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.

项目概要/摘要 Devika Nair 博士是范德比尔特大学肾内科医学助理教授医疗中心。借助这款 K23，她将提高行为的精确度、个性化和可扩展性通过开发和迭代完善一种新颖的、能够实时进行多成分、适应性行为干预。奈尔博士将获得 1) 新精通行为科学研究，包括分析包含患者报告的队列数据评估、招募和留住新的纵向队列以及开发适应性行为干预措施； 2) 与 CKD 相关的老年医学领域的新知识（认知和身体功能）；和 3) 实施科学和混合方法设计的新能力。一家投资、整合、成立的团队将支持奈尔博士向独立过渡。 Kerri Cavanaugh 博士将提供指导在行为科学中。沃伦·泰勒博士将提供老年病学和体验式学习方面的指导神经认知评估。 Daniel Cukor 博士将提供行为干预方面的指导。罗素博士罗斯曼将提供实施科学方面的指导。 David Schlundt 博士将提供混合方面的指导方法设计。疾病自我护理行为（即体力活动）参与度不佳会导致不良后果患有 CKD 的老年人（增长最快的肾脏疾病人群）的心血管事件和死亡。现有的改善该群体自我保健行为的干预措施是“一刀切”的，并且不会导致由于剪裁和剂量调整不足而导致持久的行为改变。患者激活，可修改自我效能感、知识、解决问题的能力以及行为支持需求水平的衡量标准，尽管已纳入 CKD 立法政策，但仍对 CKD 进行了调查。认知功能、神经生物学目标导向行为和解决问题的能力所必需的过程在 CKD 中经常受到损害，但其影响参与疾病自我护理行为的影响尚不清楚。阐明神经生物学和行为学自我保健行为的机制，确定新的干预目标，并开发一种新颖的适应性行为干预后，奈尔博士将 1) 测试自我效能、患者激活和认知功能是否与参与 CKD 自我护理行为的频率； 2) 定义患者激活水平和 CKD 如何自我调节护理行为随着时间的推移而变化，以告知干预剂量、支持量和频率； 3）识别患者的行为目标和无效自我护理的触发因素，以告知时机和干预部分选择； 4）确定患者对行为监测频率和干预实施模式的偏好； 5）确定卫生系统干预措施实施的障碍和促进因素； 6) 迭代细化进行可用性测试的原型。该奖项将为同时开展的 R03 试点可行性和后续工作提供信息 R01 测试干预效果并推进奈尔博士的目标，以获得行为科学、适应性方面的专业知识干预开发、老年病学、混合方法和实施科学。