目的是将定性和定量结合起来。 接近了。运用混合方法加强对文化和语境因素的理解 在HTN中影响SDM是创新的，并将促进文化一致性干预措施的发展 促进HTN控制，缩小种族/民族差距。这项研究和拟议的培训计划将提供 多民族人群混合方法研究的基本经验和技能 健康差距。拟议的学习和培训计划将允许申请人发展成为一名护士科学家。 世卫组织将领导跨学科研究，通过SDM改善心血管风险管理。建议数 这项研究介绍了国家护理研究所的《健康：促进健康和预防》 疾病“是科学关注的领域，并将增加关于种族、民族和 其他影响SDM的因素以及SDM与HTN控制的关系。