Health Freedom Path to Wellness: A Culturally-Relevant and Patient-Centered mHealth Intervention to Promote Cardiovascular Health Equity

健康自由之路的健康：一种与文化相关且以患者为中心的移动医疗干预措施，以促进心血管健康公平

• 批准号: 10303552
• 负责人: Aqueasha Martin Hammond
• 金额: $ 25.87万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-21 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10303552
• 关键词: Address; Adherence; Adult; African American; Behavior; Behavior Therapy; Behavioral; Behavioral Medicine; Blood Pressure Monitors; COVID-19 pandemic; Cardiology; Cardiovascular Diseases; Caring; Chronic Disease; Communities; Complex; Decision Making; Development; Diabetes Mellitus; Discipline of Nursing; Disease Outcome; Economics; Education; Educational Intervention; Educational workshop; Effectiveness; Ensure; Feasibility Studies; Freedom; Friends; General Population; Goals; Habits; Health; Health Food; Health Services; Health Technology; Health education; Healthcare Systems; Home Blood Pressure Monitoring; Hypertension; Individual; Informatics; Intervention; Interview; Kidney Diseases; Life Style; Low income; Medical; Methods; Mission; Mobile Health Application; Morbidity - disease rate; Obesity; Outcome; Participant; Patient Education; Patients; Perception; Persons; Pharmaceutical Preparations; Phase; Physical activity; Population; Process; Protocols documentation; Publishing; Research; Research Design; Risk Factors; Risk Reduction; Self Care; Self Management; Social support; Structure; Subgroup; System; Testing; United States National Institutes of Health; Urban Community; base; burden of illness; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; community based participatory research; computer human interaction; contextual factors; design; disability; disease disparity; disorder control; education access; evidence base; evidence based guidelines; experience; good diet; health care quality; health communication; health data; health disparity; health equity; heuristics; human centered computing; informatics tool; mHealth; mortality; patient oriented; patient-clinician communication; preference; programs; prototype; racial disparity; satisfaction; sociodemographics; socioeconomics; therapy design; tool; usability; user centered design; virtual

ABSTRACT Despite decades of recognition, African Americans (AAs) and adults living in urban communities continue to experience disproportionately higher rates of cardiovascular diseases (CVD) and associated risk factors, such as hypertension, diabetes, obesity, and kidney disease, than their representation in the general population. As the leading cause of mortality in the US and worldwide, CVD also causes serious morbidity, disability, and economic losses. AAs and adults living in low-income and urban communities represent particularly vulnerable subgroups of persons burdened by major CVD risk factors and experience poorer health outcomes. These health disparities in CVD burden and outcomes are influenced by complex sociodemographic, socioeconomic, healthcare system, and community factors, including patient self-management behaviors, utilization and quality of health services, provider-patient communication, healthy food availability, education, and social support. Effective strategies for CVD risk reduction and self-management behaviors include self-blood pressure (BP) monitoring, lifestyle changes (including healthy diet and physical activity habits), adherence to medications, and shared medical decision-making. These strategies represent a cornerstone of recommended care for CVD risk reduction and have been associated with significant improvements in CVD control among treated patients. Our primary study goal is to adapt an existing evidence-based, face-to-face, CVD educational and behavioral strategy intervention, the Health Freedom Circle of Friends program, into a mobile health (mHealth) intervention. The two-phase project will use principles of community-based participatory research (CBPR), human-centered computing, and personal informatics to develop a culturally-sensitive educational and behavioral mHealth intervention to promote CVD risk reduction and self-management behaviors among AAs and other groups disproportionately burdened by CVD (phase 1) and later test the mHealth intervention’s acceptability, usability, and satisfaction among key stakeholders (phase 2). We will use a mixed-methods, user-centered design approach to identify goals, needs, challenges, and preferences for participating in the culturally-sensitive, community-based mHealth personal informatics tool to promote CVD health equity. Aim 1 will establish patients’ needs and preferences for a community-based mHealth intervention tool to support CVD prevention and self-management using semi-structured interviews. Aim 2 will design a culturally-sensitive mHealth intervention prototype and tailor content using an iterative process within sequential in-person participatory design workshops. Aim 3 will assess the acceptability, usability, and satisfaction of the mHealth tool within a feasibility study among AAs and other groups disproportionately burdened by CVD. Our existing community stakeholder advisory board will provide input throughout all study phases. Our proposed study will contribute to the NIH’s mission to design and test culturally-sensitive mHealth tools for CVD health equity.

摘要 尽管几十年来得到了承认，但生活在城市社区的非裔美国人（AAs）和成年人继续受到歧视， 心血管疾病（CVD）和相关风险因素的发生率不成比例地高， 高血压、糖尿病、肥胖和肾脏疾病的发病率高于他们在一般人群中的代表性。作为 作为美国和世界范围内死亡的主要原因，CVD还导致严重的发病率、残疾， 经济损失生活在低收入和城市社区的AA和成年人特别脆弱 受主要心血管疾病风险因素影响的人群亚组，健康状况较差。这些 CVD负担和结果的健康差异受复杂的社会人口统计学，社会经济学， 医疗系统和社区因素，包括患者自我管理行为、利用和质量 健康服务、医患沟通、健康食品供应、教育和社会支持。 降低心血管疾病风险和自我管理行为的有效策略包括自我血压（BP） 监测、生活方式改变（包括健康饮食和体育活动习惯）、药物依从性， 和共同的医疗决策。这些策略代表了CVD推荐护理的基石 风险降低，并与治疗患者中CVD控制的显著改善相关。 我们的主要研究目标是调整现有的基于证据的，面对面的，CVD教育和行为 战略干预，健康自由的朋友圈计划，成为一个移动的健康（mHealth） 干预该项目分为两个阶段，将采用基于社区的参与性研究（CBPR）原则， 以人为本的计算和个人信息学，以发展一个文化敏感的教育和 行为mHealth干预，以促进心血管疾病的风险降低和自我管理行为之间的AA 和其他群体不成比例地负担心血管疾病（第1阶段），后来测试mHealth干预的 关键利益相关者的可接受性、可用性和满意度（第2阶段）。我们将使用混合方法， 以用户为中心的设计方法，以确定目标，需求，挑战和参与的偏好， 文化敏感，基于社区的mHealth个人信息学工具，以促进CVD健康公平。要求1 将确定患者对基于社区的移动健康干预工具的需求和偏好，以支持心血管疾病 使用半结构化访谈进行预防和自我管理。目标2将设计一个文化敏感的 移动健康干预原型和定制内容使用迭代过程中连续的人 参与式设计研讨会。目标3将评估mHealth的可接受性、可用性和满意度 在AA和其他CVD负担不成比例的群体中进行可行性研究。我们现有 社区利益攸关方咨询委员会将在所有研究阶段提供投入。我们建议的研究将 有助于美国国立卫生研究院的使命，设计和测试文化敏感的mHealth工具，CVD健康公平。