Coping with Asthma through Life Management (CALM)

项目摘要/摘要： 压力是哮喘药物依从性和哮喘控制的关键障碍。拉撒路·福克曼的模型 压力是指当一个人感受到压力时，被评估为超出了他们的资源， 危及他们的福祉。在我的初步焦点小组中，患有哮喘的黑人成年人报告说， 心理社会压力(例如，感知歧视、工作压力、照顾者负担)、与健康相关的压力(例如， 自我管理哮喘困难)和经济压力(如经济压力)是哮喘的障碍 服药依从性和控制性。然而，同时针对这些压力源的干预并不是 通常在患有哮喘的黑人成年人中进行评估。为了填补这一证据空白，我将确定轻微压力的类型， 在NHLBI资助的队列中，与哮喘严重程度增加相关的慢性压力和应对策略(即， 杰克逊心脏研究)的黑人成年人(目标1)。然后，我将利用这些发现来开发和从文化上量身定做 新的压力管理干预措施，称为CAME(通过生命管理应对哮喘)(目标2)， 并在卫生系统中试行其实施(目标3)。平静将是一种创新的、适应文化的压力 管理干预旨在通过针对3种常见的压力源来促进适应性应对 患有哮喘的黑人成年人-心理社会问题，哮喘自我管理能力差，以及经济压力-与 目的是管理压力的影响，并最终改善哮喘用药依从性和哮喘 控制力。我的中心假设是，冷静，针对布莱克特别面临的多个压力来源 成人哮喘，将在卫生系统中可行地实施，将被计划参与者接受， 并将提供一种潜在的有效干预措施，以增加哮喘用药不依从性和哮喘 控制力。拟议的研究将在L.Ebony Boulware博士的指导下进行，医学博士，公共卫生硕士 (初级导师，健康差异，定性方法)，Loretta G.que博士，医学博士(共同初级导师，哮喘 研究)，Laura Porter博士(共同导师，临床心理学，健康行为学)，Christopher E.Cox博士， 医学博士，公共卫生硕士(合作者，应对技能培训)和马伦·奥尔森博士(合作者，生物统计学)。通过 为了达到研究目标，我将产生一个最终的平静干预方案，为随机试验做准备 这是一项对照试验，将作为哮喘健康差异的独立研究事业的基础。

Project Summary/Abstract: Stress is a key barrier to asthma medication adherence and asthma control. The Lazarus Folkman's Model of Stress states that a person experiences stress when a stimulus, appraised as exceeding their resources, endangers their well-being. In my preliminary focus groups, Black adults with asthma reported that increased psychosocial stress (e.g., perceived discrimination, job stress, caregiver burden), health-related stress (e.g., difficulty self-managing asthma), and economic stress (e.g., economic strain) were barriers to asthma medication adherence and control. However, interventions simultaneously targeting these stressors are not commonly evaluated in Black adults with asthma. To fill this evidence gap, I will identify types of minor stress, chronic stress, and coping strategies associated with increased asthma severity in a NHLBI-funded cohort (i.e., Jackson Heart Study) of Black adults (Aim 1). I will then use these findings to develop and culturally tailor a novel stress management intervention, called CALM (Coping with Asthma through Life Management) (Aim 2), and pilot its implementation in a health system (Aim 3). CALM will be an innovative, culturally-adapted, stress management intervention designed to promote adaptive coping by targeting 3 common sources of stress in Black adults with asthma—psychosocial issues, poor asthma self-management, and economic strain—with the aim of managing the effects of stress and ultimately improving asthma medication adherence and asthma control. My central hypothesis is that CALM, targeting multiple sources of stress specifically faced by Black adults with asthma, will be feasibly implemented in a health system, will be acceptable to program participants, and will provide a potentially effective intervention to increase asthma medication nonadherence and asthma control. The proposed research will be conducted under the mentorship of Dr. L. Ebony Boulware, MD, MPH (primary mentor, health disparities, qualitative methods), Dr. Loretta G. Que, MD (co-primary mentor, asthma research), Dr. Laura Porter, PhD (co-mentor, clinical psychology, health behavior), Dr. Christopher E. Cox, MD, MPH (collaborator, coping skills training), and Dr. Maren Olsen, PhD (collaborator, biostatistics). By accomplishing the research aims, I will yield a finalized CALM intervention that will be ready for a randomized controlled trial and will serve as foundation for an independent research career in asthma health disparities.