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

项目摘要/摘要 超过80%的非裔美国人报告在过去一年中经历过歧视；认为 歧视与健康差距有关，包括遵守情况不佳。遵从性差可能会导致 非裔美国人中无节制高血压的高患病率。我们提出了一种创新的方法，使用 价值观肯定，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初步研究。 在诊所就诊前做一次简短的价值观肯定练习，结果是改善了 在访问期间非裔美国患者与提供者之间的沟通，并提出改进建议 就诊后6个月服药依从性。我们建议推进我们先前的工作，填补 通过进行随机对照试验比较价值肯定练习和对照获得的证据 三大卫生系统1100例高血压患者运动情况调查主要结局是6个月。 降压治疗依从性的改变与血压改变的次要结果。 我们还将探索干预效果的可能机制，并正式评估传播情况。 在目标1中，我们将比较价值观肯定练习和控制练习的效果 非裔美国患者在三种临床环境下的抗高血压药物依从性。我们 假设患者随机接受价值肯定将在6个月内有更大的依从性变化 与对照组相比，效果将部分受患者因素的影响(先前的经验 歧视)，独立于提供者因素(隐性种族偏见、过去的差异培训、自我 照顾少数族裔患者的效果)，并由患者激活进行调解。 在目标2中，我们将比较非裔美国人患者的价值观肯定练习与其 对白人高血压患者的影响。我们假设价值观的肯定程度会提高 非洲裔美国人患者的依从性更高，这表明干预是有针对性的 感觉到的与种族有关的歧视。 在AIM 3中，我们将使用RE-AIM正式评估广泛传播的干预措施 (覆盖范围、有效性、采用、实施和维护)框架。我们假设 干预措施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。由于价值观肯定并不是高血压或非裔美国人所特有的，这项研究将 第一个为可能减少医疗保健的低资源干预提供证据 在广泛的卫生保健条件和人群中存在差异。

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.