SToRytelling to Improve DiseasE outcomes in Gout: The STRIDE-GO Study

讲故事可改善痛风疾病的结果：STRIDE-GO 研究

基本信息

批准号：
8783912
负责人：
Jasvinder A Singh
金额：
--
依托单位：
BIRMINGHAM VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-08-01 至 2015-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8783912
关键词：
Accident and Emergency department Activities of Daily Living Acute Address Adherence Adoption Affect African American Alcohols Area Arthritis Attitude Behavior Behavior Therapy Body Weight decreased Caucasians Caucasoid Race Chronic Chronic Disease Chronic Obstructive Airway Disease Clinic Cognitive Communication Congestive Heart Failure Coronary Arteriosclerosis Cultural Characteristics Diet Disease Disease Management Disease Outcome Disease susceptibility Evaluation Flare Focus Groups Future Gout Health Health Services Healthcare Hyperlipidemia Hypertension Inpatients Intervention Interview Knowledge Lead Learning Low Literacy Population Manuals Medical Care Costs Methods Minority Mission Modeling Monitor Morbidity - disease rate Organ Osteoporosis Outcome Pain Patient Outcomes Assessments Patients Pharmaceutical Preparations Philadelphia Procedures Process Quality of life Research Personnel Research Priority Resistance Resources Rheumatoid Arthritis Risk Self Management Serum Severity of illness Structure Symptoms Testing Transportation Urate Veterans Videotape Visit Voice Work absorption base behavior change communication theory cost disability disorder risk effective therapy health belief health disparity improved innovation joint destruction novel novel strategies patient oriented randomized trial theories therapy adherence therapy development

项目摘要

DESCRIPTION (provided by applicant): Background and Objective: Poor disease self-management in chronic diseases is a problem and is associated with poorer health outcomes and higher health care resource utilization. Compared to Caucasians, African-Americans have even poorer disease self-management and worse outcomes in most chronic diseases. Patients often do not perceive disease severity and susceptibility to disease complications since severe symptoms of chronic conditions such as such as gout, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) etc. are usually intermittent. Our objective is to develop a patient-centered, culturally relevant narrative intervention, or "storytelling", based on the Health Belief Model (HBM) for behavior change, using narrative communication theory as methodological framework for intervention delivery. We aim to improve disease self-management among African-American Veterans, using gout as our "test case". Storytelling in the patient's own voices has the power to directly and more effectively help patients overcome intrapersonal and structural barriers and reinforce the benefits associated with optimal gout self-management. While shown to be successful in hypertension, an asymptomatic chronic disease, no evidence of efficacy of storytelling intervention exists for chronic symptomatic diseases, such as COPD, CHF, gout etc. Project Objectives and Aims: Our long-term objective is to improve health outcomes in Veterans and reduce health disparities. The objective of the proposed study, the first step in this direction, i to develop a novel storytelling intervention in Veterans' own voices to improve disease self-management and outcomes in African- American Veterans with gout, the most common type of inflammatory arthritis in Veterans, associated with significant pain and suffering, utilization and cost. Our Specific Aim (SA)s are: SA1, Formatively Identify Components of a Video Intervention - Conduct formative evaluations with patient interviews to develop a theory-based, culturally-relevant storytelling intervention to promote disease self-management among African-American Veterans with gout; SA2, Create an Intervention Video - Develop and test the feasibility of a storytelling intervention based on the results of Specific Aim 1; and SA3, Develop a Video Storytelling Manual - Develop a manual for use by investigators that describes the storytelling concept and presents step-by-step procedures for creating Video storytelling interventions. Project Methods: For Aim#1, we will perform in-depth interviews in 36 African-American veterans with gout at Birmingham and Philadelphia VA using HBM probes to identify barriers and facilitators to optimal gout self- management. For Aim#2, we will create an intervention video by inviting 12-15 storytelling stars from our qualitative work in Aim#1, chosen due to their eloquence and persuasive of their stories, videotaping the stories, decomposing into story units, rating stories on constructs of HBM and narrative communication theory, adding didactic material as "Learn more" section using material developed for patients, testing feasibility in focus groups in 32 African-American veterans with gout at Birmingham and Philadelphia VA, iteratively refining and finalizing the storytelling intervention alongside a control intervention.For Aim #3, we will develop a storytelling manual to be made available to other investigators and present HSR&D Cyber seminars for knowledge dissemination. Alignment with VA mission and priorities: This study serves the VA's mission of improving the health of veterans and by focusing on understudied minorities with poorer disease outcomes, addresses a priority area of health disparities. The results of this study will lead to a low cost patient-centered intervention for African- American Veterans with gout to improve patient outcomes, that we propose to test in a future randomized trial. Gout will serve as a "use case" for chronic disease self-management. If successful, the storytelling intervention can be adapted to other chronic symptomatic diseases such as COPD, CHF etc.

描述（由申请人提供）：背景和目的：慢性病的自我管理不良是一个问题，与较差的健康结果和较高的医疗资源利用率相关。与白人相比，非洲裔美国人的疾病自我管理能力更差，大多数慢性病的预后也更差。由于痛风、慢性阻塞性肺病(COPD)、充血性心力衰竭(CHF)等慢性病的严重症状通常是间歇性的，因此患者常常意识不到疾病的严重程度和对疾病并发症的易感性。我们的目标是基于行为改变的健康信念模型（HBM），使用叙事沟通理论作为干预实施的方法框架，开发一种以患者为中心、与文化相关的叙事干预或“讲故事”。我们的目标是改善非裔美国退伍军人的疾病自我管理，以痛风作为我们的“测试案例”。用患者自己的声音讲故事能够直接、更有效地帮助患者克服个人和结构性障碍，并增强与最佳痛风自我管理相关的益处。虽然讲故事干预在治疗高血压这种无症状慢性疾病方面取得了成功，但没有证据表明讲故事干预对慢性阻塞性肺病、慢性心力衰竭、痛风等慢性症状疾病有效。项目目标和目的：我们的长期目标是改善健康结果退伍军人并减少健康差距。拟议研究的目标是朝这个方向迈出的第一步，即以退伍军人自己的声音开发一种新颖的讲故事干预措施，以改善患有痛风（美国最常见的炎症性关节炎类型）的非裔美国退伍军人的疾病自我管理和结果。退伍军人，与严重的疼痛和痛苦、利用和成本。我们的具体目标 (SA) 是： SA1，形成性识别视频干预的组成部分 - 通过患者访谈进行形成性评估，以开发基于理论、文化相关的讲故事干预措施，以促进患有痛风的非裔美国退伍军人的疾病自我管理; SA2，创建干预视频 - 根据具体目标 1 的结果开发并测试讲故事干预的可行性； SA3，制定视频讲故事手册 - 制定供调查人员使用的手册，描述讲故事的概念并介绍创建视频讲故事干预措施的分步程序。项目方法：对于目标#1，我们将使用 HBM 探针对伯明翰和弗吉尼亚州费城的 36 名患有痛风的非裔美国退伍军人进行深入访谈，以确定最佳痛风自我管理的障碍和促进因素。对于 Aim#2，我们将邀请 Aim#1 定性工作中的 12-15 名讲故事明星制作一个干预视频，这些明星是根据他们的口才和故事的说服力而选择的，对故事进行录像，分解成故事单元，对故事进行评级构建 HBM 和叙事沟通理论，使用为患者开发的材料将教学材料添加为“了解更多”部分，在 32 名患有痛风的非裔美国退伍军人中测试焦点小组的可行性伯明翰和费城退伍军人事务部，在控制干预的同时迭代完善和最终确定讲故事干预措施。对于目标 3，我们将制定讲故事手册以供其他调查人员使用，并举办 HSR&D 网络研讨会以传播知识。与退伍军人管理局的使命和优先事项保持一致：这项研究服务于退伍军人管理局改善退伍军人健康的使命，并通过关注疾病结果较差的未充分研究的少数群体，解决健康差异的优先领域。这项研究的结果将导致以患者为中心的低成本干预对于患有痛风的非裔美国退伍军人来说，可以改善患者的治疗结果，我们建议在未来的随机试验中进行测试。痛风将作为慢性病自我管理的“用例”。如果成功，讲故事干预可以适用于其他慢性症状性疾病，如慢性阻塞性肺病、慢性心力衰竭等。