Using values affirmation to reduce the effects of perceived discrimination on hypertension disparities

项目总结/摘要 超过80%的非裔美国人报告在过去一年中遭受歧视; 歧视与健康方面的差异有关，包括遵守情况不佳。依从性差可能导致 非裔美国人中高血压未得到控制的患病率较高。我们提出了一种创新的方法， 重视肯定，以克服歧视的威胁，增加患者的积极性，提高依从性 从而减少高血压结果的差异。我们的建议是基于我们的试点研究 证明在诊所就诊前立即进行的简短的价值观肯定练习导致改善 在访问期间，非裔美国人患者和提供者之间的沟通，并建议改善 访视后6个月的药物依从性。我们建议推进我们先前的工作，填补 通过进行一项随机对照试验，将价值观肯定练习与对照进行比较， 对三个卫生系统的1100例高血压患者进行运动锻炼的研究。主要结局为6个月 抗高血压治疗依从性的变化，次要结局为血压变化。 我们还将探讨干预效果的可能机制，并正式评估传播。 在目标1中，我们将比较价值观肯定练习和控制练习对 三种临床环境中非裔美国患者的抗高血压药物依从性。我们 假设随机分配至数值确认组的患者在6个月时的依从性变化更大 与对照组相比，该效应将部分受患者因素（先前的 歧视），独立于供应商因素（隐性种族偏见，过去的差异培训，自我， 对少数民族患者的有效护理）和由患者激活介导。 在目标2中，我们将比较非裔美国患者的价值肯定练习与其 对高血压白色患者的影响。我们假设，价值观肯定会改善 非裔美国人患者的依从性更高，表明干预针对 与种族有关的歧视。 在目标3中，我们将使用RE-AIM正式评估广泛传播的干预措施 （范围、效力、采用、实施和维持）框架。我们假设 干预将具有在初级保健中广泛传播的有利特征。 该项目具有创新性，因为它将使用一种尚未广泛应用于 医疗保健设置。由于价值观的肯定并不特定于高血压或非洲裔美国人，这项研究将 成为第一个提供证据的低资源干预，有可能减少医疗保健 在广泛的卫生保健条件和人口之间的差距。

PROJECT SUMMARY / ABSTRACT Over 80% of African Americans report experiences of discrimination in the past year; perceived discrimination is linked to health disparities including poor adherence. Poor adherence may contribute to the high prevalence of uncontrolled hypertension in African Americans. We propose an innovative approach using values affirmation to overcome the threat of discrimination to increase patient activation, improve adherence and thereby reduce disparities in hypertension outcomes. Our proposal is based upon our pilot study demonstrating a brief values affirmation exercise done immediately before a clinic visit resulted in improved communication between African American patients and providers during the visit and suggested improved medication adherence 6-months after the visit. We propose to advance our prior work and fill gaps in the evidence by conducting a randomized controlled trial comparing a values affirmation exercise to a control exercise among 1100 patients with hypertension from three health systems. The primary outcome is 6-month change in adherence to antihypertensive therapies with the secondary outcome of change in blood pressure. We will also explore possible mechanisms of the intervention effect and formally evaluate for dissemination.  In aim 1, we will compare the effects of the values affirmation exercise to a control exercise on antihypertensive medication adherence in African American patients across three clinical settings. We hypothesize patients randomized to values affirmation will have greater adherence change at 6-months compared to controls and the effect will be partially moderated by patient factors (prior experiences of discrimination), independent of provider factors (implicit racial bias, past disparities training, self- efficacy caring for minority patients) and mediated by patient activation.  In aim 2, we will compare the effects of values affirmation exercise in African American patients to its effects in white patients with hypertension. We hypothesize that values affirmation will improve adherence to a greater degree in African American patients suggesting the intervention is targeting perceived discrimination related to race.  In aim 3, we will formally evaluate the intervention for widespread dissemination using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework. We hypothesize the intervention will have favorable characteristics for widespread dissemination within primary care. The project is innovative, as it will use a novel intervention that has not been widely applied in the healthcare setting. Since values affirmation is not specific to hypertension or African Americans, this study will be the first to provide evidence for a low-resource intervention that has the potential to reduce healthcare disparities across a wide range of health care conditions and populations.