Hypertension Self-management in Refugees Living in San Diego

项目摘要 建议的指导病人为导向的研究职业发展奖（K23）是提供 候选人的培训和研究经验，将促进她作为一个独立的发展 临床医生-研究员，特别侧重于高血压干预研究领域 控制，特别是自我管理（家庭血压监测和药物自我滴定）， 这是一个处理与难民流离失所有关的心血管差异的工具。这次培训将为她提供 有机会发展以下方面的知识和技能：1）高血压流行病学和差异聚焦 关于移徙作为健康的社会决定因素，2）获得理论、发展、 实施和调整理论驱动的社区干预措施，以改善血液 通过自我管理控制压力（BP）; 3）掌握定性技能（社会网络分析） 纵向数据的多水平建模，以评估干预措施的有效性和高血压自我 管理临床试验。培训活动将包括教学课程和具体讲习班， 阅读，与导师一对一的教程，以及负责任地进行研究的指导， 关注弱势群体。候选人将利用她以前的临床和研究 与难民打交道的经验，并利用由全球 心血管疾病差异，社区干预，高血压试验，社会 移民健康的决定因素和先进的生物统计学。目前的K23研究项目来自于 现有的研究基础设施和她的导师在CVD自我管理试验中的丰富经验 差异，流行病学研究和临床试验，为我开辟了一个利基，专门从事心血管疾病临床 难民和弱势移民的审判和预防。具体目标是进行结构化的 可行性研究通过：1）了解与自我管理有关的知识，态度和行为 难民高血压; 2）制定，调整和实施文化敏感的高血压 自我管理干预难民在圣地亚哥;和3）确定影响因素的可行性和 这种干预的可接受性，以估计未来使用的效应量和结局指标 动力试验这项工作将为第一个难民的随机临床试验奠定坚实的基础。 高血压自我管理。虽然这项工作的指定初始目标是适应一个 根据最近的大型临床试验改编的循证高血压自我管理干预模式，我们 假设这种干预在难民中是可行的;他们可以做到，接受它，并为我们提供线索， 设计未来的临床试验，以了解更多关于CVD差异的科学和实施研究。的 候选人的长期目标是发展必要的专业知识，成为一个领先的试用者在理解 以及解决心血管健康方面的差距。

Project Summary The proposed Mentored Patient-Oriented Research Career Development Award (K23) is to provide the candidate with training and research experiences that will promote her development as an independent clinician-researcher, with particular emphasis in the field of intervention research addressing hypertension control, specifically self-management (home blood pressure monitoring and self-titration of medications) as a tool to deal with cardiovascular disparities related to displacement in refugees. This training will provide her with the opportunity to develop knowledge and skills in: 1) hypertension epidemiology and disparities focusing on migration as a social determinant of health,; 2) acquire knowledge in the theory, development, implementation, and adaptation of theoretically driven community-based interventions to improve blood pressure (BP) control through self-management; 3) acquire skills in qualitative (social network analysis) multilevel modeling of longitudinal data to assess the efficacy of interventions and hypertension self- management clinical trials. Training activities will include didactic coursework and specific workshops, directed readings, one-on-one tutorials with mentors, and instructions in the responsible conduct of research that focuses on vulnerable populations. The candidate will capitalize on her previous clinical and research experience with refugees, and leverage mentorship from a Training Committee comprised of globally renowned experts in the fields of CVD disparities, community interventions, hypertension trials, social determinants of immigrant health, and advanced biostatistics. The present K23 research project emerges from the existing research infrastructure and extensive experience of her mentors’ self-management trials in CVD disparities, epidemiological research and clinical trials, to carve out a niche for me to specialize in CVD clinical trials and prevention in refugees and vulnerable immigrants. The specific aims are to conduct a structured feasibility study through: 1) Understanding knowledge, attitudes and behaviors related to self-management of hypertension among refugees; 2) Developing, adapting and implementing a culturally-sensitive hypertension self-management intervention in refugees in San Diego; and 3) Identifying factors affecting the feasibility and acceptability of such an intervention to estimate effect sizes and outcome measures to be used in a future powered trial. This work will lay strong foundations for the first powered randomized clinical trial of refugee hypertension self-management ever conducted. While the specified initial goal of this work is to adapt an evidence-based hypertension self-management intervention model adapted from recent large clinical trials, we hypothesize that this intervention will be feasible in refugees; they can do it, accept it and give us leads on designing a future clinical trial to learn more about CVD disparities science and implementation research. The candidate’s longer-term goal is to develop expertise necessary to become a leading trialist in understanding and addressing cardiovascular health disparities.