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（由申请人提供）：拟议的 K23 奖项将使 Shreya Kangovi（医学博士、理学硕士）、内科医生和儿科医生能够发展利用行为科学改善低社会经济地位 (SES) 患者心血管结局的专业知识。 Kangovi 博士和她的同事开发了 IMPACT 干预措施，其中社区卫生工作者 (CHW) 帮助低 SES 患者改善健康行为并控制 CVD 危险因素。这些患者的生活充满挑战，在尝试健康行为改变的复杂过程时可能会经历挫折和失败。一项随机对照干预试验的中期结果表明，患者对健康行为改变尝试失败的反应方式是后续健康行为以及最终心血管结局的重要决定因素。 K23 提案的目标是通过帮助患者从失败中学习而不是因失败而灰心丧气，从而完善干预措施。 The proposed experiments will advance the science of understanding and modifying patients' response to failure. 行为科学文献描述了应对失败的两种方式：学习和回避。在学习中，个人利用失败信号来提高自我调节、动机和表现。在回避的情况下，个人会变得不投入，并且在失败后表现更差。两种行为干预——积极情感诱导（PA）和归因再训练（AR）——可能会促进学习而不是回避。 PA 使用标准化的“随机善举”和自我肯定来提高失败后的情绪恢复能力。 AR 教会人们将失败解释为可以改变的。 PA 和 AR 已被证明可以改善失败后的行为结果，但尚未广泛应用于医疗保健领域。 Kangovi 博士将与她的导师和多学科团队合作，开发 CHW 提供的积极情感/归因再培训干预 (CPAAR)，以改善患者对失败的反应。然后，她将领导一项现实世界的比较有效性试点随机对照试验 (RCT)，比较标准与改进的 CHW 干预（使用 CPAAR）对身体活动和 CVD 结果的影响。 Kangovi 博士将受到她的主要导师 Karen Glanz 博士（宾夕法尼亚大学乔治 A. 韦斯大学流行病学和护理学教授、健康行为研究中心主任）和共同导师 Judith A. Long 博士（宾夕法尼亚大学普通内科科主任、心血管差异方面经验丰富的研究员）的指导。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 拨款申请提供信息，以比较标准与改进的 CHW 干预的有效性 RCT，以改善低 SES 患者的心血管结局。