MOVE Trial: MOtiVational Strategies to Empower African Americans to Improve Dialysis Adherence

MOVE 试验：激励非裔美国人提高透析依从性的策略

• 批准号: 10504154
• 负责人: Ebele M Umeukeje
• 金额: $ 62.61万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10504154
• 关键词: Accounting; Address; Adherence; African American; African American population; Attention; Behavior Therapy; Budgets; Caring; Chronic; Chronic Disease; Communities; Complex; Counseling; Data; Dialysis patients; Dialysis procedure; End stage renal failure; Evidence based intervention; Financial Hardship; Financial cost; Future; Goals; Health; Health behavior; Health system; Hemodialysis; High Prevalence; Hospitalization; Intervention; Kidney Diseases; Lead; Link; Medicare; Minority; Minority Groups; Mission; Modeling; Morbidity - disease rate; Motivation; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Patients; Population; Predictive Factor; Prevalence; Prevention; Process; Prospective cohort; Protocols documentation; Provider; Psychosocial Factor; Public Health; Race; Randomized; Randomized Clinical Trials; Research; Risk; Testing; base; behavior change; behavioral adherence; effectiveness implementation trial; effectiveness trial; efficacy evaluation; efficacy testing; ethnic minority; evidence base; health disparity; health equity; health equity promotion; health training; hospital readmission; improved; improved outcome; innovation; intervention delivery; medication compliance; mortality; motivational enhancement therapy; novel; psychosocial; public health relevance; racial and ethnic; treatment adherence

Hemodialysis treatment non-adherence is a public health issue because of its association with excessive hospitalizations, high morbidity, and mortality, and increased financial costs. Compared to whites, African Americans have a four-fold higher prevalence of end-stage kidney disease (ESKD), higher non-adherence rates to hemodialysis, and higher odds of hospitalizations. Motivational interviewing, an evidence-based intervention that creates a bond between patients and providers, targets improvement in motivation-related psychosocial factors associated with adherence behaviors. Interventions for such factors are typically developed based on the dominant culture and may not be valid and generalizable to minority groups. Culturally tailored interventions lead to more durable change in African Americans yet there is a lack of studies testing the efficacy of such approaches to improve hemodialysis treatment adherence in African Americans. Use of culturally tailored motivational interviewing in African Americans with ESKD will promote health equity by improving dialysis treatment adherence, reducing hospitalizations, and enhancing other critical outcomes. Our long-term goal is to establish culturally sensitive strategies and multi-level interventions to improve outcomes in kidney disease. The overall objective of this project is to evaluate the efficacy of a culturally tailored motivational interviewing intervention developed using a rigorous theoretical framework on improving hemodialysis treatment adherence in African Americans with ESKD. The central hypothesis is that culturally tailored motivational interviewing will lead to improved hemodialysis treatment adherence. We will test this hypothesis in the following Specific Aims in a randomized clinical trial (RCT) in African American patients with ESKD. Compared to usual dialysis care, we aim to: Evaluate the efficacy of 8 weeks of culturally tailored motivational interviewing (MOVE) on improving hemodialysis treatment adherence at (1) 3 months, and (2) 6 months post-randomization. At the successful completion of the proposed research, the expected outcomes will include evidence of the efficacy of culturally tailored motivational interviewing on improving hemodialysis treatment adherence in African American patients with ESKD. The proposed research is innovative because of the novel application of a culturally tailored, evidence-based behavioral intervention developed using a rigorous theoretical framework (PEN-3); the use of specifically-trained health coaches to optimize intervention delivery; and the focus on understudied and overrepresented African American patients with ESKD to address the public health issue of hemodialysis treatment non-adherence. Study results will provide a strong basis for conducting an effectiveness and implementation trial, which is expected to have a significant impact on hemodialysis adherence, hospitalizations, morbidity, and mortality. This research strongly aligns with NIDDK's mission to promote health equity by addressing health disparities in kidney disease.

不依从血液透析治疗是一个公共健康问题，因为它与过度血液透析治疗有关。 住院治疗、高发病率和死亡率以及增加的财务成本。与白人相比，非洲人 美国人的终末期肾病 (ESKD) 患病率高出四倍，不依从性更高 血液透析率和住院率更高。动机性访谈，基于证据的 在患者和提供者之间建立联系的干预措施，旨在改善与动机相关的行为 与依从行为相关的心理社会因素。针对这些因素的干预措施通常是 基于主流文化而制定的，可能不适用于少数群体，也不适用于少数群体。文化上 量身定制的干预措施可以为非裔美国人带来更持久的变化，但缺乏测试的研究 这些方法在提高非裔美国人血液透析治疗依从性方面的功效。使用 对患有 ESKD 的非裔美国人进行根据文化定制的动机访谈将通过以下方式促进健康公平： 提高透析治疗的依从性、减少住院率并改善其他关键结果。 我们的长期目标是制定文化敏感战略和多层次干预措施，以改善 肾脏疾病的结果。该项目的总体目标是评估文化的有效性 使用严格的理论框架开发定制的动机访谈干预措施，以提高 患有 ESKD 的非裔美国人的血液透析治疗依从性。中心假设是文化上 量身定制的动机访谈将提高血液透析治疗的依从性。我们将测试这个 以下假设是在非裔美国患者中进行的一项随机临床试验（RCT）中的具体目标 ESKD。与常规透析护理相比，我们的目标是： 评估 8 周文化定制的疗效 关于提高 (1) 3 个月和 (2) 6 个月时血液透析治疗依从性的动机访谈 (MOVE) 随机化后几个月。成功完成拟议研究后，预期结果 将包括根据文化定制的动机访谈对改善血液透析的有效性的证据 非洲裔美国 ESKD 患者的治疗依从性。所提出的研究具有创新性，因为 一种根据文化量身定制、基于证据的行为干预的新颖应用，采用严格的方法开发 理论框架（PEN-3）；使用经过专门培训的健康教练来优化干预措施； 重点关注研究不足且代表性过高的非裔美国 ESKD 患者，以解决 不遵守血液透析治疗的公共卫生问题。研究结果将为 进行有效性和实施试验，预计将产生重大影响 血液透析依从性、住院率、发病率和死亡率。这项研究与 NIDDK 的研究高度一致 使命是通过解决肾脏疾病方面的健康差异来促进健康公平。