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Phone-based Interventions under Nurse Guidance after Stroke II (PINGS II)

中风后在护士指导下进行的电话干预 II (PINGS II)

基本信息

批准号：
10405058
负责人：
BRUCE OVBIAGELE
金额：
$ 56.95万
依托单位：
NORTHERN CALIFORNIA INSTITUTE/RES/EDU
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-04-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10405058
关键词：
Academy Accident and Emergency department Address Adherence Adoption Adult Africa South of the Sahara Age Algorithms American Antihypertensive Agents Area Belief Brain Diseases Car Phone Cardiovascular system Caring Cellular Phone Chronic Country Data Effectiveness Etiology Event Focus Groups Funding Ghana Goals Health Health Benefit Health Personnel Health Services Accessibility Health Technology Health care facility Health education Healthcare Home Blood Pressure Monitoring Hospitals Hybrids Hypertension Improve Access Incidence Income Instruction Intake Intention Intervention Investments Learning Measures Mediator of activation protein Medical center Medicine Modification Monitor Nurses Outcome Outcome Measure Patients Pharmaceutical Preparations Physicians Pilot Projects Policies Population Prevalence Prevention strategy Quality of life Randomized Controlled Trials Recurrence Research Research Design Resource-limited setting Resources Risk Factors Self Efficacy Self Management Standardization Stroke System Techniques Telephone Testing Text Messaging Theoretical model Therapeutic Time United States United States National Institutes of Health Ursidae Family Work adverse outcome base blood pressure control blood pressure intervention blood pressure medication burden of illness cardiovascular emergency cardiovascular risk factor care outcomes clinical practice effectiveness evaluation efficacy testing evidence base experience global health high risk hospital readmission hypertension control hypertensive hypertensives implementation barriers implementation context implementation facilitators implementation strategy improved indexing low and middle-income countries mHealth medication compliance modifiable risk mortality post stroke preference primary outcome programs satisfaction secondary outcome stroke incidence stroke patient stroke risk stroke survivor systematic review treatment as usual underserved area unhealthy lifestyle usability usual care arm vascular risk factor

项目摘要

PROJECT SUMMARY Global estimates suggest that sub-Saharan Africa (SSA) now has the highest incidence and prevalence of stroke. However, limited system resources, meager patient resources, uncoordinated care, and shortage of clinicians, greatly hamper the capacity of countries in SSA to implement effective measures aimed at controlling key vascular risk factors such as hypertension (HTN) to thwart stroke recurrence in routine clinical practice. In particular, SSA has the highest estimated effect size of HTN for stroke causation worldwide. HTN is often unrecognized, undertreated and uncontrolled in a significant proportion of the adult population in this region due to a clustering of factors including cultural beliefs and misconceptions about hypertension, low self-efficacy, non- adherence to treatment, unavailability of health facilities, health personnel, lack of access to of antihypertensive medications, therapeutic inertia by physicians, and other factors. With the anticipated continued transition from primarily infectious conditions to chronic non-communicable diseases, the burden of stroke in SSA is likely to increase even further over the next several decades. Given all of the aforementioned factors, it is an urgent priority for countries in SSA to develop and test self-management interventions to control hypertension among those at highest risk of adverse outcomes. The overall objective of Phone-based Intervention under Nurse Guidance after Stroke II (PINGS-2) is to deploy a hybrid study design to firstly, demonstrate the efficacy in a randomized controlled trial of a theoretical-model-based, mHealth technology-centered, nurse-led, multi-level integrated approach to substantially improve longer term BP control among 500 recent stroke patients encountered at 10 hospitals in Ghana. Secondly, PINGS II seeks to develop an implementation strategy for routine integration and policy adoption of mhealth for post-stroke BP control in a LMIC setting. We will leverage experience gained from the NIH Global Brain Disorders funded R21 pilot study (NS094033) to test efficacy of a refined, culturally-tailored, and potentially implementable intervention aimed at addressing the premier modifiable risk for stroke & other key variables in an under-resourced system burdened by suboptimal care & outcomes. The primary outcome is blood pressure control at month 12 alongside a host of secondary outcome measures such as medication adherence, self-efficacy, cardiovascular emergency department encounters, quality of life, and mediator outcomes. While it is important to establish the efficacy of a nurse-led, m-health-centered self- management intervention for blood pressure control in LMICs, it equally crucial to simultaneously begin crafting an implementation plan. Hence we will seek to identify context-specific implementation facilitators and barriers, to understand the implementation context, and craft evidence-based implementation strategies for routine use & policy adoption of the PINGS intervention in Ghana through multiple stakeholder engagements.

项目总结