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.