StoryGuides-Making Comparative Effectiveness Useful for Vulnerable Patients

描述(由申请人提供)：StoryGudes：使比较有效性对脆弱患者有用将通过讲故事(叙事交流)在文化上调整AHRQ比较有效性患者指南(指南)，在随机试验中测试其使用情况，并积极促进积极、广泛的传播。尽管《指南》写得很清楚，临床上也很可靠，但行为改变，特别是在弱势群体中的行为改变，需要积极和创新的传播，否则就会错过它们的好处。更具体地说，我们将调整并向在库珀绿色医疗系统(CGHS)接受治疗的非裔美国高血压(HTN)和糖尿病(DM)患者提供比较有效性内容，CGHS是阿拉巴马州伯明翰的市中心安全网设置。相关指南包括那些关注心血管风险的指南，如HTN、DM和高脂血症。指南中的内容将被制作成从社区中提取的讲故事的剧集，并以数字视频光盘(DVD)的形式呈现。我们以前的工作表明，这种方法是强大和有效的。我们的具体目标是：(SA1)--利用叙事传播理论的原则和阿什顿患者-医生交流的种族/民族模式，让患者和提供者参与形成工作；(SA2)--在CGHS内针对患有HTN和DM的非裔美国患者的随机对照试验中评估干预措施，将250名患者随机分为干预组(讲故事DVD)和对照组(不讲故事的DVD指南)；(SA3)--为患者、提供者、卫生系统领导人和研究人员开发和部署互联网传播仓库(IDD)。IDD将允许很容易地下载干预产品。我们还将为其他条件、环境和地理区域制作类似产品的交互式逐步指南。对于二次分析，我们将收集服药依从性、自我效能、介入干预的强度、合并症、用药和化验值。正式的调解分析将阐明干预工作的机制。一项经济分析将从不同角度审查传播和制作新的叙事干预措施的成本。我们的团队已经合作了五年多，拥有包括文化能力、行为信息学以及减少健康差距的干预措施的开发和测试在内的专业知识。我们已经：(1)与CGHS的患者和提供者-合作伙伴建立了牢固的关系；(2)维护了注册的患者池，因为他们有兴趣参与新的研究；以及(3)开发了有效的数据收集机制。通过呼吁普遍的人类讲故事的活动，我们的创新工具将加速将指南纳入日常实践。讲故事是一种灵活的干预，很容易适应新的指南和新的患者群体，并很容易传播给广泛的受众。 公共卫生相关性：StoryGuides-使比较有效性对弱势患者有用将开发互动式、文化定制和扫盲适当的干预措施，以促进对弱势人群使用比较有效性信息。这种干预将基于有效而强大的社区讲故事或叙事交流技术。

DESCRIPTION (provided by applicant): StoryGuides: Making Comparative Effectiveness Useful for Vulnerable Patients will culturally adapt the AHRQ Comparative Effectiveness Patient Guides (the Guides) through storytelling (narrative communication), test their use in a randomized trial, and actively promote active, widespread dissemination. Although the Guides are clearly written and clinically sound, behavior change, especially within vulnerable populations, requires active and innovative dissemination, or their benefit will be missed. More specifically, we will adapt and deliver comparative-effectiveness content to African American patients with hypertension (HTN) and diabetes (DM) treated in the Cooper Green Health System (CGHS), an inner-city, safety-net setting in Birmingham Alabama. Relevant Guides include those focused on cardiovascular risk, such as HTN, DM, and hyperlipidemia. Content from the Guides will be developed into storytelling episodes drawn from the community and presented on digital video discs (DVDs). Our previous work has shown that this approach is powerful and effective. Our specific aims are: (SA1) --- Drawing upon the principles of narrative communication theory and the Ashton Racial/Ethnic Model of Patient - Doctor Communication, engage patients and providers in formative work; (SA2) --- Evaluate the intervention in a randomized controlled trial within CGHS for African American patients with HTN and DM by randomizing 250 patients to an intervention group (storytelling DVDs) and 250 patients to a comparison group (Guides on DVDs without storytelling); (SA3) --- Develop and deploy an Internet Dissemination Depot (IDD) for patients, providers, health system leaders, and researchers. The IDD will allow intervention products to be easily downloaded. We will also produce an interactive, step-by-step guide for making similar products for other conditions, settings, and geographic regions. For secondary analyses, we will collect medication adherence, self efficacy, and intensity of intervention engagement, co-morbidity, medications, and laboratory values. Formal mediation analyses will elucidate the mechanisms through which the intervention works. An economic analysis will examine the cost of disseminating and producing new narrative interventions from different perspectives. Our team has been collaborating for over five years, with expertise that includes cultural competency, behavioral informatics, and the development and testing of interventions to reduce health disparities. We have: (1) established solid relationships with patients and provider-partners at CGHS, (2) maintained a pool of patients registered for their interest in participating in new studies, and (3) developed mechanisms for efficient data collection. By appealing to the universal human activity of storytelling, our innovative tools will accelerate the uptake of the Guides into routine practice. Storytelling is a flexible intervention, readily adaptable to new Guides and new patient populations and easily disseminated to broad audiences. PUBLIC HEALTH RELEVANCE: StoryGuides - Making Comparative Effectiveness Useful for Vulnerable Patients will develop interactive, culturally tailored, and literacy appropriate interventions to promote use of comparative effectiveness information to vulnerable populations. The intervention will be based on the effective and powerful technique of community-based storytelling, or narrative communication.