# Storytelling for Reducing Gap in AC Use in African Americans with Atrial Fibrillation

> **NIH NIH R21** · UNIV OF MASSACHUSETTS MED SCH WORCESTER · 2024 · $248,434

## Abstract

Six million Americans suffer from atrial fibrillation (AF), a heart rhythm abnormality that is a major risk factor
for stroke. Despite this, only half of eligible AF patients receive anticoagulation (AC) treatment. The gap in AC
use is even larger for African-Americans with their use ranging 10-22% less compared to Whites and
Hispanics. Storytelling is one promising patient facing intervention to promoting initiation of and persistence
with AC in African-American patients. According to the Slater Model of Narrative Communication, two
constructs facilitate behavior change. They include homophily, or identification with the characters in a
storytelling narrative, and transportation, or absorption into a story line. Using this model, we posit that a
patient not on AC watching stories of patients who initiated or resumed AC after hesitancy or setback will
develop more accurate risk perception, increased belief in AC benefit, and decreased perceived barriers to
using AC. Through story development groups (focus groups geared to identify compelling stories and star
storytellers) of African-American patients, we will generate material for a storytelling intervention. We then
propose to conduct a pilot and feasibility trial of the storytelling intervention with African-American patients
who are not adherent to AC. In the trial, we will assess intervention fidelity and transportation, measure
recruitment and retention, and follow trends in initiation and persistence with AC that will inform a larger trial.
Specific Aims. Aim 1: (Story Development) In accordance with the Adapted Slater and Health Belief
models, develop a storytelling intervention for promoting initiation of and persistence with AC among African
American patients. Aim 1a: (Selection of Storytellers and Stories) Convene story development groups with
patients from our two study sites (n=33 total). In these groups, we will inquire about patients’ experiences with
initiation of and persistence with AC; through this inquiry, we will identify initiation/persistence challenges,
compelling stories which illustrate these challenges, and adaptive coping strategies used by patients and
“star” storytellers. Aim 1b: (Filming Stories) Create an interview guide to re-elicit the most compelling
stories from each star storyteller (n=10) in greater detail and then conduct individual videotaped interviews
with each star. Aim 1c: (Video analysis and rating) Conduct thematic analysis of the videotaped interview
to identify key story units; a patient advisory panel will rate the units to identify those which will make it into
final videos. Aim 2 (Randomized trial) – Assign eligible patients in 1:1 ratio to watch intervention vs. control
videos (comparison, didactic videos without stories). Eligible patients include African-American patients with
AF not on AC but recommended to use AC in the past one year (n=40; 20 intervention and 20 control
patients). Aims 2a: (Fidelity and transportation) Measure time spent vie...

## Key facts

- **NIH application ID:** 10840965
- **Project number:** 5R21MD017646-02
- **Recipient organization:** UNIV OF MASSACHUSETTS MED SCH WORCESTER
- **Principal Investigator:** Alok Kapoor
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $248,434
- **Award type:** 5
- **Project period:** 2023-05-13 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10840965

## Citation

> US National Institutes of Health, RePORTER application 10840965, Storytelling for Reducing Gap in AC Use in African Americans with Atrial Fibrillation (5R21MD017646-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10840965. Licensed CC0.

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