SToRytelling to Improve DiseasE outcomes in Gout: The STRIDE-GO Study

讲故事可改善痛风疾病的结果：STRIDE-GO 研究

• 批准号: 8783912
• 负责人: Jasvinder A Singh
• 金额: --
• 依托单位: BIRMINGHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2015-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8783912
• 关键词: Accident and Emergency department; Activities of Daily Living; Acute; Address; Adherence; Adoption; Affect; African American; Alcohols; Area; Arthritis; Attitude; Behavior; Behavior Therapy; Body Weight decreased; Caucasians; Caucasoid Race; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Clinic; Cognitive; Communication; Congestive Heart Failure; Coronary Arteriosclerosis; Cultural Characteristics; Diet; Disease; Disease Management; Disease Outcome; Disease susceptibility; Evaluation; Flare; Focus Groups; Future; Gout; Health; Health Services; Healthcare; Hyperlipidemia; Hypertension; Inpatients; Intervention; Interview; Knowledge; Lead; Learning; Low Literacy Population; Manuals; Medical Care Costs; Methods; Minority; Mission; Modeling; Monitor; Morbidity - disease rate; Organ; Osteoporosis; Outcome; Pain; Patient Outcomes Assessments; Patients; Pharmaceutical Preparations; Philadelphia; Procedures; Process; Quality of life; Research Personnel; Research Priority; Resistance; Resources; Rheumatoid Arthritis; Risk; Self Management; Serum; Severity of illness; Structure; Symptoms; Testing; Transportation; Urate; Veterans; Videotape; Visit; Voice; Work; absorption; base; behavior change; communication theory; cost; disability; disorder risk; effective therapy; health belief; health disparity; improved; innovation; joint destruction; novel; novel strategies; patient oriented; randomized trial; theories; therapy adherence; therapy development

DESCRIPTION (provided by applicant): Background and Objective: Poor disease self-management in chronic diseases is a problem and is associated with poorer health outcomes and higher health care resource utilization. Compared to Caucasians, African-Americans have even poorer disease self-management and worse outcomes in most chronic diseases. Patients often do not perceive disease severity and susceptibility to disease complications since severe symptoms of chronic conditions such as such as gout, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) etc. are usually intermittent. Our objective is to develop a patient-centered, culturally relevant narrative intervention, or "storytelling", based on the Health Belief Model (HBM) for behavior change, using narrative communication theory as methodological framework for intervention delivery. We aim to improve disease self-management among African-American Veterans, using gout as our "test case". Storytelling in the patient's own voices has the power to directly and more effectively help patients overcome intrapersonal and structural barriers and reinforce the benefits associated with optimal gout self-management. While shown to be successful in hypertension, an asymptomatic chronic disease, no evidence of efficacy of storytelling intervention exists for chronic symptomatic diseases, such as COPD, CHF, gout etc. Project Objectives and Aims: Our long-term objective is to improve health outcomes in Veterans and reduce health disparities. The objective of the proposed study, the first step in this direction, i to develop a novel storytelling intervention in Veterans' own voices to improve disease self-management and outcomes in African- American Veterans with gout, the most common type of inflammatory arthritis in Veterans, associated with significant pain and suffering, utilization and cost. Our Specific Aim (SA)s are: SA1, Formatively Identify Components of a Video Intervention - Conduct formative evaluations with patient interviews to develop a theory-based, culturally-relevant storytelling intervention to promote disease self-management among African-American Veterans with gout; SA2, Create an Intervention Video - Develop and test the feasibility of a storytelling intervention based on the results of Specific Aim 1; and SA3, Develop a Video Storytelling Manual - Develop a manual for use by investigators that describes the storytelling concept and presents step-by-step procedures for creating Video storytelling interventions. Project Methods: For Aim#1, we will perform in-depth interviews in 36 African-American veterans with gout at Birmingham and Philadelphia VA using HBM probes to identify barriers and facilitators to optimal gout self- management. For Aim#2, we will create an intervention video by inviting 12-15 storytelling stars from our qualitative work in Aim#1, chosen due to their eloquence and persuasive of their stories, videotaping the stories, decomposing into story units, rating stories on constructs of HBM and narrative communication theory, adding didactic material as "Learn more" section using material developed for patients, testing feasibility in focus groups in 32 African-American veterans with gout at Birmingham and Philadelphia VA, iteratively refining and finalizing the storytelling intervention alongside a control intervention.For Aim #3, we will develop a storytelling manual to be made available to other investigators and present HSR&D Cyber seminars for knowledge dissemination. Alignment with VA mission and priorities: This study serves the VA's mission of improving the health of veterans and by focusing on understudied minorities with poorer disease outcomes, addresses a priority area of health disparities. The results of this study will lead to a low cost patient-centered intervention for African- American Veterans with gout to improve patient outcomes, that we propose to test in a future randomized trial. Gout will serve as a "use case" for chronic disease self-management. If successful, the storytelling intervention can be adapted to other chronic symptomatic diseases such as COPD, CHF etc.

描述（由申请人提供）： 背景和目的：慢性病患者的疾病自我管理较差是一个问题，与较差的健康结果和较高的卫生保健资源利用率相关。与白人相比，非洲裔美国人的疾病自我管理更差，大多数慢性病的结果更差。患者通常不感知疾病严重性和对疾病并发症的易感性，因为慢性病症的严重症状例如痛风、慢性阻塞性肺病（COPD）、充血性心力衰竭（CHF）等通常是间歇性的。我们的目标是开发一个以患者为中心的，文化相关的叙事干预，或“讲故事”，基于健康信念模型（HBM）的行为改变，使用叙事沟通理论作为干预提供的方法框架。我们的目标是改善非洲裔美国退伍军人的疾病自我管理，使用痛风作为我们的“测试案例”。用患者自己的声音讲故事，能够直接、更有效地帮助患者克服内在和结构性障碍，并加强与最佳痛风自我管理相关的益处。虽然被证明是成功的高血压，一种无症状的慢性疾病，没有证据表明存在的慢性症状性疾病，如慢性阻塞性肺病，CHF，痛风等项目目标和宗旨的疗效讲故事的干预：我们的长期目标是改善退伍军人的健康结果，减少健康差距。拟议研究的目的，在这个方向上的第一步，我开发一种新的讲故事的干预退伍军人自己的声音，以改善疾病自我管理和结果在非洲裔美国退伍军人痛风，最常见的类型的炎性关节炎的退伍军人，与显着的疼痛和痛苦，利用和 成本我们的具体目标（SA）是：SA 1，形成性地识别视频干预的组成部分-通过患者访谈进行形成性评估，以开发基于理论的，文化相关的讲故事干预，以促进患有痛风的非裔美国退伍军人的疾病自我管理; SA 2，创建干预视频-根据具体目标1的结果开发和测试讲故事干预的可行性;和SA 3，制定视频讲故事手册-制定供研究者使用的手册，描述讲故事的概念，并介绍创建视频讲故事干预的分步程序。项目方法：对于目标#1，我们将使用HBM探针对伯明翰和费城VA的36名患有痛风的非裔美国退伍军人进行深入访谈，以确定最佳痛风自我管理的障碍和促进因素。对于目标#2，我们将通过邀请12-15个讲故事的明星来创建干预视频，这些明星来自我们在目标#1中的定性工作，根据他们的故事的口才和说服力来选择，对故事进行录像，分解成故事单元，根据HBM和叙事沟通理论的结构对故事进行评级，使用为患者开发的材料添加教学材料作为“了解更多”部分，在伯明翰和弗吉尼亚州费城的32名患有痛风的非裔美国退伍军人中进行焦点小组的可行性测试，反复完善并最终确定讲故事干预以及控制干预。对于目标#3，我们将开发一个讲故事手册，供其他研究人员使用，并举办HSR&D网络研讨会以传播知识。与退伍军人管理局的使命和优先事项的一致性：这项研究服务于退伍军人管理局的使命，即改善退伍军人的健康，并通过关注研究不足的少数民族疾病结果较差，解决了健康差距的优先领域。这项研究的结果将导致低成本的以病人为中心的干预 对于非裔美国退伍军人痛风，以改善病人的结果，我们建议在未来的随机试验测试。痛风将作为慢性病自我管理的“用例”。如果成功的话，讲故事的干预可以适用于其他慢性症状性疾病，如COPD，CHF等。

项目成果

Insurance Payer Type and Patient Income Are Associated with Outcomes after Total Shoulder Arthroplasty.

保险付款人类型和患者收入与全肩关节置换术后的结果相关。

• DOI: 10.3899/jrheum.190287
• 发表时间: 2020
• 期刊: The Journal of rheumatology
• 作者: Singh,JasvinderA;Cleveland,JohnD
• 通讯作者: Cleveland,JohnD