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

描述（由申请人提供）：美国的少数种族和族裔成员具有更高的心血管疾病易感性，心血管疾病的发病率更高，患心血管疾病后的结局更差。造成这些差异的原因是复杂和多方面的，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广泛的长期目标，即建立一种实用且可复制的方法，以减少偏倚对临床治疗的影响。具体而言，该项目将制定和评估一项干预措施，通过自我肯定减少陈规定型观念的威胁，从而减少偏见的影响。陈规定型观念威胁是指少数群体成员担心被根据与他们所属群体有关的陈规定型观念进行评判;这种担心引起的压力损害了业绩。我们假设，在临床环境中，刻板印象威胁引起的压力，使患者和供应商能够有效地沟通，这反过来又削弱了访问的效果，以提高患者的自我管理行为。自我肯定是一个过程，在这个过程中，个人的整体价值感得到加强，使个人能够更好地承受心理威胁。拟议的项目适应临床设置的自我肯定练习，提高课堂表现。该研究的设置是一个独立的门诊诊所，是安全网医院系统的一部分。在拟定的探索性研究中，将200例高血压患者（100例非洲裔美国人和100例拉丁美洲人）随机分配至实验组或对照组。实验受试者将在计划的初级保健访视之前立即完成10-15分钟的练习，其中他们将写一个关于对他们重要的价值的简短段落;对照受试者将被要求写一个可能对其他人重要的价值。随后的访问将被录音，以便以后编码和分析互动的质量。访问后，患者将回答一份问卷，评估与医生的沟通质量，药物依从性，压力水平，对医生的信任，药物自我效能和情绪。在下一次随访访视后，患者将通过电话接受相同问卷调查（无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访视依从性。该项目的主要结局指标是少数高血压患者对抗高血压药物依从性的变化。主要的次要措施是干预对患者血压的影响。我们将使用压力，信任，效能和情绪的措施，探讨干预的机制效果。其他措施将允许评估在常规临床实践中实施干预的可行性。我们预计，从拟议的项目中获得的数据将通知设计一个更大的研究，其目的是明确的干预措施的有效性证明。公共卫生相关性：高血压对少数民族患者健康状况的影响大于非少数民族患者。该项目的目标是通过改善少数民族患者与医疗保健提供者的沟通，改善对他们的高血压治疗。

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.