An Intervention to Reduce the Effect of Racial/Ethnic Bias on Hypertension Care

减少种族/民族偏见对高血压护理影响的干预措施

• 批准号: 7922162
• 负责人: Edward Paul Havranek
• 金额: $ 17.57万
• 依托单位: DENVER HEALTH AND HOSPITAL AUTHORITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2012-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7922162
• 关键词: Address; Adherence; African American; Ambulatory Care Facilities; Antihypertensive Agents; Behavior; Blood Pressure; Cardiovascular Diseases; Caring; Chronic Disease; Clinical; Code; Communication; Complex; Computerized Medical Record; Data; Development; Discrimination; Economics; Education; Effectiveness of Interventions; Evaluation; Exercise; Exposure to; Face; Fright; Funding Opportunities; Goals; Health; Health Personnel; Healthcare; Healthcare Systems; High Prevalence; Hospitals; Hypertension; Incidence; Individual; Inequality; Institute of Medicine (U.S.); Intervention; Latino; Light; Measures; Minority; Minority Groups; Moods; Outcome; Outcome Measure; Patients; Perception; Performance; Persons; Pharmaceutical Preparations; Physicians; Population; Prejudice; Primary Health Care; Process; Provider; Questionnaires; Randomized; Regimen; Reporting; Research; Schedule; Self Care; Self Efficacy; Self Management; Stereotyping; Stress; Surveys; System; Telephone; Testing; Trust; Ursidae Family; Visit; Work; Writing; base; clinical care; clinical practice; compliance behavior; coping; design; ethnic discrimination; experience; follow-up; health care delivery; hypertension treatment; improved; innovation; intervention effect; medication compliance; member; novel; pressure; primary outcome; psychologic; public health relevance; racial and ethnic; racial and ethnic disparities; response; safety net; social

DESCRIPTION (provided by applicant): Members of racial and ethnic minorities in the U.S. have a higher prevalence of conditions that predispose to cardiovascular disease, a higher incidence of cardiovascular disease, and poorer outcomes after developing cardiovascular disease. The causes of these differences are complex and multiple, but it is now widely accepted that bias is one of the causes. The research proposed in this application serves the broad, long-term objective of establishing a practical and replicable means to reduce the impact of bias on clinical encounters. Specifically, the project will develop and evaluate an intervention that reduces the impact of bias by reducing stereotype threat through self-affirmation. Stereotype threat is the concept that members of minority groups are apprehensive of being judged according to the stereotypes associated with the group of which they are members; the stress induced by this apprehension impairs performance. We hypothesize that in clinical settings, the stress induced by stereotype threat renders patients and providers less able to communicate effectively which in turn impairs the effect of the visit to improve patient self-management behavior. Self-affirmation is a process in which global sense of personal worth is strengthened, making individuals better able to tolerate psychological threats. The proposed project adapts for a clinical setting a self-affirmation exercise that improved classroom performance. The setting for the study is a free-standing outpatient clinic that is part of a safety net hospital system. In the proposed exploratory study, 200 patients with hypertension (100 African American and 100 Latino) will be randomized to either experimental or control conditions. Experimental subjects will complete immediately prior to a scheduled primary care visit a 10-15 minute exercise in which they write a brief paragraph about a value important to them; control subjects will be asked to write about a value that might be important to others. The subsequent visit will be audio-taped for later coding and analysis of the quality of the interaction. Following the visit, patients will respond to a questionnaire assessing the quality of communication with their physician, medication adherence, stress level, trust in their physician, medication self-efficacy, and mood. After their next follow-up visit, patients will be surveyed by telephone with the same questionnaire (without the mood and stress evaluation questions), and have blood pressure and medication and visit adherence assessed from the electronic medical record. The primary outcome measure for the project is the change in minority hypertensive patients' adherence with antihypertensive medication. The main secondary measure is the effect of the intervention on patients' blood pressure. We will use the measures of stress, trust, efficacy, and mood to explore the mechanistic effects of the intervention. Additional measures will allow assessment of the feasibility of implementing the intervention in routine clinical practice. We anticipate that the data obtained from the proposed project will inform the design of a larger study whose purpose is definitive demonstration of the intervention's effectiveness. PUBLIC HEALTH RELEVANCE: High blood pressure contributes more to poor health in minority patients than in non-minority patients. The goal of this project is to improve the treatment of high blood pressure for minority patients by improving their communication with their health care providers.

描述（由申请人提供）：美国少数族裔成员罹患心血管疾病的几率较高，心血管疾病的发病率较高，且患心血管疾病后的预后较差。造成这些差异的原因复杂且多样，但现在人们普遍认为偏见是原因之一。本申请中提出的研究服务于建立一种实用且可复制的方法来减少偏倚对临床遭遇的影响的广泛、长期目标。具体来说，该项目将开发和评估一种干预措施，通过自我肯定减少刻板印象威胁，从而减少偏见的影响。刻板印象威胁是指少数群体成员担心根据与其所属群体相关的刻板印象来评判；这种忧虑引起的压力会影响表现。我们假设，在临床环境中，刻板印象威胁引起的压力使患者和提供者有效沟通的能力降低，进而削弱了就诊改善患者自我管理行为的效果。自我肯定是一个整体个人价值感得到加强的过程，使个人能够更好地忍受心理威胁。拟议的项目适应临床环境，进行自我肯定练习，提高课堂表现。该研究的地点是一个独立的门诊诊所，是安全网医院系统的一部分。在拟议的探索性研究中，200 名高血压患者（100 名非裔美国人和 100 名拉丁裔）将被随机分配到实验条件或对照条件下。实验对象将在预定的初级保健就诊之前立即完成一项 10-15 分钟的练习，其中他们写了一段关于对他们来说重要的价值观的简短段落；控制对象将被要求写下对其他人可能重要的价值观。随后的访问将被录音，以便稍后编码和分析交互质量。就诊后，患者将填写一份调查问卷，评估与医生的沟通质量、用药依从性、压力水平、对医生的信任、用药自我效能和情绪。下次随访后，将使用相同的问卷通过电话对患者进行调查（不包含情绪和压力评估问题），并根据电子病历评估血压和药物治疗以及就诊依从性。该项目的主要结果指标是少数高血压患者抗高血压药物依从性的变化。主要的次要指标是干预措施对患者血压的影响。我们将使用压力、信任、功效和情绪等指标来探索干预的机制效应。其他措施将允许评估在常规临床实践中实施干预措施的可行性。我们预计从拟议项目中获得的数据将为更大规模研究的设计提供信息，其目的是明确证明干预措施的有效性。公共卫生相关性：与非少数族裔患者相比，高血压对少数族裔患者健康状况不佳的影响更大。该项目的目标是通过改善少数族裔患者与医疗保健提供者的沟通来改善他们的高血压治疗。