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.

项目概要 先前的研究重点是将健康的社会决定因素 (SDH) 与慢性病的分布联系起来。 社区群体内的疾病，如心力衰竭（HF）。这些研究反映了种族、民族和 社会经济少数群体受心衰负担最重。虽然心力衰竭患者充分的自我护理是 已知可显着预防病情加重、减少再入院、改善生活质量和整体 对于 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境需求，而这些需求是 SDH 的运作机制 限制心衰患者的自我护理选择。这些机制可能是SDH导致的途径 不同人群中心力衰竭负担的分配不均和不公平。只有通过评估 患者确定的影响自我护理行为的特定需求可以有针对性地进行干预以改善 遭受 SDH 负面影响的弱势群体的健康状况。因此，本研究提出 密集申请将使申请人做好准备进行混合方法研究，以了解 社区居住心力衰竭住院患者 SDH 与心力衰竭自我护理的关系。这 该目标将通过三个具体目标来实现： 1) 定量评估 SDH 和 SDH 之间的关系 通过测试 7 个 SDH 核心，对 145 名因心力衰竭恶化住院的社区住宅参与者进行心力衰竭自我护理 领域（种族、收入、教育、就业、邻里、住房状况/稳定性和社会 整合/支持），作为心力衰竭自我护理（维护、监测、管理和信心）的预测因素 使用向后消除回归分析，2）定性地探索感知、信念和 定量样本中极端情况的经历（不良和良好的自我护理维护，N = 40） 在一对一访谈中使用吉布反思循环来了解 SDH 及其自我保健选择。这 这样，我们将确定参与者突出的基本情况需求，并作为可操作的 SDH 限制心力衰竭患者自我护理选择的机制。在目标 3 中，我们将描述 通过整合定性研究，了解自我报告的 SDH 与参与者自我护理行为之间的差异 以及从极端案例中获得的定量数据，以识别 SDH 中的差异或一致性模式 和自我保健行为。本研究首先使用混合方法来探索 SDH 和 HF 自我护理之间的关系，并确定患者具体的基本需求作为可操作的 SDH 影响自我保健的机制。拟议的研究与战略计划相一致 国家护理研究所促进健康、预防疾病、改善健康状况 个人和促进健康公平。