A Mixed Methods Study of Chronic Kidney Disease (CKD) Self-Management

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Chronic kidney disease (CKD) is a growing epidemic, affecting close to 15% of the US population, and is gen- erally progressive, with potentially fatal complications of cardiovascular disease and end-stage kidney disease. Directed treatment of CKD is challenging because CKD is a syndrome with causes that are often not identifia- ble and a dearth of disease-specific interventions. However, there are some cross-cutting approaches that are broadly beneficial for people with CKD, and are recommended by current CKD management guidelines, which include advising patients to engage in self-management behaviors (e.g., monitor blood pressure, maintain physical activity, and avoid tobacco). To date, there has been limited research on self-management in pre- dialysis CKD. The few published studies demonstrate poor uptake of recommended self-management behav- iors, which highlights the need to 1) understand the reasons for substandard engagement in recommended behaviors, and 2) develop and evaluate new approaches to improve CKD self-management. Sarah Schrauben, MD, MSCE, a nephrologist, will target this understudied area in her proposed K23 Award. Dr. Schrauben is positioned to use this award to launch an independently funded research career in the rich environment at the University of Pennsylvania, as she has completed a Masters degree in clinical epidemiology, through which she gained experience in epidemiology, biostatistics, study design, and during her post-doctoral fellowship, conducted a preliminary study on self-management behaviors in a large CKD observational cohort, as well as participated in formal training in qualitative and mixed methods research. Her proposed K23 work will utilize in- depth interviews with CKD patients to understand the influences of participating in health behaviors and identi- fy relevant factors for the design and implementation of a self-management support intervention (Aim 1). In a large cohort of individuals with CKD, Dr. Schrauben will investigate potential predictors of recommended self- management behavior engagement to identify patient characteristics important for a self-management support intervention (Aim 2). Using this information, she will develop a patient-centered self-management support in- tervention harnessing health behavior theory and mobile health (mHealth) technology and then pilot its feasibil- ity (Aim 3). Through her proposed career development, she seeks to gain skills in 1) clinical trial design, im- plementation, and evaluation, 2) mixed research methods, 3) advanced statistical analyses, including the longi- tudinal data analyses from the pilot trial, while garnering expertise in 4) implementation science, and 5) health behavior research. To achieve these objectives, Dr. Schrauben has assembled a multi-disciplinary mentorship team led by national experts in renal epidemiology, biostatistics, clinical trials, mixed research methods, im- plementation science, health behavior research, and interventions leveraging mHealth. Upon completion of these K23 activities, Dr. Schrauben will be poised to conduct a RCT supported by a R01 grant, leveraging her training to improve self-management among persons with CKD.