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

基本需求导航干预，以解决患有糖尿病肾病的非裔美国人的多维逆境

• 批准号: 10676228
• 负责人: Mukoso N Ozieh
• 金额: $ 19.12万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-22 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10676228
• 关键词: 2 arm randomized control trial; Address; Adult; African; African American; African American population; American; Behavior; Blood Pressure; Cardiovascular system; Caring; Chronic Disease; Chronic Kidney Failure; Clinical; Complex; Data; Diabetes Mellitus; Diabetic Nephropathy; Dimensions; Eating; Educational Intervention; Effectiveness; End stage renal failure; Exercise; Financial Hardship; Glycosylated hemoglobin A; Goals; Habits; Health; Individual; Intervention; Intervention Studies; Knowledge; Life Style; Lipids; Low Income Population; Low income; Measures; Minority Groups; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Participant; Pathway interactions; Patient Education; Patient-Focused Outcomes; Patients; Population; Poverty; Quality of life; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research; Risk Factors; SF-12; Safety; Self Care; Self Management; Subgroup; Testing; Transportation; United States; arm; cardiovascular disorder risk; clinical center; design; efficacy evaluation; experience; feasibility testing; follow-up; food insecurity; high risk; housing instability; improved; kidney disease education; medication compliance; mortality; novel; patient navigation; patient navigator; process improvement; programs; randomized, clinical trials; recruit; social adversity; therapy design; treatment as usual

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.

项目摘要 大约三分之一的糖尿病成人患有慢性肾脏疾病，通常称为糖尿病肾病。 肾病（DKD）。DKD是美国终末期肾病的主要原因。非洲 美国人是一个脆弱的亚群，因为他们更容易患上2型糖尿病，有22%的 患慢性肾脏疾病（CKD）的风险更高，进展为 ESRD与非西班牙裔白人（NHW）相比。此外，CKD在非洲的患病率不成比例 生活在贫困中的美国人，与NHW相比，他们患ESRD的风险高出四倍。 生活在贫困中的挑战包括多方面的逆境，定义为有三个或三个以上的社会问题， 住房不稳定、粮食不安全、交通需求、公用事业需求、人际安全等逆境， 和财政紧张。多维逆境影响DKD复杂的自我管理， 影响健康结果。生活在贫困中的非裔美国人，患有DKD， 多方面的逆境导致不良结果。患者教育和自我管理行为 包括自我监控，生活方式改变（例如，饮食和运动习惯）和药物依从性 代表管理和优化DKD患者临床结局的基石。研究 显示设计良好的教育干预措施可以提高知识，自我管理和患者的结果。 然而，有证据表明，非洲裔美国人不太可能进行自我管理行为 与NHW相比，旨在改善自我管理行为的干预措施可能存在变量 由于多维逆境的有效性。有证据表明，患者导航程序可能是 改善健康结果和解决个人多方面逆境的有希望的战略 生活在贫困之中一个重要的未回答的问题是，基本型是否需要导航干预， 解决多维逆境与病人教育和生活方式教练相结合， 改善临床和以患者为中心的结果。此外，我们不知道是否整合社会 逆境干预研究可以帮助减少慢性病临床结果的健康差异 在少数民族中。我们小组的初步数据表明，一种新的干预措施， 教育、基本需求导航和生活方式辅导，以解决多方面的逆境， 在这个人群中有效。因此，使用随机对照试验，R21提案将解决一些问题， 我们目前对患有DKD的低收入非洲裔美国人的知识存在差距， 逆境它还将为一项大规模的、具有适当把握度的随机临床试验提供初步数据 (R01)关注患有DKD的非裔美国人的多维逆境。这个项目的长期目标是 目的是确定有效的策略，以改善DKD风险因素的控制和减缓DKD的进展， 非洲裔美国人经历了多重社会困境。