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

血液透析治疗不依从性是一个公共卫生问题，因为它与过度的 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 美国人的终末期肾病（ESKD）患病率高出四倍， 血液透析率和更高的住院几率。动机访谈，一个基于证据的 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 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 这是基于主流文化发展起来的，可能对少数群体无效和不适用。文化 量身定制的干预措施导致非洲裔美国人更持久的变化，但缺乏研究测试 这些方法改善非裔美国人血液透析治疗依从性的有效性。使用 在患有ESKD的非裔美国人中进行文化定制的动机访谈将促进健康公平， 提高透析治疗依从性，减少住院治疗，并提高其他关键结果。 我们的长期目标是制定文化敏感战略和多层次干预措施， 肾脏疾病的结果。该项目的总体目标是评估一种文化 量身定制的动机访谈干预开发使用严格的理论框架，提高 非裔美国ESKD患者血液透析治疗依从性核心假设是， 定制的动机访谈将导致血液透析治疗依从性的改善。我们将测试这个 在非裔美国人患者中进行的随机临床试验（RCT）中的以下特定目的假设 ESKD。与常规透析护理相比，我们的目标是： 在（1）3个月和（2）6个月时，对改善血液透析治疗依从性进行动机访谈（MOVE） 随机化后个月。在成功完成拟议的研究，预期成果 将包括文化定制的动机访谈对改善血液透析的有效性的证据 非裔美国ESKD患者的治疗依从性。这项研究具有创新性，因为 一种文化定制的、基于证据的行为干预的新应用， 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的实施; 以及关注研究不足和代表性过高的非裔美国ESKD患者，以解决 血液透析治疗不依从性的公共卫生问题。研究结果将为 开展有效性和实施试验，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 使命是通过解决肾脏疾病的健康差异来促进健康公平。

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.