Evidence is mounting that poor communication between doctor and patient during the medical encounter is amajor driver of minority health disparities. Minority patients experience disproportionate difficulty withcommunication during doctor visits. The quality of communication during the medical interaction isassociated 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 trialin 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 communicatemore effectively with their doctors. The study will determine if participating in formal 'How to Talk to YourDoctor (and get your doctor to talk to YOU)' (HTTTYD) communication training delivered by lay healtheducators is beneficial by comparing persons randomly assigned to receive such training with thoserandomized to usual care. We will test the hypothesis that people with diabetes and hypertensionrandomized to participate in HTTTYD communication training (n =250) are significantly more likely at sixmonths to show a decline in their glycosylated hemoglobin by >1 percentage point and/or a decline of >10mm Hg systolic blood pressure compared with people randomized to usual care (n =250). The study ispowered to have an 80% likelihood of being able to detect a difference of 14% in the proportion of patientswho manifest improvements of that magnitude. Secondary hypotheses are that, compared with thoserandomized to usual care, people with diabetes and hypertension randomized to participate in HTTTYDcommunication training are significantly more likely to report a) improvements in their use of effectivecommunication behaviors during doctor visits; b) increases in their level of trust in and satisfaction with theirdoctors; c) improvements in their self-management behaviors; and d) improvements in their adherence tomedications prescribed for diabetes and hypertension. The overall goal of this research is to improveminority health and reduce minority health disparities by testing an inexpensive and widely-applicable meansof enabling patients to be more effective partners in the doctor-patient relationship. Diabetes andhypertension affect African Americans disproportionately; glycemic and blood pressure control can reducemortality and morbidity.
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