Development of a Community Health Worker-Led Stress Reduction Intervention for Low-Income COPD Patients

项目总结 这项K23提案的总体目标是为D.O.Trisha Parekh提供职业发展和 让她成为慢性阻塞性疾病的独立研究员所需的研究经验 肺部疾病(COPD)健康差异，具有社会护理整合和心理压力方面的专业知识 使用社区卫生工作者干预减少低收入社区。社交化的弊端 健康的决定因素，如社会经济地位低，与慢性阻塞性肺病的不良后果有关， 包括更频繁的住院、更早的再入院和更高的死亡率。大多数人 减少再次入院的干预措施侧重于解决健康的医学决定因素，值得注意的是 缺乏解决妨碍更好的健康结果的社会需求。随之而来的心理压力 随着贫困和其他不利的社会因素的影响，健康可能会对下游产生负面影响 行为、心理和生理影响。对于慢性阻塞性肺疾病患者，这些应激反应可能包括 增加烟草使用，增加焦虑或抑郁的风险，或增加全身炎症，所有这些 这些都是COPD急性加重的危险因素。关于社会问题的重大知识差距 健康决定因素、与COPD相关的感受到的压力水平以及相关的临床结果 由于边缘化群体的压力很大，必须加以解决，以减少健康差距和 提高这些人的生活质量。在这份K23提案中，在专家指导下 团队，Parekh博士将进行一项混合方法的研究，以通知开发一种有针对性的 社区卫生工作者主导的低收入COPD患者减压干预将重点放在1) 解决未得到满足的社会需求，2)提供COPD疾病教育，3)促进积极应对 行为。本研究项目的具体目标如下：目标1：确定可修改的社会 COPD患者感知压力的健康预测因素和临床结局的决定因素；目标2： 了解高危COPD患者感受到的压力体验；目标3：开发和测试可行性 社区卫生工作者的干预，以减轻低收入COPD患者的压力。在完成时 目标3，这种干预措施将准备在R系列赠款资助的随机对照试验中进行测试， 减轻压力的主要结果和减少急性护理使用和烟草的次要结果 对生活质量的利用和提高。在K23课程结束时，Parekh博士将接受培训并 过渡到具有COPD健康专业知识的成功独立研究人员所需的经验 差距。

PROJECT SUMMARY The overall goal of this K23 proposal is to provide Trisha Parekh, D.O., with the career development and research experience necessary to allow her to become an independent researcher in chronic obstructive pulmonary disease (COPD) health disparities, with expertise in social care integration and psychological stress reduction in low-income communities using community health worker interventions. Disadvantages of social determinants of health, such as low socioeconomic status, are associated with adverse outcomes in COPD, including more frequent hospitalizations, early readmissions, and increased mortality. A majority of interventions to reduce readmission focus on addressing medical determinants of health, with a notable absence of addressing social needs that impede better health outcomes. The psychological stress associated with poverty and other disadvantages of social determinants of health can lead to negative downstream behavioral, psychological, and physiological effects. For COPD patients, these stress responses may include increased tobacco use, increased risk of anxiety or depression, or increased systemic inflammation, all of which are risk factors for acute exacerbations of COPD. Substantial knowledge gaps on the social determinants of health, their associated levels of perceived stress in COPD, and clinical outcomes associated with high levels stress in marginalized groups must be addressed in order to reduce health disparities and improve quality of life for these individuals. In this K23 proposal, under the guidance of an expert mentorship team, Dr. Parekh will conduct a mixed methods research study to inform the development of a targeted community health worker-led stress reduction intervention in low-income COPD patients that will focus on 1) addressing unmet social needs, 2) providing COPD disease education, and 3) promoting proactive coping behaviors. The specific aims for this research project are as follows: Aim 1: Identify modifiable social determinant of health predictors and clinical outcomes of perceived stress in COPD patients; Aim 2: Understand perceived stressful experiences in high-risk COPD patients; Aim 3: Develop and test the feasibility of a community health worker intervention to reduce stress in low-income COPD patients. At the completion of Aim 3, this intervention will be ready to be tested in a R-series grant funded randomized controlled pilot with the primary outcome of stress reduction and secondary outcomes of reduction in acute care use and tobacco use and improvement in quality of life. At the conclusion of this K23, Dr. Parekh will have the training and experience needed to transition to a successful independent investigator who has an expertise in COPD health disparities.