Self-management behaviors among COPD patients with multi-morbidity

多种疾病的慢性阻塞性肺病患者的自我管理行为

• 批准号: 8976686
• 负责人: Alex D Federman
• 金额: $ 80.9万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-03 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8976686
• 关键词: Academic advising; Acute; Adherence; Adult; Affect; Anxiety; Attention; Behavior; Belief; Chicago; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Cities; Cognitive; Cohort Studies; Comorbidity; Complex; Counseling; Data; Diabetes Mellitus; Disease; Education; Emotional; Fatigue; Future; Goals; Health; Health behavior; Hospitalization; Hypertension; Illness impact; Individual; Informal Social Control; Intervention; Interview; Knowledge; Major Depressive Disorder; Mediating; Medical; Mental Depression; Methods; Modeling; Morbidity - disease rate; Neurobehavioral Manifestations; New York City; Outcome; Pathway interactions; Patients; Perception; Pharmaceutical Preparations; Plant Roots; Prospective Studies; Recruitment Activity; Research; Research Design; Self Care; Self Management; Symptoms; Testing; Time; Translating; asthmatic patient; base; behavioral outcome; clinical care; cognitive change; cognitive process; compliance behavior; depressed patient; depressive symptoms; design; illness perceptions; improved; interest; medication compliance; programs; prospective; prototype; public health priorities; public health relevance; response; theories

 DESCRIPTION (provided by applicant): Outcomes for patients with multi-morbidity (MM) are often poor, in part because of low adherence to self-management behaviors (SMB).Research has identified key determinants of SMB for individual diseases and shown the powerful influence that illness representations and medication beliefs have on these behaviors. Yet, little is known about the impact of illness representations in the context of MM where beliefs about one illness and its treatments may be at odds, or symbiotic, with those for comorbidities. Without this knowledge, our ability to provide optimal self-management support for MM patients is limited. The goal of this study is to determine how beliefs about chronic illness and their treatments affect SMB in the context of MM and to translate this information into self-management support counseling modules for use in future interventions. We will focus on patients with chronic obstructive pulmonary disease (COPD), a disabling and costly health problem, and evaluate the impact of 3 comorbid conditions that differ in level of self-management complexity and symptomatology: hypertension (HTN), diabetes (DM),and depression. The study design is rooted in the Self Regulation Model (SRM), a theory of health behaviors that has been used to develop interventions, but has only been applied to research on behaviors around single diseases. Depression is of great interest in the study of the SRM because patients with depression often have maladaptive representations and perceptions of illness. By understanding the interplay of illness representations and medication beliefs and their impact on SMB in the context of comorbidities, we will advance both the SRM and the clinical care of patients with MM. The Specific Aims are to: 1) Examine the interactive effects of COPD, HTN, and DM related cognitive and emotional illness representations and medication beliefs on patients' self-management of these conditions over time; 2) Assess the association of major depression with COPD SMB over time and evaluate the pathways, via illness representations and medication beliefs, mediating this relationship;(3) Guided by findings from Aims 12 and the SRM, develop and pilot test education and counseling modules for COPD patients with MM to promote adherence to SMB. We will conduct a mixed methods prospective cohort study of 400 COPD patients with HTN or DM in NY City and Chicago and interview them every 3 months for 15 months. We will also conduct interviews during and after COPD exacerbations to assess changes illness representations and their impact on SMB. For Aim 3, we will conduct qualitative interviews with patients who have good or low medication adherence to understand cognitive processes that guide SMB and to identify the self-management strategies they use. We will then create counseling modules to improve self-management and pilot them among 100 patients. The study will expand the SRM to MM, elucidate how patients respond to varying beliefs in the context of MM, and provide prototype self-management support counseling modules for application to a future, fully developed intervention to improve SMB and outcomes for adults with MM.

 描述（由申请人提供）：患有多种疾病（MM）的患者的治疗效果通常很差，部分原因是自我管理行为（SMB）的依从性较低。研究已经确定了 SMB 对个体疾病的关键决定因素，并显示了强大的影响力。疾病表征和药物信念对这些行为的影响然而，人们对多发性骨髓瘤背景下疾病表征的影响知之甚少，因为对一种疾病及其治疗的信念可能与针对一种疾病及其治疗的信念不一致或共生。如果没有这些知识，我们为 MM 患者提供最佳自我管理支持的能力是有限的。 关于慢性病及其治疗的信念如何在 MM 背景下影响 SMB，并将这些信息转化为自我管理支持咨询模块，以用于未来的干预措施。代价高昂的健康问题，并评估自我管理水平不同的 3 种共存疾病的影响 复杂性和症状学：高血压 (HTN)、糖尿病 (DM) 和抑郁症 该研究设计植根于自我调节模型 (SRM)，这是一种健康行为理论，已用于制定干预措施，但仅应用于治疗。围绕单一疾病的行为研究对 SRM 的研究非常有意义，因为抑郁症患者通常对疾病有适应不良的表征和认知，通过了解疾病表征和药物信念的相互作用及其对 SMB 的影响。针对合并症，我们将推进 MM 患者的 SRM 和临床护理，具体目标是： 1) 检查 COPD、HTN 和 DM 相关认知和情绪疾病表征以及药物信念对患者自我的相互作用影响。随着时间的推移对这些病症的管理；2) 评估重度抑郁症与 COPD SMB 随着时间的推移的关联，并通过疾病表征和药物信念评估途径，调节这种关系；(3) 以 Aims 的研究结果为指导12 和 SRM，为患有 MM 的 COPD 患者开发和试点测试教育和咨询模块，以促进对 SMB 的依从性。我们将对纽约市和芝加哥的 400 名患有 HTN 或 DM 的 COPD 患者进行混合方法前瞻性队列研究，并对他们进行采访。我们还将在 COPD 恶化期间和之后进行 3 个月的访谈，以评估疾病表征的变化及其对 SMB 的影响。对于目标 3，我们将对药物依从性良好或较低的患者进行定性访谈。了解指导 SMB 的认知过程并确定他们使用的自我管理策略，然后我们将创建咨询模块来改善自我管理并在 100 名患者中进行试点，该研究将 SRM 扩展到 MM，阐明患者的反应。 MM背景下的不同信念，并提供自我管理原型 支持咨询模块，用于未来成熟的干预措施，以改善 MM 成人的 SMB 和结果。