PROJECT SUMMARY / ABSTRACT
African Americans (AAs) have the highest age-adjusted death rates from major cardiovascular diseases of all
racial groups. Many race-related factors contribute to AAs' high rates of CVD. For example, exposure to
interpersonal and structural racism contributes to chronic stress, negative emotional states, and poor health
behaviors, which, in turn, lead to adverse cardiovascular outcomes. AAs with racially discordant providers
experience poorer interpersonal processes of care (less shared decision-making and psychosocial talk) and
report lower levels of trust than AAs with same race providers. The candidate's long-term hypothesis is: inviting
AA patients to discuss their experiences of racism visit will strengthen the therapeutic relationship and thereby
improve AAs' cardiovascular outcomes. Drawing on social cognitive theory and contact theory, the candidate
proposes to develop and test a feasible and acceptable method for health care providers to communicate
about racism with AA patients. We focus on US born, non-Hispanic, AA patients, because they have the worst
cardiovascular health outcomes, and, as a group, longstanding exposure to racism. For providers, we focus on
White residents because (1) most health care providers are White; (2) the literature shows that race-discordant
relationships have poorer interpersonal processes of care; (3) residents are actively building their
communication skills and responsiveness to diverse populations, and (4) residents may have less entrenched
behaviors than practicing physicians. In Aim 1, the candidate will conduct focus groups with AA patients and
White residents training in Internal Medicine, Med-Peds, and Family Medicine to identify attitudes about and
barriers to discussing racism. Then, in Aim 2, the candidate will develop an intervention to communicate about
racism that improves residents' self-efficacy and outcome expectancies, prior to pilot testing the intervention in
Aim 3. A community advisory board will advise the candidate throughout the research process. The
candidate's long-term career goal is to become an independent investigator who reduces racial disparities by
developing innovative evidence-based interventions to address the multiple mechanisms through which racism
adversely affects health. The career development plan includes training in advanced qualitative and
quantitative methods, community engaged research and concept mapping, communication about racism,
implementation science, and clinical research. The candidate has an exceptional team of mentors and advisors
who are distinguished scholars in the aforementioned areas. The candidate is well-positioned to conduct this
research, which will transition her to independence as an investigator and lay the foundation for a large-scale
randomized trial. She has access to a rich academic environment, which includes a department with a strong
record of publications and extramural funding, an excellent School of Public Health, a Clinical and Translational
Science Institute that invests in junior faculty, and a state-of-the art Simulation Center.