Self-Management and Resilience Trajectories in African American Adults with Hypertension

非洲裔美国成人高血压患者的自我管理和恢复轨迹

• 批准号: 10544763
• 负责人: CAROLYN Harmon Still
• 金额: $ 24.15万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-30 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10544763
• 关键词: Adult; African American; African American population; Antihypertensive Agents; Behavior; Behavioral; Biology; Blood Pressure; Cells; Chronic; Chronic Disease; Cognition; Communities; Complex; Data; Diabetes Mellitus; Diagnosis; Disease Management; Expenditure; Family; Fostering; Future; Gills; Glass; Goals; Health; Health Personnel; Health protection; Heart failure; Hydrocortisone; Hypertension; Incidence; Individual; Intake; Interleukins; Intervention; Intervention Studies; Life Cycle Stages; Life Style Modification; Link; Longitudinal cohort; Malignant Neoplasms; Mediating; Medical; Mental Depression; Modeling; Morbidity - disease rate; Outcome; Participant; Patient Care; Pattern; Personal Satisfaction; Pharmaceutical Preparations; Physical activity; Physiological; Population Group; Practice Management; Quality of life; Recommendation; Research; Risk; Sampling; Science; Self Efficacy; Self Management; Societies; Sodium; Stressful Event; Time; Treatment Protocols; Work; behavior change; biological adaptation to stress; biopsychosocial; blood pressure control; cardiovascular disorder risk; care costs; coping; cost; design; emotion regulation; good diet; health management; health related quality of life; hypertension control; improved; instrument; mange; medication compliance; mortality; multiple chronic conditions; negative emotional state; optimism; patient oriented; perceived stress; promote resilience; protective factors; psychologic; recruit; resilience; smoking cessation

PROJECT SUMMARY/ABSTRACT: Although substantial data are available on the treatment and management of hypertension (HTN), lifestyle modification and medication adherence to antihypertensives therapy, self-managing HTN remains suboptimal in African Americans (AA) and has major impacts on health outcomes and patient care cost with direct medical expenditures estimated to cost $42.9 billion annually. Self-managing HTN to a blood pressure (BP) goal of <130/80 mmHg presents challenges such as juggling multiple medications and health care providers, dealing with complex recommendations and treatment regimens, and coping with negative emotional states. Resilience can be an important factor that protects health, well-being, and quality of life in the context of self- managing HTN. However, there has been a paucity of studies that have examined the biopsychosocial mechanisms that foster effective HTN self-management and resilience among AA. Understanding the mechanism that influence HTN self-management and resilience holds the promise of new modifiable targets for behavior change interventions. This R21 application, Self-management and Resilience Trajectories in African Americans with Hypertension, will explore the influence of resilience precursors on self-management behaviors and on stress response, and the effects that these associations have on health outcomes (health- related quality of life and BP) over a 6-month period. Our research is guided by the theoretical underpinnings of both Glass and McAtee’s Society-Behavior-Biology Nexus of nested hierarchical influences on health and the work of Szanton and Gill’s Society-to-Cell framework. Using a descriptive longitudinal cohort design, we will recruit a convenient sample of 125 AA diagnosed with HTN with multiple chronic condition (MCCs). Participants will be administered a battery of instruments to capture potential covariates, study variables, and observe outcomes at baseline and months 3 and 6. The aims of this study are to [1] Assess the association among resilience precursors (dispositional optimism and resilience, emotion regulation); stress response (cortisol, interleukins, depression cognitions, perceived stress); HTN self-management behaviors and capability (self-efficacy for chronic disease mangement, medication adherence to antihypertensives); and health outcomes (HQROL, BP) among AA with HTN and MCCs at baseline and Months 3 and 6; [2] Determine if stress response mediate the relationship between resilience precursors and health outcomes over time when controlling for risk regulators; [3] Determine if self-management behaviors mediate the relationship between resilience precursors and health outcomes over time when controlling for risk regulators; and [4] Identify resilience trajectory patterns and factors that influence HTN self-management behaviors over time. This study will advance self-mangement and resilience science through the identification and understanding of how protective factors and resilience promote self-management behaviors and influence health at the individual level and inform future interventional research intended to reduce CVD risks associated with suboptimal BP.

项目摘要/摘要： 尽管可以提供有关高血压治疗和管理（HTN），但生活方式的大量数据 修改和药物遵守抗高血压疗法，自我管理的HTN保持不佳 在非洲裔美国人（AA）中，直接医疗对健康结果和患者护理费用产生了重大影响 支出估计每年耗资429亿美元。自我管理的HTN达到血压（BP）目标 <130/80 mmhg提出了挑战，例如杂耍多种药物和医疗保健提供者，交易 具有复杂的建议和治疗方案，并应对负面情绪状态。 弹性可能是保护自我背景下保护健康，福祉和生活质量的重要因素 管理HTN。但是，已经很少研究了生物心理社会的研究 在AA中促进了有效的HTN自我管理和弹性的机制。了解 影响HTN自我管理和弹性的机制具有新的可修改目标的承诺 用于行为改变干预措施。 R21应用程序，自我管理和弹性轨迹 有高血压的非裔美国人将探索弹性前体对自我管理的影响 行为和压力反应以及这些关联对健康结果的影响（健康 - 相关的生活质量和BP）在6个月内。我们的研究以理论基础为指导 Glass和McAtee的社会行为 - 嵌套等级影响健康和对健康的影响 Szanton和Gill的社会对细胞框架的作品。使用描述性纵向队列设计，我们将 招募一个方便的125个AA样本，该样本诊断为患有多个慢性病（MCC）的HTN。 参与者将被管理一系列工具，以捕获潜在的协变量，研究变量和 在基线和第3和第6个月时观察结果。这项研究的目的是评估关联 在弹性前体（处置乐观和韧性，情绪调节）中；压力反应 （皮质醇，白细胞介素，抑郁认知，感知压力）； HTN的自我管理行为和 能力（慢性疾病操纵的自我效能感，遵守抗高血压的药物）；和 AA中的健康成果（HQROL，BP）在基线时与HTN和MCC以及第3和第6个月； [2]确定 如果压力反应介导了弹性前体和健康结果之间的关系，那么 控制风险调节器； [3]确定自我管理行为是否介导 控制风险调节器时，弹性前体和健康结果随着时间的流逝；和[4]识别 随着时间的推移影响HTN自我管理行为的弹性轨迹模式和因素。这项研究 通过识别和理解方式，将推动自我融合和韧性科学 保护因素和韧性促进自我管理行为并影响个人的健康 水平并告知未来的介入研究，旨在降低与BP相关的CVD风险。