Mixed-Methods Study of Multidimensional Adversity in Inner-City African American Adults with Chronic Kidney Disease and Type 2 Diabetes Mellitus

患有慢性肾病和 2 型糖尿病的内城非裔美国成年人多维逆境的混合方法研究

• 批准号: 10448678
• 负责人: Mukoso N Ozieh
• 金额: $ 14.92万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-06-19 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10448678
• 关键词: Address; Adult; African American; African American population; Behavior; Behavior Therapy; Blood Pressure; Centers for Disease Control and Prevention (U.S.); Chronic Kidney Failure; Clinical; Community Health Aides; Complex; Complications of Diabetes Mellitus; Cream; Data; Development; Diabetic Nephropathy; Disease Management; Disease Progression; Effectiveness; Employment; End stage renal failure; Financial Hardship; Glycosylated hemoglobin A; Goals; Individual; Intervention; Intervention Studies; Interview; Knowledge; Life Style; Lipids; Long-Term Effects; Mentored Patient-Oriented Research Career Development Award; Methods; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Patient Education; Patient-Focused Outcomes; Patients; Population; Quality of life; Randomized Controlled Trials; Research Design; Review Literature; Risk; Role; Safety; Sampling; Self Care; Self Management; Time; Transportation; Yang; barrier to care; base; behavior change; career; dietary adherence; exercise adherence; experience; food insecurity; health disparity; high risk; housing instability; improved; inner city; innovation; intervention mapping; medication compliance; peer support; social adversity

PROJECT SUMMARY Approximately 40% of individuals with type 2 diabetes (T2DM) have chronic kidney disease (CKD), also known as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease (ESRD), and ESRD is the most expensive complication of diabetes. African American adults are almost twice as likely to have DKD and are three times more likely to progress to ESRD. Inner-city populations, made up of predominantly African Americans, are at high risk for DKD. Challenges of living in the inner-city include multidimensional adversity, defined as having three or more social adversities such as loss of employment, housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain. African American adults living in the inner-city disproportionately experience multidimensional adversity, which impacts the complex self-management of DKD such as self-monitoring and behavior modification. The compounded risks of being African American, living in the inner-city, having T2DM and multidimensional adversity likely contribute to the accelerated rate of CKD progression among African American adults and potentiate existing health disparities. Patient education and self-management behaviors improve patient outcomes and represent the cornerstone of DKD management. In addition, behavioral intervention studies in African American adults with T2DM incorporating cultural tailoring, peer-support/coaching, and community health workers have shown promise in improving short-term clinical outcomes. However, their benefits are not sustained long-term, and they do not produce long-term effects on lifestyle and behavior changes. Further, majority of existing studies do not account for the unique challenges of inner-city African American adults which limits effectiveness of patient education and self-management behaviors in African American adults living in the inner-city long-term. Similarly, studies in African American adults with T2DM and CKD that incorporate the challenges of living with multidimensional adversity are scarce, despite growing evidence which recognizes the negative effects of multidimensional adversity on clinical outcomes in this population. Therefore, the goal of this proposal is to address these gaps in knowledge using a convergent parallel mixed methods study design to understand the role and effect of multidimensional adversity in African American adults with DKD. In addition, this proposal will identify appropriate intervention components which will inform the development of a culturally tailored intervention that addresses multidimensional adversity to improve clinical outcomes, quality of life, and self-care behaviors in African American adults with DKD living in the inner-city. Ultimately, findings from this proposal will serve as a preliminary data for addressing multidimensional adversity in a large-scale appropriately powered, multicenter, randomized controlled trial focused on African American adults with DKD.

项目摘要 大约40％的2型糖尿病患者（T2DM）患有慢性肾脏病（CKD），也 称为糖尿病肾病（DKD）。 DKD是终结阶段肾脏疾病（ESRD）的主要原因，并且 ESRD是糖尿病最昂贵的并发症。非裔美国人成年人的可能性几乎是 具有DKD，进入ESRD的可能性要高三倍。内城人口，由 主要是非洲裔美国人，有DKD的高风险。城市内生活的挑战包括 多维逆境，定义为具有三个或更多的社会逆境，例如失业， 住房不稳定，粮食不安全，运输需求，公用事业需求，人际安全性和财务压力。 生活在城市内部的非裔美国人成年人不成比例地经历多维逆境，这是 影响DKD的复杂自我管理，例如自我监控和行为修改。这 成为非裔美国人，生活在市中心，拥有T2DM和多维风险 逆境可能导致非洲裔美国成年人和 增强现有的健康差异。患者教育和自我管理行为改善了患者 结果并代表DKD管理的基石。此外，行为干预研究 具有T2DM的非洲裔美国成年人结合了文化剪裁，同伴支持/教练和社区 卫生工作者在改善短期临床结果方面表现出了希望。但是，他们的好处不是 长期持续，并且不会对生活方式和行为改变产生长期影响。更远， 大多数现有研究并不理解非裔美国人内城成年人的独特挑战 这限制了非洲裔美国成年人的患者教育和自我管理行为的有效性 长期生活在城市内。同样，对具有T2DM和CKD的非裔美国人成年人的研究 尽管证据越来越多 认识到多维逆境对该人群临床结果的负面影响。 因此，该提案的目的是使用收敛的混合来解决这些知识中的这些差距 方法研究设计，以了解多维逆境在非裔美国人中的作用和影响 成人DKD。此外，该建议将确定适当的干预组件，以告知 开发具有文化量身定制的干预措施，该干预措施解决了多维逆境以改善 非裔美国人成年人的临床结果，生活质量和自我保健行为 内城。最终，该提案的发现将作为解决的初步数据 在大规模适当的，多中心，随机对照试验中的多维逆境 专注于具有DKD的非裔美国人成年人。