Targeted management intervention for African-American men with TIA or stroke

描述（由申请人提供）：中风是导致残疾的主要原因，第三大死亡原因，也是美国人中资源最密集的疾病之一。非裔美国人（AA）的中风率几乎是欧美人（EA）的两倍，而且首次经历中风的非裔美国人更年轻，中风残疾更严重，中风后并发症更多，与EA相比恢复更慢。鉴于与中风相关的不成比例的负担和巨大的人道主义和经济影响，迫切需要改善中风的非裔美国人的健康状况的医疗保健方法。并减少中风复发/未来的风险。不幸的是，只有有限的文献专门关注改善AA男性中风幸存者中风后护理的参与。提议的项目是响应NIH PA-10-237：种族和少数民族男性的健康促进（R21）。针对那些有过短暂性脑缺血发作（TIA）或轻度首次中风（FTS）的AA男性的干预措施可能特别及时，因为有些人将TIA/FTS作为卒中相关事件的“叫醒电话”或“第一刷”。这个分为两个阶段的项目将使用一个迭代的、协作的过程来完善由这些研究人员在不同种族的多病态个体中开发的现有行为干预措施，然后对改进的干预措施进行初步测试。第一阶段将首先使用定性方法评估AA男性卒中后护理的障碍和促进因素，然后根据代表性咨询委员会的意见，为TIA/FTS AA男性细化针对性管理干预（TEAM）。II期将是一项前瞻性先导比较研究，在AA男性TIA/FTS患者中采用TEAM与常规治疗（TAU）。参与者将随机接受TEAM （N=19）或TAU (N=19)，并随访6个月。我们假设TEAM对于TIA/FTS的AA男性是可以接受的，并且与TAU相比，TEAM在降低卒中风险的药物治疗依从性方面有更大的改善。探索性评估将评估对自我管理（饮食、运动、吸烟/减少物质使用）和中风生物学风险标志物（血压、糖化血红蛋白、体重指数/BMI、胆固醇和甘油三酯）的影响。TEAM的一个独特之处在于使用同伴二人组（AA男性和他们的护理伙伴）来提供支持和示范行为，以改善中风后的护理。与注重恢复个人和社会角色相一致，将使用“护理伙伴”而不是“护理者”一词。拟议的研究以人为本，全面干预，利用AA家庭和社区的现有优势。该干预是一种实用且可推广的方法，适用于专科、初级保健或社区环境，并有可能扭转AA男性因中风和中风相关疾病而导致的不可接受的高发病率。

DESCRIPTION (provided by applicant): Stroke is the leading cause of disability, third leading cause of death, and one of the most resource-intensive diseases among Americans. African-Americans (AA) have a stroke rate nearly double that of Euro-Americans (EA), and AA who experience a first-ever stroke are younger, have greater stroke disability, more post-stroke complications, and slower recovery compared to EA. Given the disproportionate burden and tremendous humanitarian and financial impact related to stroke, there is a critical need for healthcare approaches that that will improve health outcomes in AA men who have had a stroke, and reduce recurrent/future risk for stroke. Unfortunately, there is only a limited literatre that has specifically focused on improving engagement in post- stroke care for AA men stroke survivors. The proposed project is in response to NIH PA-10-237: Health Promotion among Racial and Ethnic Minority Males (R21). Interventions targeted to those AA men who have had transient ischemic attack (TIA) or a milder first-time stroke (FTS) may be particularly well-timed as some individuals experience the TIA/FTS as a "wake up call" or "first-brush" with a stroke-related event. This 2-phase project will use an iterative, collaborative process to refine an existing behavioral intervention developed by these investigators in ethnically diverse multiply morbid individuals, and then preliminarily test the refined intervention. Phase I will first use qualitative methods to evaluate barriers and facilitators to post- stroke care in AA men, and will then refine a TargetEd MAnageMent Intervention (TEAM) for AA men with TIA/FTS informed by input from a representative advisory board. Phase II will be a prospective pilot comparative study of TEAM vs. treatment as usual (TAU) in AA men with TIA/FTS. Participants will be randomized to receive either TEAM (N=19) or TAU (N=19) and followed for 6 months. We hypothesize that TEAM will be acceptable to AA men with TIA/FTS, and will be associated with greater improvement in medication adherence with prescribed stroke risk reduction pharmacotherapies compared to TAU. Exploratory assessments will evaluate effects on self-management (diet, exercise, smoking/substance use reduction) and biological risk markers for stroke (blood pressure, HbA1c, Body Mass Index/BMI, cholesterol, and triglycerides). A unique feature of TEAM is the use of Peer Dyads (AA men and their care partners) to provide support and model behaviors that will improve post-stroke care. Consistent with the focus on restoration of personal and social roles, the term "care partner" will be used rather than "caregiver". The proposed research features a person-centered, holistic intervention that takes advantage of existing strengths in AA families and communities. The intervention represents a practical and generalizable approach suitable for implementation in specialty, primary care, or community settings, and has the potential to reverse the unacceptably high morbidity seen in AA men due to stroke and stroke-related disorders.