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

血液透析治疗不坚持是一个公共卫生问题，因为它与过度 住院、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)患病率是普通人的四倍，更高的不依从性 血液透析的比率，以及更高的住院几率。以循证为基础的激励性访谈 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 与坚持行为相关的心理社会因素。对这些因素的干预通常是 在主流文化的基础上发展起来的，可能不适用于少数群体，也不适用于少数群体。从文化上讲 量身定做的干预措施导致非裔美国人发生更持久的变化，但缺乏研究验证 这种方法改善非裔美国人血液透析治疗依从性的有效性。使用 在ESKD的非裔美国人中进行文化定制的激励性访谈将通过以下方式促进健康公平 改善透析治疗的依从性，减少住院，并提高其他危重结局。 我们的长期目标是制定对文化敏感的战略和多层次的干预措施，以改善 肾脏疾病的转归。这个项目的总体目标是评估一种文化上的 使用严格的改进理论框架制定了量身定制的动机访谈干预措施 患有ESKD的非裔美国人的血液透析治疗依从性。中心假设是，从文化上讲 量身定做的激励性访谈将提高血液透析治疗的依从性。我们将对此进行测试 在一项针对非洲裔美国人的随机临床试验(RCT)中，以下特定目的的假设 ESKD。与通常的透析护理相比，我们的目标是：评估8周文化定制的疗效 关于提高血液透析治疗依从性的激励性访谈(MOVE)在(1)3个月和(2)6个月 随机化后几个月。在成功完成拟议的研究后，预期结果 将包括根据文化定制的激励性访谈在改善血液透析方面的有效性的证据 非裔美国人ESKD患者的治疗依从性。拟议的研究具有创新性，因为 一种以文化为基础的、基于证据的行为干预的新应用 理论框架(PEN-3)；使用受过专门培训的健康教练来优化干预提供； 重点关注患有ESKD的非裔美国人患者研究不足和代表性过高，以解决 血液透析治疗不坚持的公共卫生问题。研究结果将为以下工作提供有力的基础 进行有效性和实施试验，预计将对 血液透析依从性、住院率、发病率和死亡率。这项研究与NIDDK的研究非常一致 通过解决肾脏疾病的健康差距来促进健康公平的使命。

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.