The Development and Implementation of a Culturally-Congruent Educational Film designed for PLWHIV to Address Patients' Trauma Histories, Barriers to Care, and CVD Risk Reduction

开发和实施专为艾滋病毒携带者设计的文化一致性教育电影，以解决患者的创伤史、护理障碍和降低心血管疾病风险

• 批准号: 10019763
• 负责人: ARLEEN F. BROWN
• 金额: $ 2.16万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10019763
• 关键词: Address; Adherence; Adoption; Affect; Anxiety; Attention; Award; Behavior; Behavioral; California; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Client; Clinic; Clinical; Cognitive; Color; Complex; Computers; Confounding Factors (Epidemiology); Data Collection; Development; Disease Outcome; Educational Curriculum; Effectiveness of Interventions; Emotional; Ensure; Environment; Ethnic Origin; Evaluation; Failure; Film; Focus Groups; Future; Gender Identity; Goals; Grant; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health system; Healthcare; Heart; Human; Hybrids; Infrastructure; Institutes; Intervention; Knowledge; Los Angeles; Manuscripts; Measures; Medical; Mental Health; Methods; Mind; Modeling; Monitor; Morbidity - disease rate; Neurosciences; Outcome; Parents; Participant; Patients; Phase; Posttraumatic growth; Provider; Publications; Quasi-experiment; Questionnaires; Race; Readiness; Recommendation; Recording of previous events; Research; Research Design; Risk Factors; Risk Reduction; Sampling; Services; Site; Statistical Data Interpretation; Symptoms; System; Telephone; Testing; Time; Training; Trauma; Trauma patient; Use Effectiveness; Writing; barrier to care; base; cardiovascular disorder risk; cardiovascular health; comorbidity; comparative efficacy; comparison intervention; depressive symptoms; design; dosage; effectiveness implementation study; efficacy testing; emotion regulation; ethnic minority population; experience; follow-up; healing; health disparity; implementation strategy; interest; member; mortality; multiple chronic conditions; novel; parent grant; post intervention; post-traumatic symptoms; programs; recruit; retention rate; satisfaction; symposium; therapy design; treatment adherence; Address; Adherence; Adoption; Affect; Anxiety; Attention; Award; Behavior; Behavioral; California; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Client; Clinic; Clinical; Cognitive; Color; Complex; Computers; Confounding Factors (Epidemiology); Data Collection; Development; Disease Outcome; Educational Curriculum; Effectiveness of Interventions; Emotional; Ensure; Environment; Ethnic Origin; Evaluation; Failure; Film; Focus Groups; Future; Gender Identity; Goals; Grant; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health system; Healthcare; Heart; Human; Hybrids; Infrastructure; Institutes; Intervention; Knowledge; Los Angeles; Manuscripts; Measures; Medical; Mental Health; Methods; Mind; Modeling; Monitor; Morbidity - disease rate; Neurosciences; Outcome; Parents; Participant; Patients; Phase; Posttraumatic growth; Provider; Publications; Quasi-experiment; Questionnaires; Race; Readiness; Recommendation; Recording of previous events; Research; Research Design; Risk Factors; Risk Reduction; Sampling; Services; Site; Statistical Data Interpretation; Symptoms; System; Telephone; Testing; Time; Training; Trauma; Trauma patient; Use Effectiveness; Writing; barrier to care; base; cardiovascular disorder risk; cardiovascular health; comorbidity; comparative efficacy; comparison intervention; depressive symptoms; design; dosage; effectiveness implementation study; efficacy testing; emotion regulation; ethnic minority population; experience; follow-up; healing; health disparity; implementation strategy; interest; member; mortality; multiple chronic conditions; novel; parent grant; post intervention; post-traumatic symptoms; programs; recruit; retention rate; satisfaction; symposium; therapy design; treatment adherence

Abstract/Project Summary (Parent Award) Cardiovascular disease (CVD) has emerged as an increasingly important cause of morbidity and mortality among people living with HIV (PLWHIV). Now that HIV is considered a manageable chronic disease, the identification and treatment of comorbid medical conditions including CVD are increasingly the focus of research and clinical attention. What is missing, however, is yet another critical component of care for PLWHIV: integrated care for histories of trauma. Experiences of trauma increase the likelihood of HIV infection as well as CVD risk, yet health care for PLWHIV is rarely coordinated to address these three intersecting issues of HIV, CVD, and trauma, particularly among those disproportionately affected by HIV, i.e., ethnic minority patients. Histories of trauma among PLWHIV are associated with inconsistent treatment adherence and non-adherence, and trauma history alone is associated with poor CVD outcomes. Failure to address trauma poses significant barriers to the adoption of CVD risk strategies among PLWHIV. Health systems that coordinate and integrate care across HIV and chronic conditions such as CVD may provide the infrastructure needed to address the complex interplay of these conditions and their therapies. We have designed a novel blended, culturally congruent, evidence-informed care model, “Healing our Hearts, Minds and Bodies” (HHMB), to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Recognizing the need to ensure that PLWHIV receive CVD guideline- concordant care, we have also identified implementation strategies to prepare providers and clinics for addressing CVD risk among their HIV-positive patients. Therefore, using a hybrid type II effectiveness/implementation study design, the goal of this study is to increase both patient and organizational readiness to address trauma and CVD risk among PLWHIV. The Specific Aims are: (1) to assess and enhance organizational readiness for addressing trauma and CVD risk among ethnic minority PLWHIV; specifically, a phased approach will drive the use of implementation strategies designed to educate, monitor, and support providers and staff in adhering to CVD care guidelines; (2) using mixed methods, to (a) evaluate the use and effectiveness of implementation strategies over time, and (b) identify barriers and facilitators to organizational adoption of guidelines, provider adherence to guidelines, feasibility, and sustainability; and (3) to evaluate the effect of HHMB on cognitive-behavioral, emotional, and physical outcomes among 260 PLWHIV, specifically patient activation, engagement in care, knowledge of CVD risk, adherence to clinicians' recommendations, cardiovascular health, mental health symptoms, and satisfaction with care. We will use the RE-AIM framework to guide the evaluation and the Replicating Effective Programs (REP) Framework to guide the use of implementation strategies and the tailoring of the care model within our participating implementation settings.

摘要/项目摘要（父母奖） 心血管疾病（CVD）已成为发病率的日益重要的原因 艾滋病毒（PLWHIV）的人的死亡率。现在艾滋病毒被认为是 可控制的慢性病，​​合并症的识别和治疗 包括CVD包括研究和临床关注的重点。缺什么， 然而，是PLWHIV护理的另一个关键组成部分：对历史的综合护理 创伤。创伤经历增加了HIV感染和CVD风险的可能性，但 PLWHIV的医疗保健很少协调解决这三个相交的艾滋病毒问题， CVD和创伤，特别是在受艾滋病毒影响不成比例的人中，即种族 少数族裔患者。 PLWHIV中创伤的历史与不一致有关 治疗依从性和不遵守性，仅创伤历史与CVD差有关 结果。未能解决创伤有重大障碍CVD风险 PLWHIV之间的策略。协调和整合艾滋病毒和整合护理的卫生系统 CVD等慢性条件可能会提供解决复合物所需的基础设施 这些疾病及其疗法的相互作用。我们设计了一部小说，在文化上融合了 一致，证据信息的护理模型，“治愈我们的心，思想和身体”（HHMB）， 解决患者的创伤历史和护理障碍，并准备患者参与 CVD降低风险。认识到有必要确保PLWHIV接受CVD指南 - 一致的护理，我们还确定了实施策略，以准备提供者和 针对HIV阳性患者解决CVD风险的诊所。因此，使用混合类型 II有效性/实施研究设计，本研究的目的是增加两名患者 以及在PLWHIV中解决创伤和CVD风险的组织准备。具体 目的是：（1）评估和增强解决创伤和CVD的组织准备 少数民族PLWHIV的风险；具体来说，分阶段的方法将推动使用 实施策略旨在教育，监控和支持提供者和员工 遵守CVD护理指南； （2）使用混合方法，以（a）评估使用和 随着时间的推移，实施策略的有效性，（b）确定障碍和促进者 组织采用准则，提供者对准则的理解，可行性以及 可持续性； （3）评估HHMB对认知行为，情感和 260个PLWHIV的身体结果，特别是患者激活，参与护理， 了解CVD风险，遵守临床医生的建议，心血管健康， 心理健康症状和对护理的满意度。我们将使用Re-Aim框架指导 评估和复制有效程序（REP）框架，以指导使用 我们参与的实施策略和护理模型的裁缝 实现设置。