Development of a Community Health Worker-Led Stress Reduction Intervention for Low-Income COPD Patients

为低收入慢性阻塞性肺病患者制定社区卫生工作者主导的减压干预措施

基本信息

批准号：
10227146
负责人：
Trisha M Parekh
金额：
$ 16.88万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10227146
关键词：
Accident and Emergency department Acute Address Adult Anxiety Area Behavioral Caring Cessation of life Chronic Disease Chronic Obstructive Airway Disease Chronic stress Clinical Communities Community Health Aides Competence Confidence Intervals Coping Behavior Custom Data Development Disadvantaged Disease Education Emergency department visit Engineering Epidemiology Feedback Food Access Foundations Frequencies Funding Future Genetic Goals Grant Health Health Care Costs Health Insurance Health behavior High Prevalence Hospitalization Income Individual Institute of Medicine (U.S.)Intervention Interview K-Series Research Career Programs Knowledge Lead Low Income Population Low income Medical Medicine Mental Depression Mentors Mentorship Methods Modeling Morbidity - disease rate Odds Ratio Outcome Outcome Measure Patients Physiological Poverty Preparation Psychological Stress Public Health Quality of life Randomized Randomized Controlled Trials Research Research Design Research Methodology Research Personnel Research Project Grants Resources Risk Risk Factors Series Smoking Status Social support Stress Stress and Coping Surveys Targeted Research Testing Tobacco use Training Training Activity Transportation United States United States National Academy of Sciences Work acute care adverse outcome base behavior influence biological adaptation to stress care systems career career development community based research community engaged research community engagement coping cost experience feasibility testing follow-up health care availability health care delivery health care service utilization health disparity high risk hospital readmission housing instability improved improved outcome innovation insight intervention mapping low socioeconomic status mortality patient population perceived stress predict clinical outcome premature primary outcome programs prototype psychologic research and development research study response secondary outcome smoking prevalence social social disadvantage social health determinants stress management stress reduction stressor systemic inflammatory response theories therapy development

项目摘要

PROJECT SUMMARY The overall goal of this K23 proposal is to provide Trisha Parekh, D.O., with the career development and research experience necessary to allow her to become an independent researcher in chronic obstructive pulmonary disease (COPD) health disparities, with expertise in social care integration and psychological stress reduction in low-income communities using community health worker interventions. Disadvantages of social determinants of health, such as low socioeconomic status, are associated with adverse outcomes in COPD, including more frequent hospitalizations, early readmissions, and increased mortality. A majority of interventions to reduce readmission focus on addressing medical determinants of health, with a notable absence of addressing social needs that impede better health outcomes. The psychological stress associated with poverty and other disadvantages of social determinants of health can lead to negative downstream behavioral, psychological, and physiological effects. For COPD patients, these stress responses may include increased tobacco use, increased risk of anxiety or depression, or increased systemic inflammation, all of which are risk factors for acute exacerbations of COPD. Substantial knowledge gaps on the social determinants of health, their associated levels of perceived stress in COPD, and clinical outcomes associated with high levels stress in marginalized groups must be addressed in order to reduce health disparities and improve quality of life for these individuals. In this K23 proposal, under the guidance of an expert mentorship team, Dr. Parekh will conduct a mixed methods research study to inform the development of a targeted community health worker-led stress reduction intervention in low-income COPD patients that will focus on 1) addressing unmet social needs, 2) providing COPD disease education, and 3) promoting proactive coping behaviors. The specific aims for this research project are as follows: Aim 1: Identify modifiable social determinant of health predictors and clinical outcomes of perceived stress in COPD patients; Aim 2: Understand perceived stressful experiences in high-risk COPD patients; Aim 3: Develop and test the feasibility of a community health worker intervention to reduce stress in low-income COPD patients. At the completion of Aim 3, this intervention will be ready to be tested in a R-series grant funded randomized controlled pilot with the primary outcome of stress reduction and secondary outcomes of reduction in acute care use and tobacco use and improvement in quality of life. At the conclusion of this K23, Dr. Parekh will have the training and experience needed to transition to a successful independent investigator who has an expertise in COPD health disparities.

项目概要该 K23 提案的总体目标是为 D.O. Trisha Parekh 提供职业发展和让她成为慢性阻塞性肺疾病独立研究员所必需的研究经验肺部疾病（COPD）健康差异，具有社会护理整合和心理压力方面的专业知识利用社区卫生工作者的干预措施减少低收入社区的收入。社交的缺点健康的决定因素，例如低社会经济地位，与慢性阻塞性肺病的不良后果有关，包括更频繁的住院治疗、提前再入院和死亡率增加。大多数减少再入院的干预措施重点是解决健康的医学决定因素，其中值得注意的是无法满足阻碍取得更好健康成果的社会需求。相关的心理压力贫困和健康问题社会决定因素的其他不利因素可能导致下游负面影响行为、心理和生理影响。对于慢性阻塞性肺病患者来说，这些应激反应可能包括烟草使用增加、焦虑或抑郁风险增加或全身炎症增加，所有这些这些是 COPD 急性加重的危险因素。社会知识存在巨大差距健康的决定因素、慢性阻塞性肺病患者感知压力的相关水平以及相关的临床结果必须解决边缘化群体的高压力问题，以减少健康差距和提高这些人的生活质量。在本次K23提案中，在专家导师的指导下 Parekh 博士团队将进行一项混合方法研究，为开发有针对性的药物提供信息社区卫生工作者主导的低收入慢性阻塞性肺病患者减压干预措施将重点关注 1) 解决未满足的社会需求，2) 提供慢性阻塞性肺疾病教育，以及 3) 促进积极应对行为。本研究项目的具体目标如下：目标 1：确定可修改的社会慢性阻塞性肺病患者的健康预测因素和感知压力的临床结果的决定因素；目标 2：了解高危慢性阻塞性肺病患者感受到的压力经历；目标 3：开发并测试可行性社区卫生工作者干预以减轻低收入慢性阻塞性肺病患者的压力。完成时目标 3，该干预措施将准备好在 R 系列拨款资助的随机对照试点中进行测试减轻压力的主要结果和减少急性护理使用和烟草的次要结果使用和改善生活质量。在 K23 结束时，Parekh 博士将接受培训并转变为具有慢性阻塞性肺病健康专业知识的成功独立研究者所需的经验差异。