A mixed methods study to understand the relationship between social determinants of health and self-care in community dwelling patients with heart failure

一项混合方法研究，旨在了解社区居住心力衰竭患者健康的社会决定因素与自我护理之间的关系

• 批准号: 9814599
• 负责人: Foster Osei Baah
• 金额: $ 3.78万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-28 至 2020-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9814599
• 关键词: Address; Age; American; Area; Atlases; Audiotape; Behavior; Belief; Berlin; Chronic Disease; Communities; Cues; Data; Decision Making; Development; Disease; Education; Elements; Employment; Enabling Factors; Enrollment; Exhibits; Germany; Goals; Health; Health Promotion; Healthcare; Heart failure; Housing; Income; Individual; Intervention; Interview; Lead; Link; Maintenance; Measures; Methods; Minority Groups; Monitor; National Institute of Nursing Research; Neighborhoods; Outcome; Participant; Pathway interactions; Patient Self-Report; Patients; Pattern; Perception; Personal Satisfaction; Persons; Physiological; Population Group; Process; Protocols documentation; Psychometrics; Quality of life; Race; Regression Analysis; Reporting; Research; Research Personnel; Resources; Risk; Sampling; Scholarship; Self Care; Social Work; Societies; Strategic Planning; Surveys; Symptoms; System; Testing; Vulnerable Populations; Work; cost; design; experience; health care service; health equity; hospital readmission; improved; indexing; prevent; programs; racial and ethnic; reduce symptoms; social health determinants; social integration; socioeconomics; theories

PROJECT SUMMARY Prior research has focused on linking social determinants of health (SDH) to the distribution of chronic diseases such as Heart failure (HF) within community groups. These studies reflect that racial, ethnic, and socioeconomic minority groups are the most burdened by HF. While adequate self-care in HF patients is known to significantly prevent exacerbations, reduce readmissions, improve quality of life and overall wellbeing, little is known about the relationship between SDH and HF self-care. Specifically, investigators are unsure of patients' fundamental situational needs that serve as operational mechanisms through which SDH limit the self-care choices of HF patients. These mechanisms may be the pathway through which SDH lead to the unequal distribution and inequity in HF burden among disparate population groups. Only by assessing the specific patient-identified needs that influence self-care behavior can interventions be targeted to improve health among vulnerable groups who suffer the negative effects of SDH. Therefore, this proposed research intensive application will prepare the applicant to conduct a mixed methods study to understand the relationship between SDH and HF self-care in hospitalized community dwelling patients with HF. This goal will be achieved through three specific aims: 1) Quantitatively assess the relationship between SDH and HF self-care in 145 community dwelling participants hospitalized for exacerbation of HF by testing 7 SDH core domains (Race, Income, Education, Employment, Neighborhood, Housing status/stability, and Social integration/support), as predictors of HF self-care (maintenance, monitoring, management and confidence) using backward elimination regression analyses, 2) Qualitatively explore the perceptions, beliefs and experiences of extreme cases (poor and excellent self-care maintenance, N=40) within the quantitative sample surrounding SDH and their self-care choices using the Gibb's reflective cycle in one-on-one interviews. This way, we will identify fundamental situational needs that are salient to participants and serve as operational mechanisms through which SDH limit the self-care choices of HF patients. In aim 3, we will describe differences in the self-reported SDH in relation to participants' self-care behavior by integrating the qualitative and quantitative data obtained from the extreme cases to identify patterns of differences or congruence in SDH and self-care behavior. The proposed study is first to use a mixed methods approach to explore the relationship between SDH and HF self-care and identify patient specific fundamental needs as operational mechanisms through which SDH influence self-care. The proposed study aligns with the strategic plan of the National Institute of Nursing Research of promoting health, preventing illness, improving the health of individuals and advancing health equity.

项目摘要 先前的研究重点是将健康的社会决定因素（SDH）与慢性分布联系起来 社区群体内心力衰竭（HF）等疾病。这些研究反映了种族，种族和 社会经济少数群体是HF负担最大。虽然HF患者的足够自我保健是 已知可以显着防止加重，减少再入院，改善生活质量和整体 健康，对SDH和HF自我保健之间的关系知之甚少。具体来说，调查人员是 不确定患者的基本情况需求是SDH的操作机制 限制HF患者的自我保健选择。这些机制可能是SDH导致的途径 不同人口群体中HF负担的不平等分布和不平等。仅通过评估 影响自我保健行为的特定患者确定的需求可以针对以改进的针对性 遭受SDH负面影响的弱势群体的健康。因此，这项提出的研究 密集申请将使申请人准备进行混合方法研究，以了解 住院社区住宅患者的SDH与HF自我保健之间的关系。这 目标将通过三个具体目标来实现：1）定量评估SDH和 145个社区住宅参与者的HF自我保健因测试7 SDH核心而导致HF加剧的住院 域（种族，收入，教育，就业，社区，住房状况/稳定和社会 集成/支持），作为HF自我护理的预测因素（维护，监视，管理和信心） 使用向后消除回归分析，2）定性地探索看法，信念和 量化样本中极端情况（差和出色的自我保健维护，n = 40）的经历 在一对一的访谈中，使用GIBB的反思周期围绕SDH及其自我保健选择。这 方式，我们将确定对参与者显着的基本情况需求并充当运营 SDH限制了HF患者的自我保健选择的机制。在AIM 3中，我们将描述 通过整合定性，自我报告的SDH与参与者的自我保健行为的差异 以及从极端情况获得的定量数据，以识别SDH的差异模式或一致性 和自我保健行为。拟议的研究首先使用混合方法探索 SDH与HF自我护理之间的关系，并确定患者特定的基本需求作为操作 SDH影响自我保健的机制。拟议的研究与 国家护理研究所促进健康，预防疾病，改善健康 个人并促进健康公平。