Activation for Self-Care Needs in Older Adults with Chronic Kidney Disease: ACTIVE SENIORS with CKD

激活患有慢性肾病的老年人的自我护理需求：患有 CKD 的活跃老年人

基本信息

批准号：
10662453
负责人：
Devika Nair
金额：
$ 17.57万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10662453
关键词：
Academic Medical Centers Active Learning Administrator Adult Affect Age Ally Area Atherosclerosis Award Behavior Behavior Therapy Behavior monitoring Behavioral Behavioral Mechanisms Behavioral Sciences Biological Process Cardiovascular system Cessation of life Chronic Chronic Kidney Failure Cognition Cognitive deficits Cohort Studies Competence Data Development Dialysis procedure Disease Disease Progression Dose Elderly Equipment and supply inventories Event Exercise Frequencies Funding Generations Geriatrics Glomerular Filtration Rate Goals Health Health system Impairment Individual Influentials Inpatients Instruction Intervention Interview Investments Kidney Kidney Diseases Knowledge Longitudinal cohort Measures Medicine Methods Morbidity - disease rate National Heart, Lung, and Blood Institute Nephrology Neurobiology Neurocognitive Odds Ratio Outcome Measure Participant Patient Outcomes Assessments Patient Preferences Patients Persons Physical Exercise Physical Function Physical activity Policies Population Principal Investigator Problem Solving Process Prospective cohort Protocols documentation Reporting Research Research Personnel Risk Reduction Sampling Self Care Self Efficacy Testing Theory of Change Time Translating Treatment Efficacy United States United States National Institutes of Health adaptive intervention behavior change cardiovascular health cardiovascular risk factor career cognitive function cohort design executive function federal policy hazard implementation intervention implementation science improved innovation interest intervention delivery mental state mortality neurobiological mechanism novel portability professor progression risk prototype recruit skills therapy development uptake usability

项目摘要

PROJECT SUMMARY/ABSTRACT Dr. Devika Nair is an Assistant Professor of Medicine in the Division of Nephrology at Vanderbilt University Medical Center. With this K23, she will advance the precision, personalization, and scalability of behavioral interventions for older adults with chronic kidney disease (CKD) by developing and iteratively refining a novel, multicomponent, adaptive behavioral intervention able to be dosed in real-time. Dr. Nair will gain 1) new proficiency in behavioral science research, including analyzing cohort data containing patient-reported assessments, recruiting and retaining a new, longitudinal cohort, and developing adaptive behavioral interventions; 2) new knowledge in areas of geriatrics relevant to CKD (cognition and physical function); and 3) new competency in implementation science and mixed-methods design. An invested, integrated, and established team will support Dr. Nair's transition to independence. Dr. Kerri Cavanaugh will provide instruction in behavioral science. Dr. Warren Taylor will provide instruction in geriatrics and experiential learning in neurocognitive assessment. Dr. Daniel Cukor will provide instruction in behavioral interventions. Dr. Russell Rothman will provide instruction in implementation science. Dr. David Schlundt will provide guidance in mixed- methods design. Poor engagement in disease self-care behaviors (i.e., physical activity) leads to adverse cardiovascular events and death in older adults with CKD, the fastest growing kidney disease population. Existing interventions to improve self-care behaviors in this group are `one-size-fits-all' and do not result in durable behavior change due to inadequate tailoring and dose adjustment. Patient Activation, a modifiable measure of self-efficacy, knowledge, problem-solving skill, and level of need for behavioral support, is under- investigated in CKD despite its inclusion in CKD legislative policy. Cognitive function, the neurobiological processes requisite of goal-directed behavior and problem-solving skill, is often impaired in CKD yet its impact on engagement in disease self-care behaviors is unknown. To elucidate neurobiological and behavioral mechanisms of self-care behaviors, identify new intervention targets, and develop a novel, adaptive behavioral intervention, Dr. Nair will 1) test whether self-efficacy, Patient Activation and cognitive function associate with frequency of engagement in CKD self-care behaviors; 2) define how Patient Activation levels and CKD self- care behaviors change over time to inform intervention dosing, amount of support, and frequency; 3) identify patients' behavioral goals and triggers for ineffective self-care to inform timing and intervention component selection; 4) identify patient preferences for behavioral monitoring frequency and intervention delivery mode; 5) identify barriers and facilitators to intervention implementation into the health system; and 6) iteratively refine the prototype with usability testing. This award will inform a concurrent R03 to pilot feasibility and subsequent R01 to test intervention efficacy and advance Dr. Nair's goals to gain expertise in behavioral science, adaptive intervention development, geriatrics, mixed-methods, and implementation science.