Basic Needs Navigation Intervention to Address Multidimensional Adversity in African Americans with Diabetic Kidney Disease

基本需求导航干预，以解决患有糖尿病肾病的非裔美国人的多维逆境

基本信息

批准号：
10676228
负责人：
Mukoso N Ozieh
金额：
$ 19.12万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-22 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10676228
关键词：
2 arm randomized control trial Address Adult African African American African American population American Behavior Blood Pressure Cardiovascular system Caring Chronic Disease Chronic Kidney Failure Clinical Complex Data Diabetes Mellitus Diabetic Nephropathy Dimensions Eating Educational Intervention Effectiveness End stage renal failure Exercise Financial Hardship Glycosylated hemoglobin A Goals Habits Health Individual Intervention Intervention Studies Knowledge Life Style Lipids Low Income Population Low income Measures Minority Groups Monitor Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Outcome Participant Pathway interactions Patient Education Patient-Focused Outcomes Patients Population Poverty Quality of life Randomized Randomized, Controlled Trials Reduce health disparities Research Risk Factors SF-12 Safety Self Care Self Management Subgroup Testing Transportation United States arm cardiovascular disorder risk clinical center design efficacy evaluation experience feasibility testing follow-up food insecurity high risk housing instability improved kidney disease education medication compliance mortality novel patient navigation patient navigator process improvement programs randomized, clinical trials recruit social adversity therapy design treatment as usual

项目摘要

PROJECT SUMMARY Approximately 1 in 3 adults with diabetes have chronic kidney disease commonly referred to as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease in the United States. African Americans are a vulnerable subgroup, as they are more likely to develop type 2 diabetes mellitus, have a 22% higher risk of developing chronic kidney disease (CKD) and are almost four times more likely to progress to ESRD compared to non-Hispanic whites (NHW). In addition, CKD is disproportionately prevalent in African Americans living in poverty and they have a four-fold higher risk of developing ESRD compared to NHW. Challenges of living in poverty include multidimensional adversity, defined as having three or more social adversities such as housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain. Multidimensional adversity impacts the complex self-management of DKD and negatively impacts health outcomes. The constellation of living in poverty, being African American, having DKD and multidimensional adversity results in poor outcomes. Patient education and self-management behaviors including self-monitoring, lifestyle changes (e.g., eating and exercise habits) and medication adherence represent the cornerstone of managing and optimizing clinical outcomes in individuals with DKD. Research shows well-designed educational interventions improves knowledge, self-management, and patient outcomes. However, evidence suggests that African Americans are less likely to perform self-management behaviors compared to NHW and that interventions designed to improve self-management behaviors may have variable effectiveness due to multidimensional adversity. Evidence suggests patient navigation programs may be a promising strategy to improve health outcomes and address multidimensional adversity among individuals living in poverty. An important unanswered question is whether a basic needs navigation intervention that addresses multidimensional adversity in combination with patient education and lifestyle coaching leads to improved clinical and patient-centered outcomes. In addition, we do not know whether integrating social adversity into intervention studies can help reduce health disparities in clinical outcomes for chronic diseases in minority populations. Preliminary data from our group suggest a novel intervention that incorporates DKD education, basic needs navigation, and lifestyle coaching to address multidimensional adversity may be effective in this population. Therefore, using a randomized control trial this R21 proposal will address a number of gaps in our current knowledge in low-income African Americans with DKD experiencing multidimensional adversity. It will also provide preliminary data for a large-scale appropriately powered, randomized clinical trial (R01) focused on multidimensional adversity in African Americans with DKD. The long-term goal of this project is to identify effective strategies for improving DKD risk factor control and slowing the progression of DKD in African Americans experiencing multiple social adversities.

项目概要大约三分之一的成人糖尿病患者患有慢性肾病，通常称为糖尿病肾脏疾病（DKD）。 DKD 是美国终末期肾病的主要原因。非洲人美国人是一个弱势群体，因为他们更有可能患上 2 型糖尿病，有 22% 患慢性肾病 (CKD) 的风险更高，并且进展为慢性肾病的可能性几乎高出四倍 ESRD 与非西班牙裔白人 (NHW) 的比较。此外，慢性肾病（CKD）在非洲尤为普遍。生活贫困的美国人患 ESRD 的风险是 NHW 的四倍。生活在贫困中的挑战包括多维逆境，定义为具有三个或更多社会因素住房不稳定、粮食不安全、交通需求、公用事业需求、人际安全等逆境，和财务压力。多维逆境影响 DKD 复杂的自我管理并产生负面影响影响健康结果。生活贫困、非裔美国人、患有 DKD 和多维逆境会导致不良结果。患者教育和自我管理行为包括自我监测、生活方式的改变（例如饮食和运动习惯）和药物依从性代表了 DKD 患者管理和优化临床结果的基石。研究显示精心设计的教育干预措施可以提高知识、自我管理和患者的治疗效果。然而，有证据表明非裔美国人不太可能进行自我管理行为与 NHW 相比，旨在改善自我管理行为的干预措施可能存在差异由于多维逆境而产生的有效性。有证据表明患者导航程序可能是改善健康结果并解决个人多维逆境的有前景的策略生活贫困。一个重要的悬而未决的问题是，基本设施是否需要导航干预结合患者教育和生活方式指导来解决多维逆境改善临床和以患者为中心的结果。此外，我们不知道是否整合社交干预研究中的逆境有助于减少慢性病临床结果的健康差异在少数民族人口中。我们小组的初步数据表明了一种结合 DKD 的新颖干预措施解决多维逆境的教育、基本需求导航和生活方式指导可能是对该人群有效。因此，通过随机对照试验，该 R21 提案将解决一些问题我们目前对患有 DKD 的低收入非裔美国人的认识存在多方面的差距逆境。它还将为大规模适当动力的随机临床试验提供初步数据 (R01) 关注患有 DKD 的非裔美国人的多维逆境。本项目的长期目标旨在确定改善 DKD 危险因素控制并减缓 DKD 进展的有效策略非裔美国人经历着多种社会逆境。