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（由适用提供）：多发病患者（MM）的结果通常很差，部分原因是对自我管理行为的依从性较低（SMB）。研究已经确定了SMB的关键决定者对个别疾病的关键决定者，并表明疾病代表和药物对这些行为的有力影响。然而，在MM的背景下，疾病表征的影响知之甚少，在MM的背景下，人们对一种疾病及其治疗可能与合并症相反，或者是共生的。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。这项研究的目的是确定 在MM的背景下，如何相信慢性疾病及其治疗会影响SMB，并将这些信息转化为自我管理支持咨询模块，以便在将来的干预措施中使用。我们将专注于患有慢性阻塞性肺疾病（COPD）的患者，这是一个残疾和昂贵的健​​康问题，并评估了3种自我管理水平不同的合并症的影响 复杂性和症状学：高血压（HTN），糖尿病（DM）和抑郁症。研究设计植根于自我调节模型（SRM），这是一种用于开发干预措施的健康行为理论，但仅应用于对单个疾病周围行为的研究。抑郁症在对SRM的研究中引起了极大的兴趣，因为抑郁症患者经常患有适应不良的表征和对疾病的看法。通过了解疾病表征和药物信念的相互作用及其在合并症的背景下对SMB的影响，我们将促进MM患者的SRM和临床护理。具体目的是：1）检查COPD，HTN和DM相关的认知和情感疾病表征和药物信念对患者对这些疾病的自我管理的交互作用； 2）随着时间的推移，评估严重抑郁症与COPD SMB的关联，并通过疾病表征和药物信念评估途径，从而介导这种关系；（3）在AIMS 12和SRM的发现和SRM的发现中，开发和试验测试教育和咨询模块，以促进具有MM的COPD患者，以促进SMB的依恋。我们将对纽约市和芝加哥的400名HTN或DM患者进行一项混合方法前瞻性队列研究，并每3个月一次采访15个月。我们还将在COPD加剧期间和之后进行访谈，以评估变化疾病表征及其对SMB的影响。对于AIM 3，我们将对具有良好或低药物依从性的患者进行定性访谈，以了解指导SMB并确定他们使用的自我管理策略的认知过程。然后，我们将创建咨询模块，以改善自我管理，并在100名患者中试用他们。该研究将将SRM扩展到MM，阐明患者在MM背景下对不同信念的反应，并提供原型自我管理 支持咨询模块，以适用于未来，完全开发的干预措施，以改善MM成人的SMB和结果。