Background. Hypertension (HTN) is a significant public health problem that affects nearly a billion people worldwide and explains the most variance in the racial gap in mortality between blacks and whites. Successful management of HTN is often achieved through drug therapy and lifestyle change. For example, evidence- based lifestyle interventions like the NHLBI-funded Dietary Approaches to Stop Hypertension (DASH) eating plan have been shown to improve HTN control in black patients compared to whites. Yet, adherence to lifestyle change interventions still remains low; a potential explanation is that these decisions are not preference-based. Little is known about the impact of preferences on adherence to lifestyle change interventions for black patients with HTN. This K01 provides a unique opportunity to address this gap in the literature. Candidate Overview. My long-term career objective is to become an independent investigator who specializes in attenuating health disparities by studying the health care and communication preferences of patients. My short-term objective is to perform research to improve HTN management in black adults. Historically, I have done work in cancer; however, I now seek to expand my research portfolio to include cardiovascular disease broadly and hypertension specifically. Career Development and Training Plan. My educational program includes: a) structured course work, b) professional conferences pertinent to my interests, c) directed readings, d) shadowing of clinicians, and e) a research project with specific aims timed to coincide with these activities. Structured mentorship with national experts including Dr. Scott Braithwaite (medical decision making), Dr. Olugbenga Ogedegbe (hypertension, Dr. Angela Fagerlin (shared decision making), and Dr. Donna Shelley (implementation science) will promote my continued publication of manuscripts, presentations at academic meetings, and an R01 application. Research Strategy. To accomplish my aims, I will use qualitative methods (in Aims 1 and 2) including focus groups with black patients and interviews with clinicians, leading to the development of a decision support tool (in Aim 3) for which I will test the feasibility and usability of the tool to enhance preference-concordant decision making in black patients and shared decision making with their clinicians.
This K award proposal will enable me to elucidate important preferences of black patients and clinicians related to hypertension (HTN) management, with particular attention paid to lifestyle change interventions, building towards a decision support tool to facilitate preference-concordant decisions. With increased preference- concordant decisions for HTN management, it is likely that racial gaps in HTN mortality and morbidity between blacks and whites will be reduced over time.
