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Using Values Affirmation to Reduce the Effects of Perceived Discrimination on Hypertension Disparities (NCT03028597)

National Heart, Lung, and Blood Institute (NHLBI)
University of Colorado, Boulder
Kaiser Permanente
Denver Health and Hospital Authority
The objective of this study is to reduce the effects of stereotype threat on the adherence of African American patients with hypertension. The specific aims of this study, which employs a values affirmation intervention, are to: 1. Compare the effects of the values-affirmation exercise to a control condition on antihypertensive medication adherence in African American patients with uncontrolled hypertension across three clinical settings, 2. Compare the effects of the values-affirmation exercise on antihypertensive medication adherence in African American patients and white patients with uncontrolled hypertension and similar socioeconomic characteristics, and 3. Evaluate the intervention for widespread dissemination using the RE-AIM (reach, effectiveness, adoption, implementation and maintenance) framework
  • Behavioral: Intervention Values Affirmation
    Participants are asked to circle the two or three values that are MOST important to them. Next, participants are asked to think about times when the values chosen might be important to THEMSELVES and then write a few sentences to describe when and why they might be important.
    • Behavioral: Control Values Affirmation
      Participants are asked to circle the two or three items that are LEAST important to them. Next, participants are asked to think about times when the values chosen might be important to SOMEONE ELSE and then write a few sentences to describe when and why they might be important.
      Ages eligible for Study
      21 Years to 100 Years
      Genders eligible for Study
      All
      Accepts Healthy Volunteers
      Accepts Healthy Volunteers
      Inclusion Criteria:
      • Hypertension diagnosis
      • Patient at DHHA or Kaiser Permanente of Colorado/Mid-Atlantic States
      • White or African American, self-reported race
      Exclusion Criteria:
      • Pregnancy-related hypertension
      • Hypertension relating to dialysis-dependent end-stage renal disease
      • No special classes of vulnerable subjects will be enrolled
      One in 3 US adults has hypertension and African Americans are disproportionately affected; almost 40% of non-Hispanic blacks have hypertension. Although the rates of uncontrolled hypertension have been decreasing in all groups, African Americans continue to have higher rates of uncontrolled hypertension compared to white Americans. The Institute of Medicine, World Health Organization and others have identified poor adherence to medications as the most significant, modifiable contributor to uncontrolled hypertension.

      Stereotype threat may contribute to low adherence. Stereotype threat occurs when cues in the environment (such as visiting a doctor's office) trigger the threat of confirming, as self-characteristic, a negative stereotype about one's group. Although any individual may experience stereotype threat, African Americans are at greater risk due to widespread racism and past experiences of discrimination.

      Values affirmation interventions reduce stereotype threat and decrease racial disparities in various outcomes. Values affirmation exercises typically ask participants to write a few sentences about their core values. By focusing on values that are important to them, values affirmation bolsters a person's self-concept by helping them view themselves as adequate, effective, and able to control important outcomes in spite of a possible threat.

      Based on the evidence supporting the effectiveness of values affirmation in educational and other settings, the investigators hypothesize that values affirmation can similarly reduce racial disparities in medication adherence and subsequent health outcomes. By asking participating intervention patients to engage in a values affirmation exercise at an initial appointment with a primary care provider, the investigators hope to improve hypertensive medication adherence, systolic blood pressure, time under blood pressure control, and treatment intensification, and to reduce racial disparities in these outcomes.

      3 locations

      United States (3)
      • Denver Health and Hospital Authority
        recruiting
        Denver, Colorado, United States, 80204
      • Kaiser Permanente of Colorado
        not yet recruiting
        Denver, Colorado, United States, 80205
      • Kaiser Permanente Mid Atlantic States
        not yet recruiting
        Rockville, Maryland, United States, 20852
      Status:
      recruiting
      Type:
      Interventional
      Phase:
      -
      Start:
      31 December, 2016
      Updated:
      18 January, 2017
      Participants:
      1330
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