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JMIR Res Protoc. 2019 Mar 25;8(3):e12498. doi: 10.2196/12498.

Using Values Affirmation to Reduce the Effects of Stereotype Threat on Hypertension Disparities: Protocol for the Multicenter Randomized Hypertension and Values (HYVALUE) Trial.

Author information

1
University of Colorado Denver, School of Medicine, Department of Medicine, Division of Cardiology, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States.
2
Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD, United States.
3
Denver Health and Hospital Authority, Department of Medicine, Denver, CO, United States.
4
Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States.
5
University of Colorado Denver, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States.
6
University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, United States.
7
University of Colorado School of Medicine, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Denver Health and Hospital Authority, Department of Medicine, Denver, CO, United States.

Abstract

BACKGROUND:

Medication nonadherence is a significant, modifiable contributor to uncontrolled hypertension. Stereotype threat may contribute to racial disparities in adherence by hindering a patient's ability to actively engage during a clinical encounter, resulting in reduced activation to adhere to prescribed therapies.

OBJECTIVE:

The Hypertension and Values (HYVALUE) trial aims to examine whether a values-affirmation intervention improves medication adherence (primary outcome) by targeting racial stereotype threat.

METHODS:

The HYVALUE trial is a patient-level, blinded randomized controlled trial comparing a brief values-affirmation writing exercise with a control writing exercise among black and white patients with uncontrolled hypertension. We are recruiting patients from 3 large health systems in the United States. The primary outcome is patients' adherence to antihypertensive medications, with secondary outcomes of systolic and diastolic blood pressure over time, time for which blood pressure is under control, and treatment intensification. We are comparing the effects of the intervention among blacks and whites, exploring possible moderators (ie, patients' prior experiences of discrimination and clinician racial bias) and mediators (ie, patient activation) of intervention effects on outcomes.

RESULTS:

This study was funded by the National Heart, Lung, and Blood Institute. Enrollment and follow-up are ongoing and data analysis is expected to begin in late 2020. Planned enrollment is 1130 patients. On the basis of evidence supporting the effectiveness of values affirmation in educational settings and our pilot work demonstrating improved patient-clinician communication, we hypothesize that values affirmation disrupts the negative effects of stereotype threat on the clinical interaction and can reduce racial disparities in medication adherence and subsequent health outcomes.

CONCLUSIONS:

The HYVALUE study moves beyond documentation of race-based health disparities toward testing an intervention. We focus on a medical condition-hypertension, which is arguably the greatest contributor to mortality disparities for black patients. If successful, this study will be the first to provide evidence for a low-resource intervention that has the potential to substantially reduce health care disparities across a wide range of health care conditions and populations.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT03028597; https://clinicaltrials.gov/ct2/show/NCT03028597 (Archived by WebCite at http://www.webcitation.org/72vcZMzAB).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):

DERR1-10.2196/12498.

KEYWORDS:

African Americans; health care disparities; hypertension; medication adherence; social values

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