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: 10454999
• 负责人: Aqueasha Martin Hammond
• 金额: $ 20.18万
• 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 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10454999
• 关键词: Address; Adherence; Adult; African American population; 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; community-level factor; 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.

抽象的 尽管获得了数十年的认可，非裔美国人 (AA) 和生活在城市社区的成年人仍然继续 心血管疾病 (CVD) 和相关危险因素的发病率不成比例地较高，例如 高血压、糖尿病、肥胖症和肾病等疾病，比它们在普通人群中的代表性要高。作为 CVD 是美国和全世界死亡的主要原因，它还导致严重的发病率、残疾和 经济损失。生活在低收入和城市社区的 AA 和成年人尤其脆弱 受主要心血管疾病危险因素影响且健康状况较差的人群。这些 心血管疾病负担和结果的健康差异受到复杂的社会人口、社会经济、 医疗保健系统和社区因素，包括患者自我管理行为、利用和质量 卫生服务、提供者与患者的沟通、健康食品的供应、教育和社会支持。 降低 CVD 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（包括健康饮食和身体活动习惯）、坚持药物治疗、 以及共同的医疗决策。这些策略是 CVD 推荐护理的基石 风险降低，并与接受治疗的患者 CVD 控制的显着改善相关。 我们的主要研究目标是采用现有的基于证据的、面对面的 CVD 教育和行为方法 战略干预，健康自由朋友圈计划，进入移动健康（mHealth） 干涉。该两阶段项目将采用基于社区的参与性研究（CBPR）的原则， 以人为本的计算和个人信息学，以开发文化敏感的教育和 行为移动健康干预促进 AA 中 CVD 风险的降低和自我管理行为 和其他承受 CVD 负担过重的群体（第一阶段），然后测试移动医疗干预的效果 主要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来确定参与的目标、需求、挑战和偏好 具有文化敏感性、基于社区的移动医疗个人信息学工具，可促进心血管疾病健康公平。目标1 将确定患者对基于社区的移动医疗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 移动健康干预原型并在连续的面对面中使用迭代过程定制内容 参与式设计研讨会。目标 3 将评估移动医疗的可接受性、可用性和满意度 AA 和其他承受 CVD 负担过重的群体的可行性研究中的一个工具。我们现有的 社区利益相关者咨询委员会将在所有研究阶段提供意见。我们提出的研究将 为 NIH 的使命做出贡献，即设计和测试文化敏感的移动医疗工具，以实现 CVD 健康公平。