Still Climbin’: A Randomized Controlled Trial of an Intervention to Improve Coping with Discrimination, Address Medical Mistrust, and Reduce Health Disparities among Black Sexual Minority Men

Abstract: Black men, especially Black sexual minority men (SMM), are negatively affected by health and healthcare disparities: They show worse outcomes for preventable conditions and preventable complications from chronic conditions, and are less likely to engage with healthcare than are White men and women. Moreover, Black SMM display strikingly high rates of HIV and other sexually transmitted infections. Based on evidence-based theory that discrimination contributes meaningfully to disparities, we propose to conduct a randomized controlled trial (RCT) of an 8-session culturally congruent cognitive behavior therapy group intervention, Still Climbin’, which aims to increase effective coping responses to discrimination (from intersectional race and sexual minority identities) and reduce medical mistrust among Black SMM, with the goal of improving healthcare engagement and receipt of evidence-based preventive care. Still Climbin’ has a strong scientific basis in our prior pilot work, which found that the proposed intervention is acceptable to key stakeholders, feasible to conduct, and associated with improved effective coping. The specific aims are: (1) To conduct a randomized controlled trial to test the effects of Still Climbin’, a culturally congruent cognitive behavior therapy group intervention, on healthcare engagement (e.g., at least one ambulatory visit in the past 6 months) and receipt of evidence-based preventive care (e.g., chronic disease screenings) among Black sexually minority men; (2) To examine mechanisms of the intervention’s effects on improved healthcare engagement and receipt of evidence-based preventive care, including more effective coping skills and reduced medical mistrust; and (3) To examine potential moderators of the intervention’s effects (e.g., age, HIV-serostatus and other health conditions). In the context of established community-academic partnerships, we will conduct the RCT with 300 Black SMM, randomizing 150 to the intervention group and 150 to a wait-list control group. Participants will complete surveys at baseline and 3-, 6-, and 12-months post-baseline to assess the primary outcomes, and potential mediators, covariates, and moderators. Healthcare engagement, receipt of evidence-based care, and health conditions will be verified with medical records. With the exception of our own work, we are not aware of any interventions that address coping with discrimination from intersectional identities in order to improve health outcomes among Black SMM. Our research is consistent with Healthy People 2020, which recommends developing interventions to address effects of discrimination among sexual minority individuals. Although structural-level interventions are critical for reducing societal discrimination as a long-term strategy, individual- level interventions—such as Still Climbin’—are needed in tandem to reduce discrimination’s immediate health effects.

Project Number:5R01MD014722-03

https://reporter.nih.gov/search/o5468n5DokOS3FYxFf7EXw/project-details/10307134

Contact PI/ Project Leader

BOGART, LAURA M, SENIOR BEHAVIORAL SCIENTIST (LBOGART@RAND.ORG)

Organization