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

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（家长奖） 心血管疾病（CVD）已成为日益重要的发病原因 艾滋病毒感染者（PLWHIV）的死亡率。 可控制的慢性病、合并症的识别和治疗 包括CVD在内的疾病日益成为研究和临床关注的焦点。 然而，艾滋病毒感染者护理的另一个重要组成部分是：对感染史的综合护理 创伤经历会增加感染艾滋病毒的可能性以及心血管疾病的风险。 艾滋病毒感染者的卫生保健很少得到协调来解决这三个相互交叉的艾滋病毒问题， 心血管疾病和创伤，特别是在那些受艾滋病毒影响尤其严重的人群中，即种族 少数感染者的创伤史与不一致有关。 治疗依从性和不依从性以及创伤史与不良心血管疾病相关 未能解决创伤问题对接受 CVD 风险构成重大障碍。 卫生系统中协调和整合艾滋病毒感染者和艾滋病毒感染者的护理的战略。 CVD 等慢性病可能提供解决复杂问题所需的基础设施 我们设计了一种新颖的融合文化的疗法。 一致的、以证据为依据的护理模式“治愈我们的心灵、思想和身体”(HHMB) 解决患者的创伤史和护理障碍，并帮助患者做好参与治疗的准备 认识到需要确保 PLWHIV 接受 CVD 指南 - 协调护理，我们还确定了实施战略，以帮助提供者和 因此，诊所使用混合类型来解决 HIV 阳性患者的 CVD 风险。 II 有效性/实施研究设计，本研究的目标是增加患者 以及组织应对 PLWHIV 患者的创伤和 CVD 风险的准备情况。 目标是：(1) 评估和加强组织应对创伤和心血管疾病的准备情况 具体来说，分阶段的方法将推动少数民族艾滋病毒携带者的风险； 旨在教育、监督和支持提供者和工作人员的实施战略 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，实施战略的有效性，以及 (b) 识别障碍和促进因素 组织采用指南、提供商遵守指南、可行性和 可持续性；(3) 评估 HHMB 对认知行为、情绪和行为的影响。 260 名 PLWHIV 感染者的身体状况，特别是患者的激活、护理参与度、 了解 CVD 风险、遵守销售建议、心血管健康、 心理健康症状以及护理满意度 我们将使用 RE-AIM 框架来指导。 评估和复制有效计划（REP）框架来指导使用 我们参与的实施策略和护理模式的定制 实施设置。