A Mixed Methods Study of Chronic Kidney Disease (CKD) Self-Management

慢性肾脏病 (CKD) 自我管理的混合方法研究

基本信息

批准号：
10200943
负责人：
Sarah Jeanne Schrauben
金额：
$ 4.66万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-03 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10200943
关键词：
Address Adherence Adoption Affect Age Area Award Behavior Biometry Blood Glucose Blood Pressure Monitors Cardiovascular Diseases Characteristics Chronic Kidney Failure Chronic Kidney Insufficiency Clinical Clinical Management Clinical Practice Guideline Clinical Trials Clinical Trials Design Cohort Studies Data Data Analyses Development Dialysis procedure Disease Disease Management Disease Outcome Disease Progression Economic Burden Education End stage renal failure Environment Epidemic Epidemiology Evaluation Feedback Fellowship Funding Grant Guidelines Health Health Technology Health behavior Hypertension Individual Intervention Intervention Studies Intervention Trial Interview Investigation Kidney Longevity Master&apos s Degree Mentored Patient-Oriented Research Career Development Award Mentorship Methods Nature Obesity Outcome Participant Patient Outcomes Assessments Patient Preferences Patients Pennsylvania Persons Physical activity Population Positioning Attribute Postdoctoral Fellow Predictive Factor Publishing Recommendation Research Research Design Research Methodology Research Personnel Research Priority Risk Science Self Management Statistical Data Interpretation Structure Syndrome Technology Testing Time Tobacco Training United States National Institutes of Health Universities Work approach behavior career career development clinical epidemiology cohort comorbidity cost cost effective design experience feasibility trial health economics health literacy healthy lifestyle implementation science improved mHealth multidisciplinary novel strategies patient engagement patient oriented patient oriented research pilot trial prevent programs prototype psychosocial recruit self-management program skills theories therapy design therapy development uptake usability

项目摘要

Chronic kidney disease (CKD) is a growing epidemic, affecting close to 15% of the US population, and is gen- erally progressive, with potentially fatal complications of cardiovascular disease and end-stage kidney disease. Directed treatment of CKD is challenging because CKD is a syndrome with causes that are often not identifia- ble and a dearth of disease-specific interventions. However, there are some cross-cutting approaches that are broadly beneficial for people with CKD, and are recommended by current CKD management guidelines, which include advising patients to engage in self-management behaviors (e.g., monitor blood pressure, maintain physical activity, and avoid tobacco). To date, there has been limited research on self-management in pre- dialysis CKD. The few published studies demonstrate poor uptake of recommended self-management behav- iors, which highlights the need to 1) understand the reasons for substandard engagement in recommended behaviors, and 2) develop and evaluate new approaches to improve CKD self-management. Sarah Schrauben, MD, MSCE, a nephrologist, will target this understudied area in her proposed K23 Award. Dr. Schrauben is positioned to use this award to launch an independently funded research career in the rich environment at the University of Pennsylvania, as she has completed a Masters degree in clinical epidemiology, through which she gained experience in epidemiology, biostatistics, study design, and during her post-doctoral fellowship, conducted a preliminary study on self-management behaviors in a large CKD observational cohort, as well as participated in formal training in qualitative and mixed methods research. Her proposed K23 work will utilize in- depth interviews with CKD patients to understand the influences of participating in health behaviors and identi- fy relevant factors for the design and implementation of a self-management support intervention (Aim 1). In a large cohort of individuals with CKD, Dr. Schrauben will investigate potential predictors of recommended self- management behavior engagement to identify patient characteristics important for a self-management support intervention (Aim 2). Using this information, she will develop a patient-centered self-management support in- tervention harnessing health behavior theory and mobile health (mHealth) technology and then pilot its feasibil- ity (Aim 3). Through her proposed career development, she seeks to gain skills in 1) clinical trial design, im- plementation, and evaluation, 2) mixed research methods, 3) advanced statistical analyses, including the longi- tudinal data analyses from the pilot trial, while garnering expertise in 4) implementation science, and 5) health behavior research. To achieve these objectives, Dr. Schrauben has assembled a multi-disciplinary mentorship team led by national experts in renal epidemiology, biostatistics, clinical trials, mixed research methods, im- plementation science, health behavior research, and interventions leveraging mHealth. Upon completion of these K23 activities, Dr. Schrauben will be poised to conduct a RCT supported by a R01 grant, leveraging her training to improve self-management among persons with CKD.

慢性肾病 (CKD) 是一种日益严重的流行病，影响着近 15% 的美国人口，并且是一种日益严重的疾病。病情进展，伴有心血管疾病和终末期肾病的潜在致命并发症。 CKD 的定向治疗具有挑战性，因为 CKD 是一种综合征，其病因往往无法确定。且缺乏针对疾病的干预措施。然而，有一些跨领域方法对 CKD 患者广泛有益，并且是当前 CKD 管理指南推荐的，该指南包括建议患者进行自我管理行为（例如监测血压、维持体力活动，并避免吸烟）。迄今为止，关于预产期自我管理的研究还很有限。透析 CKD。少数已发表的研究表明，人们对推荐的自我管理行为的接受度很低。 iors，这强调了需要 1）了解推荐参与度不合格的原因行为，2) 开发和评估改善 CKD 自我管理的新方法。莎拉·施劳本，医学博士、理学硕士、肾脏病专家将在她提议的 K23 奖中针对这一尚未研究的领域。施劳本博士是定位于利用该奖项在丰富的环境中开展独立资助的研究生涯她已完成宾夕法尼亚大学临床流行病学硕士学位，她在流行病学、生物统计学、研究设计方面获得了经验，并在博士后研究期间，对大型 CKD 观察队列的自我管理行为进行了初步研究，以及参加了定性和混合方法研究的正式培训。她提议的 K23 工作将利用 in- 对 CKD 患者进行深度访谈，了解参与健康行为和识别的影响确定设计和实施自我管理支持干预的相关因素（目标 1）。在一个 Schrauben 博士将针对一大群 CKD 患者研究推荐的自我治疗的潜在预测因素管理行为参与，以确定对自我管理支持很重要的患者特征干预（目标 2）。利用这些信息，她将开发一种以患者为中心的自我管理支持—— 利用健康行为理论和移动健康（mHealth）技术进行干预，然后试点其可行性性（目标 3）。通过她提出的职业发展，她寻求获得以下方面的技能：1) 临床试验设计、改进实施和评估，2）混合研究方法，3）高级统计分析，包括长期对试点试验的数据进行分析，同时获得 4) 实施科学和 5) 健康方面的专业知识行为研究。为了实现这些目标，施劳本博士组建了多学科指导团队由肾脏流行病学、生物统计学、临床试验、混合研究方法、免疫学等方面的国家专家领导的团队实施科学、健康行为研究和利用移动医疗的干预措施。完成后在这些 K23 活动中，Schrauben 博士将准备开展一项由 R01 拨款支持的随机对照试验，利用她的旨在改善 CKD 患者自我管理的培训。