Multiethnic Perspectives of Shared Decision Making in Hypertension

项目总结/摘要 高血压（HTN）是心脏病和中风的主要危险因素，每天导致约1,000人死亡 持续存在种族/民族差异。高患病率和HTN控制率差是常见的， 黑人（57%，37%）和西班牙裔（45%，42%），而白人（44%，46%）在美国。共享决策 决策（SDM）是一种临床医生和患者使用最佳可用方案共同做出决策的方法 证据，沿着患者的偏好和价值观，并且是改善HTN控制的可能策略。小 了解种族/民族对SDM实践的影响或SDM对种族上HTN控制的影响 不同的群体。为了解决这一差距，申请人建议进行混合方法解释性顺序 从多种族HTN患者的角度研究SDM在HTN管理中的作用。这 论文研究将在父研究，丰富的生活项目。具体目标包括：1） 检查SDM、血压水平变化和自我报告的种族之间的关系， HTN患者的种族; 2）检查在12个月时预测SDM的决策的基线决定因素， 包括社会人口统计学和临床特征，对决策的感知（即，HTN知识）， 对重要他人的感知（即，满意度和对供应商的信任），以及制定和实施 3）从具有高/低SDM评分的HTN患者的角度探索SDM在BP管理中的作用， 12个月内BP水平改善/无改善; 4）描述SDM在BP管理中的作用 与SDM分数和BP水平相关的上下文。这项研究将分三个阶段进行。在第一阶段， 将分析母研究在基线和12个月随访时收集的定量数据。这些结果 然后，将指导家长研究参与者有目的地抽样参加半结构化访谈， 在第二阶段获得定性数据。定性数据将用于帮助解释第1阶段的结果。在 第三阶段，将整合定量和定性数据。本研究将采用固定设计方法， 这些方法是在计划阶段预先确定的，其具体目的是将定性和定量相结合 接近。采用混合方法加强对文化和背景因素的理解 在HTN中影响SDM是创新的，将为文化一致的干预措施的发展提供信息， 促进对高血压和高营养不良的控制，减少种族/民族差异。这项研究和拟议的培训计划将提供 在多民族人群中进行混合方法研究的基本经验和技能， 健康差距。拟议的学习和培训计划将允许申请人发展成为一名护士科学家 他将领导跨学科研究，通过SDM改善心血管风险管理。拟议 一项研究涉及国家护理研究所的“健康：促进健康和预防 疾病”领域的科学重点，并将增加对种族，民族和 影响SDM的其他因素以及SDM与HTN控制的关系。

Project Summary/Abstract Hypertension (HTN) is a major risk factor for heart disease and stroke, contributing to about 1,000 deaths a day with persistent racial/ethnic disparities. Higher prevalence and poor HTN control rates are common among Blacks (57%, 37%) and Hispanics (45%, 42%), compared to Whites (44%, 46%) in the US. Shared decision making (SDM) is an approach where clinicians and patients make decisions together using the best available evidence, along with patients' preferences and values, and is a possible strategy to improve HTN control. Little is known about the influence of race/ethnicity on SDM practices or the impact of SDM on HTN control in ethnically diverse groups. To address this gap, the applicant proposes to conduct a mixed methods explanatory sequential study to examine SDM in HTN management from the perspectives of multiethnic patients with HTN. This dissertation study will be conducted within the Parent Study, the RICH LIFE Project. Specific aims include: 1) Examine the relationship between SDM, change in level of blood pressure (BP), and self-reported race and ethnicity in patients with HTN; 2) Examine baseline determinants of decision that predict SDM at 12 months, including sociodemographic and clinical characteristics, perception of the decision (i.e., HTN knowledge), perception of important others (i.e., satisfaction and trust in providers), and resources to make and implement decisions; 3) Explore SDM in BP management from the perspective of HTN patients with high/low SDM scores, and improvement/no improvement over 12 months in level of BP; 4) Describe SDM in the BP management context in relation to SDM score and BP level. This study will be carried out in three phases. During Phase 1, quantitative data collected in the Parent Study at baseline and 12 month follow up will be analyzed. These results will then guide purposeful sampling of Parent Study participants for participation in semi-structured interviews to obtain qualitative data in Phase 2. Qualitative data will be used to help explain the findings from Phase 1. In Phase 3, quantitative and qualitative data will be integrated. The study will follow a fixed-design approach since the methods are predetermined during the planning phase with a specific intent to mix qualitative and quantitative approaches. The application of mixed methods to enhance understanding of the cultural and contextual factors influencing SDM in HTN is innovative and will inform the development of culturally congruent interventions to promote HTN control and reduce racial/ethnic disparities. This study and proposed training plan will provide foundational experience and skills in mixed methods research among multiethnic populations experiencing health disparities. The proposed study and training plan will allow the applicant to develop into a nurse scientist who will lead interdisciplinary research to improve cardiovascular risk management through SDM. The proposed study addresses the National Institute of Nursing Research's “Wellness: Promoting Health and Preventing Illness” area of scientific focus and will add to the scientific knowledge base on the impact of race, ethnicity, and other factors on SDM and the relationship between SDM and HTN control.