Basic Needs Navigation Intervention to Address Multidimensional Adversity in African Americans with Diabetic Kidney Disease

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PROJECT SUMMARY Approximately 1 in 3 adults with diabetes have chronic kidney disease commonly referred to as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease in the United States. African Americans are a vulnerable subgroup, as they are more likely to develop type 2 diabetes mellitus, have a 22% higher risk of developing chronic kidney disease (CKD) and are almost four times more likely to progress to ESRD compared to non-Hispanic whites (NHW). In addition, CKD is disproportionately prevalent in African Americans living in poverty and they have a four-fold higher risk of developing ESRD compared to NHW. Challenges of living in poverty include multidimensional adversity, defined as having three or more social adversities such as housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain. Multidimensional adversity impacts the complex self-management of DKD and negatively impacts health outcomes. The constellation of living in poverty, being African American, having DKD and multidimensional adversity results in poor outcomes. Patient education and self-management behaviors including self-monitoring, lifestyle changes (e.g., eating and exercise habits) and medication adherence represent the cornerstone of managing and optimizing clinical outcomes in individuals with DKD. Research shows well-designed educational interventions improves knowledge, self-management, and patient outcomes. However, evidence suggests that African Americans are less likely to perform self-management behaviors compared to NHW and that interventions designed to improve self-management behaviors may have variable effectiveness due to multidimensional adversity. Evidence suggests patient navigation programs may be a promising strategy to improve health outcomes and address multidimensional adversity among individuals living in poverty. An important unanswered question is whether a basic needs navigation intervention that addresses multidimensional adversity in combination with patient education and lifestyle coaching leads to improved clinical and patient-centered outcomes. In addition, we do not know whether integrating social adversity into intervention studies can help reduce health disparities in clinical outcomes for chronic diseases in minority populations. Preliminary data from our group suggest a novel intervention that incorporates DKD education, basic needs navigation, and lifestyle coaching to address multidimensional adversity may be effective in this population. Therefore, using a randomized control trial this R21 proposal will address a number of gaps in our current knowledge in low-income African Americans with DKD experiencing multidimensional adversity. It will also provide preliminary data for a large-scale appropriately powered, randomized clinical trial (R01) focused on multidimensional adversity in African Americans with DKD. The long-term goal of this project is to identify effective strategies for improving DKD risk factor control and slowing the progression of DKD in African Americans experiencing multiple social adversities.