African Americans (AAs) have the highest age-adjusted death rates from major cardiovascular diseases of all racial groups. Many race-related factors contribute to AAs' high rates of CVD. For example, exposure to interpersonal and structural racism contributes to chronic stress, negative emotional states, and poor health behaviors, which, in turn, lead to adverse cardiovascular outcomes. AAs with racially discordant providers experience poorer interpersonal processes of care (less shared decision-making and psychosocial talk) and report lower levels of trust than AAs with same race providers. The candidate's long-term hypothesis is: inviting AA patients to discuss their experiences of racism visit will strengthen the therapeutic relationship and thereby improve AAs' cardiovascular outcomes. Drawing on social cognitive theory and contact theory, the candidate proposes to develop and test a feasible and acceptable method for health care providers to communicate about racism with AA patients. We focus on US born, non-Hispanic, AA patients, because they have the worst cardiovascular health outcomes, and, as a group, longstanding exposure to racism. For providers, we focus on White residents because (1) most health care providers are White; (2) the literature shows that race-discordant relationships have poorer interpersonal processes of care; (3) residents are actively building their communication skills and responsiveness to diverse populations, and (4) residents may have less entrenched behaviors than practicing physicians.
In Aim 1, the candidate will conduct focus groups with AA patients and White residents training in Internal Medicine, Med-Peds, and Family Medicine to identify attitudes about and barriers to discussing racism. Then, in Aim 2, the candidate will develop an intervention to communicate about racism that improves residents' self-efficacy and outcome expectancies, prior to pilot testing the intervention in Aim 3. A community advisory board will advise the candidate throughout the research process. The candidate's long-term career goal is to become an independent investigator who reduces racial disparities by developing innovative evidence-based interventions to address the multiple mechanisms through which racism adversely affects health. The career development plan includes training in advanced qualitative and quantitative methods, community engaged research and concept mapping, communication about racism, implementation science, and clinical research. The candidate has an exceptional team of mentors and advisors who are distinguished scholars in the aforementioned areas. The candidate is well-positioned to conduct this research, which will transition her to independence as an investigator and lay the foundation for a large-scale randomized trial. She has access to a rich academic environment, which includes a department with a strong record of publications and extramural funding, an excellent School of Public Health, a Clinical and Translational Science Institute that invests in junior faculty, and a state-of-the art Simulation Center.
This study focuses on the well-established, but under-addressed, relationship between racism and health via the patient-provider therapeutic relationship. This project will increase health care providers' knowledge of racism as a health risk factor and equip them with the language, tools, and skills that they need to support their African American patients. By demonstrating a willingness to discuss racism, health care providers may be able to improve the therapeutic relationship with African American patients, which will ultimately improve cardiovascular outcomes.
