Improving the Collaborative Health of Minority COVID-19 Survivor & Carepartner Dyads Through Interventions Targeting Social and Structural Health Inequities

改善少数族裔 COVID-19 幸存者的协作健康

• 批准号: 10308981
• 负责人: Gayenell Smith Magwood
• 金额: $ 68.61万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308981
• 关键词: 2019-nCoV; Address; Adult; Affect; African American; Age; Anxiety; Behavior; Behavioral; COVID-19; COVID-19 morbidity; COVID-19 mortality; COVID-19 pandemic; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Chronic Kidney Failure; Color; Communities; Community Health Aides; Diabetes Mellitus; Discrimination; Environment; Exposure to; Family; Family Caregiver; Family Relationship; Fatigue; Focus Groups; Future; Goals; Health; Health Benefit; Health Personnel; Health Promotion; Health Status; Healthcare Systems; Hospitalization; Hypertension; Impairment; Individual; Information Management; Institutional Racism; Intervention; Interview; Linear Models; Link; Literature; Measures; Mental Health; Methods; Minority; Modeling; Nurses; Outcome; Pain interference; Patients; Pattern; Persons; PhenX Toolkit; Psychosocial Factor; Public Health; Qualitative Methods; Quality of life; Race; Recovery; Research; Risk; Role; SARS-CoV-2 infection; Self Efficacy; Self Management; Sick Role; Social Environment; Social Identification; Social status; Social support; Stress; Stroke; Structure; Survivors; Symptoms; System; Testing; Trauma; Treatment Efficacy; Underserved Population; arm; attentional control; barrier to care; base; care delivery; comorbidity; contextual factors; design; disorder risk; efficacy testing; ethnic minority population; experience; family support; health care availability; health disparity; health inequalities; high risk; improved; innovation; intersectionality; intervention effect; minority communities; minority health; mortality; pandemic disease; physical conditioning; preference; pressure; psychosocial; public health emergency; racial minority; racism; risk mitigation; rural area; secondary outcome; social structure; social vulnerability; sociodemographic factors; socioeconomic disadvantage; stressor; stroke patient; telehealth; theories; therapy design; trauma exposure; underserved community; underserved minority

PROJECT SUMMARY/ABSTRACT Persons of color (POC) from underserved communities are at increased risk of COVID-19 related morbidity and mortality due to a variety of social and structural health determinants (SSDH; e.g., barriers to health care access) and higher rates of underlying chronic diseases such as diabetes, hypertension, and cardiovascular disease. Additionally, stressors associated with experiences of racism/discrimination (personal and systemic) and the impact of the pandemic on their communities may further complicate the recovery and management of underlying chronic diseases for minority COVID-19 survivors, undermining the mental and physical health not only of the patient but carepartners who provide critical support. This study tests the efficacy of a telehealth- enhanced, RN-Community Health Worker (CHW) delivered dyad intervention, ICINGS FAM (Integrating Community-based Intervention Under Nurse Guidance with Families), on quality of life (QoL), and health- related outcomes in vulnerable African American (AA) adults with preexisting chronic illness and their informal carepartners (IC). Adapted from our previous WISSDOM CINGs model tested in AA stroke patients, key features of this intervention include a) strategies to address racial- and pandemic-related stressors perceived by COVID-19 survivors and ICs; and b) incorporation of the survivor/IC dyad as a unit of analysis to better understand how interpersonal and interdependent relationships impact health and health related outcomes for both partners. We hypothesize that survivor/IC dyads receiving the intervention (i.e., coaching related to COVID-19 risk mitigation, chronic disease management information, and assistance navigating the health care system) will demonstrate improved QoL and health-related secondary outcomes compared to the attention control arm receiving monthly general health promotion. The objective of iCINGS FAM is to strengthen the efficacy and agency of the dyad to manage illness behaviors as an integrated unit, termed "dyad illness management. In Aim 1, we will conduct interviews and focus groups with key community stakeholders to refine iCINGS FAM components to the individual, interpersonal, community, social environment, and SSDH assets/barriers of study dyads. In Aim 2, we will employ an RCT design to test intervention efficacy on QoL of adult AA survivors and ICs (250 dyads) with pre-existing chronic health conditions. Intervention effects on symptoms, dyadic confidence, and social support will also be investigated (Aim 2.1). In Aim 3, we will identify individual - and family - level social and structural racial trauma exposures and family illness management behaviors associated with reduced/improved QoL and health outcomes on a subset of dyads (n=50). Finally, to further contextualize study findings, in Exploratory Aim 4 we will examine associations between outcomes and community-level SSDH using PhenX structural determinant variables. This intervention has the potential to reduce health disparities and increase understanding of SSDH, sociodemographic and psychosocial factors that affect QoL and dyadic illness management behaviors in minority patients.

项目摘要/摘要 来自服务不足社区的有色人种（POC）的风险增加了Covid-19相关发病率 以及由于各种社会和结构健康决定因素而导致的死亡率（SSDH；例如，医疗保健障碍 访问）和较高的基础慢性疾病（例如糖尿病，高血压和心血管疾病） 疾病。此外，与种族主义/歧视经历相关的压力源（个人和系统） 大流行对社区的影响可能会进一步复杂化的 少数族裔共同199幸存者的基本慢性疾病，破坏了心理和身体健康 只有患者，但提供关键支持的摄制者。这项研究测试了远程医疗的功效 - 增强的，RN社区卫生工作者（CHW）提供了二元干预，染色FAM（整合 在护士指导下，基于社区的干预措施），关于生活质量（QOL）和健康 - 脆弱的非裔美国人（AA）成年人患有慢性病及其非正式的成年人的相关结果 卡雷佩纳（IC）。改编自我们以前在AA中风患者中测试的Wissdom CINGS模型 此干预的特征包括a） 解决与种族和大流行有关的压力源的策略 由COVID-19的幸存者和ICS撰写； b）将幸存者/IC二元组纳入一个分析单位以更好 了解人际关系和相互依存关系如何影响健康与健康相关的结果 双方。我们假设幸存者/IC二元组接受了干预（即，与 COVID-19风险缓解，慢性疾病管理信息和协助导航医疗保健 与关注相比 控制臂每月接受一般健康促进。糖霜的目的是加强 二元组作为综合单位的疾病行为的功效和代理，称为“二元疾病 管理。在AIM 1中，我们将与关键社区利益相关者进行访谈和焦点小组以完善 将人际，人际关系，社区，社会环境和SSDH染色家庭组成部分 研究二元组的资产/障碍。在AIM 2中，我们将采用RCT设计来测试QOL的干预功效 成人AA幸存者和ICS（250个二元组），患有慢性健康状况。干预影响 症状，二元信心和社会支持也将得到研究（AIM 2.1）。在AIM 3中，我们将确定 个人 - 家庭 - 水平的社会和结构性种族创伤和家庭疾病管理 与二元组的一部分（n = 50）的质量降低/改善的QOL和健康结果相关的行为。最后，到 进一步的上下文化研究结果，在探索目的4中，我们将研究结果之间的关联 和社区级的SSDH使用苯克斯结构决定因素变量。这种干预有可能 减少健康差异并增加对SSDH，社会人口统计学和社会心理因素的理解 这会影响少数族裔患者的质量和二元疾病管理行为。