Evidence is mounting that poor communication between doctor and patient during the medical encounter is a major driver of minority health disparities. Minority patients experience disproportionate difficulty with communication during doctor visits. The quality of communication during the medical interaction is associated with patients' biomedical outcomes including control of high blood pressure, hyperglycemia, pain, and side effects of cancer chemotherapy. In this three-year study, we will conduct a randomized control trial in people with diabetes and hypertension enrolled in the outpatient clinics of an urban public hospital (Cooper Green Hospital in Birmingham, AL) to test an intervention aimed at enabling them to communicate more effectively with their doctors. The study will determine if participating in formal """"""""How to Talk to Your Doctor (and get your doctor to talk to YOU)"""""""" (HTTTYD) communication training delivered by lay health educators is beneficial by comparing persons randomly assigned to receive such training with those randomized to usual care. We will test the hypothesis that people with diabetes and hypertension randomized to participate in HTTTYD communication training (n =250) are significantly more likely at six months to show a decline in their glycosylated hemoglobin by >1 percentage point and/or a decline of >10 mm Hg systolic blood pressure compared with people randomized to usual care (n =250). The study is powered to have an 80% likelihood of being able to detect a difference of 14% in the proportion of patients who manifest improvements of that magnitude. Secondary hypotheses are that, compared with those randomized to usual care, people with diabetes and hypertension randomized to participate in HTTTYD communication training are significantly more likely to report a) improvements in their use of effective communication behaviors during doctor visits; b) increases in their level of trust in and satisfaction with their doctors; c) improvements in their self-management behaviors; and d) improvements in their adherence to medications prescribed for diabetes and hypertension. The overall goal of this research is to improve minority health and reduce minority health disparities by testing an inexpensive and widely-applicable means of enabling patients to be more effective partners in the doctor-patient relationship. Diabetes and hypertension affect African Americans disproportionately; glycemic and blood pressure control can reduce mortality and morbidity.
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