Modifying Behavioral Response to Failure among Patients with Cardiovascular Disease Risk Factors

改变患有心血管疾病危险因素的患者对失败的行为反应

• 批准号: 9268055
• 负责人: Shreya Kangovi
• 金额: $ 17.52万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9268055
• 关键词: Accelerometer; Advisory Committees; Affect; Applications Grants; Award; Behavior; Behavior Control; Behavior Therapy; Behavioral; Behavioral Sciences; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Cognitive; Communities; Community Health Aides; Complex; Data; Development; Disease Outcome; Emotional; Emotions; Epidemiology Nursing; Evaluation; Failure; Future; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health Promotion; Health behavior; Health behavior change; Healthcare; Healthy People 2020; Heterogeneity; Individual; Informal Social Control; Internal Medicine; Internist; Intervention; Intervention Trial; Lead; Learning; Literature; Mediation; Mediator of activation protein; Mentored Patient-Oriented Research Career Development Award; Mentors; Methodology; Methods; Motivation; Outcome; Pathway interactions; Patients; Performance; Physical activity; Process; Protocols documentation; Randomized; Randomized Controlled Trials; Reaction; Reading; Research; Research Personnel; Risk Factors; SECTM1 gene; Science; Scientist; Series; Signal Transduction; Standardization; Testing; Tobacco Dependence; Training; Translating; Universities; Weight; Work; base; behavior change; behavioral outcome; behavioral response; cardiovascular disorder risk; cardiovascular health; career; comparative effectiveness; design; disorder risk; experience; experimental study; improved; interest; low socioeconomic status; multidisciplinary; pediatrician; professor; public health relevance; resilience; response; skills; theories; treatment as usual; treatment effect; trial comparing

 DESCRIPTION (provided by applicant): The proposed K23 award will allow Shreya Kangovi, MD, MS an internist and pediatrician to develop expertise in using behavioral science to improve cardiovascular outcomes among patients of low socioeconomic status (SES). Dr. Kangovi and her colleagues developed the IMPaCT intervention, in which community health workers (CHWs) help low-SES patients to improve health behaviors and control CVD risk factors. These patients have challenging lives, and may experience setbacks and failure while attempting the complex process of health behavior change. Interim results from a randomized controlled trial of the intervention suggested that the way patients reacted to failed attempts at health behavior change was an important determinant of subsequent health behavior and ultimately, cardiovascular outcomes. The goal of this K23 proposal is to refine the intervention by helping patients learn from failure, instead of being discouraged by it. The proposed experiments will advance the science of understanding and modifying patients' response to failure. The behavioral science literature describes two ways of responding to failure: learning and avoidance. In learning, individuals use failure signals to improve self-regulation, motivation and performance. In avoidance, individuals become disengaged and perform worse after failure. Two behavioral interventions -positive affect induction (PA) and attribution retraining (AR) -- may promote learning instead of avoidance. PA uses standardized "random acts of kindness" and self-affirmation to improve emotional resilience after failure. AR teaches individuals to interpret failure as modifiable. PA and AR are proven to improve behavioral outcomes after failure but have not been widely used in healthcare. Dr. Kangovi will work with her mentors and a multidisciplinary team to develop a CHW-delivered positive affect/attribution retraining intervention (CPAAR) for improving patients' response to failure. She will then lead a real-world comparative effectiveness pilot randomized controlled trial (RCT) comparing the effects of the standard versus refined CHW intervention (with CPAAR) on physical activity and CVD outcomes. Dr. Kangovi will be guided by her primary mentor, Dr. Karen Glanz, George A. Weiss University Professor of Epidemiology and Nursing at Penn and Director of the Center for Health Behavior Research and co-mentor, Dr. Judith A. Long, Chief of the Penn Division of General Internal Medicine and an experienced researcher in cardiovascular disparities. This award will provide Dr. Kangovi with skills in translating behavioral science to cardiovascular health promotion interventions. The proposed studies will inform an R01 grant application for a comparative effectiveness RCT of standard versus refined CHW intervention for improving cardiovascular outcomes among low-SES patients.

 描述（由适用提供）：拟议的K23奖将允许医学博士Shreya Kangovi，MS是一名内部和儿科医生，可以发展使用行为科学来改善社会经济状况低下（SES）患者的心血管结局方面的专业知识。 Kangovi博士和她的同事开发了影响干预措施，在这种干预措施中，社区卫生工作者（CHW）帮助低调SES患者改善健康行为并控制CVD风险因素。这些患者有挑战生命，并可能在尝试改变健康行为的复杂过程时遭受挫折和失败。干预措施的随机对照试验的临时结果表明，患者对健康行为改变尝试失败的反应是随后的健康行为，最终是心血管结局的重要决定者。这项K23提案的目的是通过帮助患者学习失败，而不是被挫败来完善干预措施。提出的实验将提高理解和修改患者对失败的反应的科学。行为科学文献描述了两种应对失败的方法：学习和回避。在学习中，个人使用失败信号来改善自我调节，动机和表现。为了避免，个人在失败后变得脱离并表现更糟。两种行为干预措施 - 阳性影响诱导（PA）和属性再培训（AR）可能会促进学习而不是回避。 PA使用标准化的“随机行为”和自我肯定来改善失败后的情绪弹性。 AR教个人将失败解释为可修改。事实证明，PA和AR可以改善失败后的行为结果，但尚未在医疗保健中广泛使用。 Kangovi博士将与她的导师和一个多学科团队合作，以开发CHW传递的积极影响/归因性再培训干预措施（CPAAR），以改善患者对失败的反应。然后，她将领导现实世界中的比较有效性试验随机对照试验（RCT），比较标准的CHW干预（与CPAAR）对体育活动和CVD结果的影响。 Kangovi博士将由她的主要导师Karen Glanz博士，乔治·韦斯大学（George A. Weiss A.该奖项将为Kangovi博士提供将行为科学转化为心血管健康促进干预措施的技能。拟议的研究将为R01赠款申请提供了用于标准和精制CHW干预措施的比较有效性RCT，以改善低SES患者的心血管结局。