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

项目总结/摘要： 虽然大量的数据是关于高血压（HTN）的治疗和管理， 抗高血压治疗的修改和药物依从性，自我管理HTN仍然不理想 在非裔美国人（AA）中，对直接医疗的健康结果和患者护理成本有重大影响 估计每年的支出为429亿美元。自我管理HTN的血压（BP）目标 <130/80 mmHg带来了挑战，例如应付多种药物和医疗保健提供者， 复杂的建议和治疗方案，以及应对负面情绪状态。 复原力可以是在自我保护的背景下保护健康、福祉和生活质量的重要因素， 管理HTN。然而，很少有研究探讨生物心理社会学， 促进AA之间有效的HTN自我管理和恢复力的机制。了解 影响HTN自我管理和弹性的机制有望实现新的可修改目标 进行行为改变干预。这个R21应用程序，自我管理和弹性轨迹， 患有高血压的非洲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，以及这些协会对健康结果的影响（健康- 相关生活质量和BP）。我们的研究是由以下理论基础指导的： 格拉斯和麦卡蒂的社会-行为-生物学关系对健康的嵌套层次影响， Szanton和Gill的Society-to-Cell框架。使用描述性纵向队列设计，我们将 招募125例诊断为HTN并伴有多种慢性疾病（MCC）AA的方便样本。 将向受试者提供一组工具，以捕获潜在的协变量、研究变量和 观察基线和第3个月和第6个月的结果。本研究的目的是[1]评估 弹性前体（性格乐观和弹性，情绪调节）;压力反应 （皮质醇，白细胞介素，抑郁认知，感知压力）; HTN自我管理行为和 能力（慢性疾病管理的自我效能，抗高血压药物的药物依从性）;以及 在基线和第3个月和第6个月时，AA伴HTN和MCC的健康结局（HQROL，BP）; [2]确定 如果随着时间的推移，压力反应介导了弹性前体和健康结果之间的关系， [3]确定自我管理行为是否介导了 当为风险监管机构进行控制时，随着时间的推移，弹性前体和健康结果;以及[4]确定 弹性轨迹模式和影响HTN自我管理行为的因素。本研究 将通过识别和理解如何推进自我管理和弹性科学 保护性因素和复原力促进自我管理行为并影响个体的健康 水平和通知未来的干预性研究，旨在减少与次优血压相关的CVD风险。

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.