Article

 

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

Downloadable Content

Download PDF
https://scholar.colorado.edu/concern/articles/s4655h701
Abstract
  • 1Share to LinkedInShare to PinterestShare to CiteULikeShare to Mendeley

     Citation

    Please cite as:

    Daugherty SL, Vupputuri S, Hanratty R, Steiner JF, Maertens JA, Blair IV, Dickinson LM, Helmkamp L, Havranek EP

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

    JMIR Res Protoc 2019;8(3):e12498

    DOI: 10.2196/12498

    PMID: 30907744

    PMCID: 6452278

    Published on 25.03.19 in Vol 8, No 3 (2019): March

    Preprints (earlier versions) of this paper are available at http://preprints.jmir.org/preprint/12498, first published Oct 12, 2018.

    Protocol

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

    1University 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

    2Kaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research Institute, Rockville, MD, United States

    3Denver Health and Hospital Authority, Department of Medicine, Denver, CO, United States

    4Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, United States

    5University of Colorado Denver, Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora, CO, United States

    6University of Colorado Boulder, Department of Psychology and Neuroscience, Boulder, CO, United States

    7University 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

    Corresponding Author:

    Stacie L Daugherty, MD, MSPH

    University of Colorado Denver

    School of Medicine, Department of Medicine, Division of Cardiology

    Adult and Child Consortium for Health Outcomes Research and Delivery Science

    12605 E. 16th Avenue

    Mailstop B130, PO Box 6511

    Aurora, CO, 80045

    United States

    Phone: 1 303 724 2088

    Fax:1 303 724 2094

    Email: stacie.daugherty@ucdenver.edu

    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.

Creator
Academic Affiliation
Journal Title
Journal Issue/Number
  • 3
Journal Volume
  • 8
Last Modified
  • 2020-07-07
Resource Type
Rights Statement
DOI
ISSN
  • 1929-0748
Language

Relationships

Items