A Mixed Methods Study of Chronic Kidney Disease (CKD) Self-Management

慢性肾脏病（CKD）是一种日益严重的流行病，影响近15%的美国人口，是一种遗传性疾病。 早期进行性，伴有心血管疾病和终末期肾病的潜在致命并发症。 CKD的定向治疗具有挑战性，因为CKD是一种综合征，其病因通常无法确定。 缺乏针对特定疾病的干预措施。然而，有一些跨领域的办法， 广泛有益于CKD患者，并由现行CKD管理指南推荐， 包括建议患者参与自我管理行为（例如，监测血压， 身体活动，避免吸烟）。到目前为止，对自我管理的研究有限， 透析CKD。少数已发表的研究表明，对建议的自我管理能力的吸收不足， 内审报告强调需要1）了解建议中未达到标准的聘用的原因， 行为，和2）开发和评估新的方法，以改善CKD自我管理。莎拉·施劳本， 医学博士，MSCE，肾脏病学家，将在她提议的K23奖中针对这一未充分研究的领域。Schrauben博士是 定位于使用这个奖项，在丰富的环境中启动独立资助的研究生涯， 宾夕法尼亚大学，因为她已经完成了临床流行病学硕士学位， 她获得了流行病学、生物统计学、研究设计方面的经验，在博士后研究期间， 在一个大型CKD观察队列中对自我管理行为进行了初步研究， 参加了定性和混合方法研究的正式培训。K23项目将在- 对CKD患者进行深度访谈，了解参与健康行为和认同的影响， fy相关因素的设计和实施的自我管理支持干预（目标1）。中 在一个CKD患者的大队列中，Schrauben博士将研究推荐自我治疗的潜在预测因素。 管理行为参与，以识别对自我管理支持重要的患者特征 干预（目标2）。利用这些信息，她将发展以病人为中心的自我管理支持- 利用健康行为理论和移动的健康（mHealth）技术进行干预，然后试点其可行性， （目标3）。通过她提出的职业发展，她寻求获得1）临床试验设计，IM- 实施和评估，2）混合研究方法，3）先进的统计分析，包括长期的， 从试点试验中获得指导性数据分析，同时获得4）实施科学和5）健康方面的专业知识 行为研究为了实现这些目标，Schrauben博士组建了一个多学科的导师队伍。 由肾脏流行病学、生物统计学、临床试验、混合研究方法、免疫学和免疫学等领域的国家专家领导的小组， 实施科学，健康行为研究和利用mHealth的干预措施。完成后 这些K23活动，Schrauben博士将准备进行一项由R 01资助的RCT，利用她的 培训以改善CKD患者的自我管理。

Chronic kidney disease (CKD) is a growing epidemic, affecting close to 15% of the US population, and is gen- erally progressive, with potentially fatal complications of cardiovascular disease and end-stage kidney disease. Directed treatment of CKD is challenging because CKD is a syndrome with causes that are often not identifia- ble and a dearth of disease-specific interventions. However, there are some cross-cutting approaches that are broadly beneficial for people with CKD, and are recommended by current CKD management guidelines, which include advising patients to engage in self-management behaviors (e.g., monitor blood pressure, maintain physical activity, and avoid tobacco). To date, there has been limited research on self-management in pre- dialysis CKD. The few published studies demonstrate poor uptake of recommended self-management behav- iors, which highlights the need to 1) understand the reasons for substandard engagement in recommended behaviors, and 2) develop and evaluate new approaches to improve CKD self-management. Sarah Schrauben, MD, MSCE, a nephrologist, will target this understudied area in her proposed K23 Award. Dr. Schrauben is positioned to use this award to launch an independently funded research career in the rich environment at the University of Pennsylvania, as she has completed a Masters degree in clinical epidemiology, through which she gained experience in epidemiology, biostatistics, study design, and during her post-doctoral fellowship, conducted a preliminary study on self-management behaviors in a large CKD observational cohort, as well as participated in formal training in qualitative and mixed methods research. Her proposed K23 work will utilize in- depth interviews with CKD patients to understand the influences of participating in health behaviors and identi- fy relevant factors for the design and implementation of a self-management support intervention (Aim 1). In a large cohort of individuals with CKD, Dr. Schrauben will investigate potential predictors of recommended self- management behavior engagement to identify patient characteristics important for a self-management support intervention (Aim 2). Using this information, she will develop a patient-centered self-management support in- tervention harnessing health behavior theory and mobile health (mHealth) technology and then pilot its feasibil- ity (Aim 3). Through her proposed career development, she seeks to gain skills in 1) clinical trial design, im- plementation, and evaluation, 2) mixed research methods, 3) advanced statistical analyses, including the longi- tudinal data analyses from the pilot trial, while garnering expertise in 4) implementation science, and 5) health behavior research. To achieve these objectives, Dr. Schrauben has assembled a multi-disciplinary mentorship team led by national experts in renal epidemiology, biostatistics, clinical trials, mixed research methods, im- plementation science, health behavior research, and interventions leveraging mHealth. Upon completion of these K23 activities, Dr. Schrauben will be poised to conduct a RCT supported by a R01 grant, leveraging her training to improve self-management among persons with CKD.