Background and Objective: Poor disease self-management in chronic diseases is a problem and is associated with poorer health outcomes and higher health care resource utilization. Compared to Caucasians, African-Americans have even poorer disease self-management and worse outcomes in most chronic diseases. Patients often do not perceive disease severity and susceptibility to disease complications since severe symptoms of chronic conditions such as such as gout, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) etc. are usually intermittent. Our objective is to develop a patient-centered, culturally relevant narrative intervention, or "storytelling", based on the Health Belief Model (HBM) for behavior change, using narrative communication theory as methodological framework for intervention delivery.
We aim to improve disease self-management among African-American Veterans, using gout as our "test case". Storytelling in the patient's own voices has the power to directly and more effectively help patients overcome intrapersonal and structural barriers and reinforce the benefits associated with optimal gout self-management. While shown to be successful in hypertension, an asymptomatic chronic disease, no evidence of efficacy of storytelling intervention exists for chronic symptomatic diseases, such as COPD, CHF, gout etc. Project Objectives and Aims: Our long-term objective is to improve health outcomes in Veterans and reduce health disparities. The objective of the proposed study, the first step in this direction, i to develop a novel storytelling intervention in Veterans'own voices to improve disease self-management and outcomes in African- American Veterans with gout, the most common type of inflammatory arthritis in Veterans, associated with significant pain and suffering, utilization and cost.
Our Specific Aim (SA)s are: SA1, Formatively Identify Components of a Video Intervention - Conduct formative evaluations with patient interviews to develop a theory-based, culturally-relevant storytelling intervention to promote disease self-management among African-American Veterans with gout;SA2, Create an Intervention Video - Develop and test the feasibility of a storytelling intervention based on the results of Specific Aim 1;and SA3, Develop a Video Storytelling Manual - Develop a manual for use by investigators that describes the storytelling concept and presents step-by-step procedures for creating Video storytelling interventions. Project Methods:
For Aim#1, we will perform in-depth interviews in 36 African-American veterans with gout at Birmingham and Philadelphia VA using HBM probes to identify barriers and facilitators to optimal gout self- management.
For Aim#2, we will create an intervention video by inviting 12-15 storytelling stars from our qualitative work in Aim#1, chosen due to their eloquence and persuasive of their stories, videotaping the stories, decomposing into story units, rating stories on constructs of HBM and narrative communication theory, adding didactic material as "Learn more" section using material developed for patients, testing feasibility in focus groups in 32 African-American veterans with gout at Birmingham and Philadelphia VA, iteratively refining and finalizing the storytelling intervention alongside a control intervention.
For Aim #3, we will develop a storytelling manual to be made available to other investigators and present HSR&D Cyber seminars for knowledge dissemination. Alignment with VA mission and priorities: This study serves the VA's mission of improving the health of veterans and by focusing on understudied minorities with poorer disease outcomes, addresses a priority area of health disparities. The results of this study will lead to a low cost patient-centered intervention for African- American Veterans with gout to improve patient outcomes, that we propose to test in a future randomized trial. Gout will serve as a "use case" for chronic disease self-management. If successful, the storytelling intervention can be adapted to other chronic symptomatic diseases such as COPD, CHF etc.
Health disparities are common, and disease outcomes in African-American Veterans with chronic conditions are worse than Caucasian Veterans. Severe symptoms (flares) of chronic symptomatic diseases such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), gout etc. are usually intermittent. Therefore, patients often do not perceive disease severity and the risk of disease complications, which contributes to poor chronic disease self-management. Gout, the most common type of inflammatory arthritis in Veterans, associated with significant morbidity, utilization and cost, will be used as an example of chronic symptomatic diseases with intermittent flares. In this study, we will develop a novel, low cost, patient- centered intervention for African American Veterans with gout to improve patient outcomes, i.e., a storytelling video intervention and a storytelling manual. Storytelling in the patient's own voices has the power to directly and more effectively address patients'barriers to optimal disease management and reinforce its benefits.