Mixed-Methods Study of Multidimensional Adversity in Inner-City African American Adults with Chronic Kidney Disease and Type 2 Diabetes Mellitus

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PROJECT SUMMARY Approximately 40% of individuals with type 2 diabetes (T2DM) have chronic kidney disease (CKD), also known as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease (ESRD), and ESRD is the most expensive complication of diabetes. African American adults are almost twice as likely to have DKD and are three times more likely to progress to ESRD. Inner-city populations, made up of predominantly African Americans, are at high risk for DKD. Challenges of living in the inner-city include multidimensional adversity, defined as having three or more social adversities such as loss of employment, housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain. African American adults living in the inner-city disproportionately experience multidimensional adversity, which impacts the complex self-management of DKD such as self-monitoring and behavior modification. The compounded risks of being African American, living in the inner-city, having T2DM and multidimensional adversity likely contribute to the accelerated rate of CKD progression among African American adults and potentiate existing health disparities. Patient education and self-management behaviors improve patient outcomes and represent the cornerstone of DKD management. In addition, behavioral intervention studies in African American adults with T2DM incorporating cultural tailoring, peer-support/coaching, and community health workers have shown promise in improving short-term clinical outcomes. However, their benefits are not sustained long-term, and they do not produce long-term effects on lifestyle and behavior changes. Further, majority of existing studies do not account for the unique challenges of inner-city African American adults which limits effectiveness of patient education and self-management behaviors in African American adults living in the inner-city long-term. Similarly, studies in African American adults with T2DM and CKD that incorporate the challenges of living with multidimensional adversity are scarce, despite growing evidence which recognizes the negative effects of multidimensional adversity on clinical outcomes in this population. Therefore, the goal of this proposal is to address these gaps in knowledge using a convergent parallel mixed methods study design to understand the role and effect of multidimensional adversity in African American adults with DKD. In addition, this proposal will identify appropriate intervention components which will inform the development of a culturally tailored intervention that addresses multidimensional adversity to improve clinical outcomes, quality of life, and self-care behaviors in African American adults with DKD living in the inner-city. Ultimately, findings from this proposal will serve as a preliminary data for addressing multidimensional adversity in a large-scale appropriately powered, multicenter, randomized controlled trial focused on African American adults with DKD.