An Intervention to Improve Communication Between Physicians and Minority Patients With Hypertension

Not Applicable

Completed

• Conditions: Hypertension
• Interventions: Behavioral: Self-affirmation exercise; Behavioral: Control

• Registration Number: NCT01037920
• Lead Sponsor: Denver Health and Hospital Authority

Brief Summary

The objective of the project is a test-of-concept of an intervention to reduce the effects of the perception of discrimination on the care of patients with chronic illness. Perception of discrimination manifests itself as stereotype threat. We hypothesize that stereotype threat impairs communication between minority patients and their physicians because of increased stress and diminished trust, resulting in interactions that are less successful at enhancing patient self-efficacy, in turn resulting in lower rates of adherence with anti-hypertensive medication.

The intervention is a self-affirmation exercise performed prior to a patient-physician visit. A similar intervention has been shown to reduce the racial gap in academic performance in middle school classrooms.

We will explore the mechanistic effects of the intervention by analysis of audiotapes of patient-provider visits following the intervention. We will measure the effect of the intervention on minority hypertensive patients' adherence with antihypertensive medication and blood pressure.

We will enroll 200 African American and Latino patients with hypertension and randomize 100 patients to perform the exercise and 100 patients to perform a null control exercise before the visit. We will assess change in patient's adherence with antihypertensive medications and in blood pressure over the six months following the index visit. In order to better understand the effects of the intervention we will measure subject's mood following the exercise, and self-reported stress levels, trust in the physician, and medication self-efficacy following the visit. We will also assess the quality of the patient-provider interaction from detailed analysis of audiotapes and from patient questionnaires. Following a subsequent patient-physician visit, we will conduct telephone interviews with patients to assess for persistence of any effects of the intervention.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2009-12-18
• Study First Submitted QC: 2009-12-18
• Study First Posted: 2009-12-23
• Study Start: 2010-01
• Primary Completion: 2011-12
• Study Completion: 2011-12
• Status Verified: 2012-07
• Last Update Submitted: 2012-07-11
• Last Update Posted: 2012-07-13

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 179

Inclusion Criteria

• diagnosis of hypertension
• age > 21 years
• use of Denver Health as their usual source of care and pharmacy services
• self-described race/ethnicity of African American or Latino
• ability to provide informed consent

Exclusion Criteria

• pregnancy-related hypertension
• end-stage renal disease
• unable to speak or write English at at least a 6th grade level.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Intervention	Self-affirmation exercise	subjects in the intervention arm will complete a self-affirmation exercise prior to a physician visit
Control	Control	subjects in the intervention arm will complete a sham exercise prior to a physician visit

Primary Outcome Measures

Name	Time	Method
medication adherence	6 months

Secondary Outcome Measures

Name	Time	Method
Blood pressure	3-6 months

Trial Locations

Locations (1)

Denver Health Medical Center; 🇺🇸 Denver, Colorado, United States