Disparities in chronic condition self-management (CCSM) experienced by older African Americans stem, to a significant degree, from their complex challenges in CCSM and physicians' poor understanding of and/or empathy for those challenges. For physicians to assist older African Americans to optimize CCSM, they must have at least a better understanding of the complex and unique CCSM challenges faced by their patients. Patients' stories have been used increasingly to promote knowledge sharing, understanding, and reflective listening across diverse groups, as well as to foster successful behavior change among CCSM patients. However, patients' stories have not yet been used to promote physicians' understanding of the life circumstances of older African American patients who struggle with CCSM. To develop an effective story approach for large-scale use, however, we first need to better understand the experience of CCSM among older African Americans, how that experience can be translated into stories for medical education, and how such stories work or not to enhance physician understanding and improve care. Those steps are necessary to improve CCSM practice with older African American patients. The long-term goals of the proposed research are to (1) address these gaps in knowledge by creating and curating a library of validated digital CCSM stories of older African Americans that effectively enhance physicians' understanding and care interactions; and (2) sustain engagement in related research at the intersection of CCSM and minority aging by graduate and undergraduate occupational therapy students and faculty.
The specific aims of the proposed R15 study are to (1) collect and analyze personal stories from older African Americans and transform them into digital narratives (videos) that reflect the most important CCSM challenges they face, and to (2) evaluate the concordance between story content and medical students' understanding of the stories. To address Aim 1 we will conduct focus groups (n = 6, 5-8 participants each) to collect older African Americans' narrative descriptions of CCSM challenges. We will analyze those narrative data to determine their core dimensions and rhetorical structure. That narrative content and structure will be validated by an expert panel (including older African Americans) and then translated into brief video stories enacted by older African Americans. To achieve Aim 2, we will use questionnaires and cognitive interviews with medical students (after video viewing) to determine their understanding of story content as well as factors that may explain variations in understanding.
Aim 2 analysis will focus on examining rates of concordance between story and student understanding, and correlations between concordance and variables that could account for its variation, such as story dimensions, student ethnicity/race, and empathy scores. Open-ended responses on the questionnaire and cognitive interview data will be analyzed to further understand patterns in medical student understanding and their potential causes.
Older African Americans have higher rates of chronic health conditions and face substantive challenges with chronic condition self-management (CCSM), yet those challenges are poorly understood by their physicians. To bridge this gap in understanding and improve care and health outcomes for older African Americans, this project will collect their stories of CCSM, extract the most important messages of those stories, and develop brief videos communicating those messages. We will then examine the ability of medical students to understand those messages and other factors that might explain misunderstanding in particular.
