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

描述(申请人提供)：中风是导致残疾的首要原因，第三大致死原因，也是美国人最耗费资源的疾病之一。非洲裔美国人(AA)的中风发生率几乎是欧洲裔美国人(EA)的两倍，与EA相比，首次中风的AA更年轻，中风残疾程度更高，中风后并发症更多，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，迫切需要医疗保健方法来改善中风患者的健康状况，并降低中风的复发/未来风险。不幸的是，只有有限的文献专门关注改善AA男性卒中幸存者卒中后护理的参与度。拟议的项目是对NIH PA-10-237：在种族和少数民族男性中促进健康(R21)的回应。针对那些有短暂性脑缺血发作(TIA)或较轻的首次中风(FTS)的AA男性的干预可能特别及时，因为一些人将TIA/FTS体验为中风相关事件的“唤醒”或“第一次刷牙”。这个分两个阶段的项目将使用迭代、协作的过程来改进这些研究人员在种族多样性多个病态个体中开发的现有行为干预，然后初步测试改进后的干预措施。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者，然后将根据代表性咨询委员会的意见，为患有TIA/FTS的AA男性完善有针对性的管理干预(团队)。第二阶段将是对患有TIA/FTS的AA男性患者进行的前瞻性试验性比较研究，研究对象为团队和照常治疗(TAU)。参与者将随机接受小组(N=19)或TAU(N=19)，并跟踪6个月。我们假设，与TAU相比，与TAU相比，该团队将被患有TIA/FTS的AA男性接受，并将与更大程度地改善与处方卒中风险降低药物疗法的用药依从性有关。探索性评估将评估对自我管理(饮食、锻炼、吸烟/减少药物使用)和中风的生物风险标记物(血压、糖化血红蛋白、体重指数/体重指数、胆固醇和甘油三酯)的影响。团队的一个独特功能是使用Peer Dyads(AA男性和他们的护理伙伴)提供支持和模范行为，以改善中风后的护理。与恢复个人和社会角色的重点一致，将使用“照顾者”一词，而不是“照顾者”。这项拟议的研究以人为中心，利用再生障碍性贫血家庭和社区的现有优势进行整体干预。这项干预代表了一种实用和可推广的方法，适合在专科、初级保健或社区环境中实施，并有可能扭转AA男性由于中风和中风相关疾病而出现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.