Development of a Community Health Worker-Led Stress Reduction Intervention for Low-Income COPD Patients

为低收入慢性阻塞性肺病患者制定社区卫生工作者主导的减压干预措施

• 批准号: 10704719
• 负责人: Trisha M Parekh
• 金额: $ 16.66万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704719
• 关键词: Accident and Emergency department; Acute; Address; Adult; Anxiety; Area; Behavioral; Caring; Cessation of life; Chronic Disease; Chronic Obstructive Pulmonary Disease; Chronic stress; Clinical; Communities; Community Health Aides; Competence; Confidence Intervals; Coping Behavior; Data; Development; Disadvantaged; Disease; Education; Emergency department visit; Engineering; Epidemiology; Exclusion; Feedback; Food; Frequencies; Funding; Future; Genetic; Goals; Grant; Health; Health Care Costs; Health Disparities Research; Health Insurance; Health behavior; High Prevalence; Hospitalization; Income; Individual; Institute of Medicine (U.S.); Intervention; Interview; Investments; K-Series Research Career Programs; Knowledge; Low Income Population; Low income; Medical; Medicine; Mental Depression; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Odds Ratio; Outcome; Outcome Measure; Patients; Physiological; Poverty; Preparation; Process; Psychological Stress; Public Health; Quality of life; Randomized; Randomized, Controlled Trials; Reduce health disparities; Research Design; Research Methodology; Research Personnel; Research Project Grants; Resources; Risk; Risk Factors; Series; Smoking Status; Social support; Stress; Stress and Coping; Stressful Event; Surveys; Targeted Research; Testing; Tobacco use; Training; Training Activity; Transact; Transportation; United States; United States National Academy of Sciences; Work; acute care; adverse outcome; behavior influence; biological adaptation to stress; care systems; career; career development; community based research; community engaged research; community engagement; coping; cost; experience; feasibility testing; follow-up; health care availability; health care delivery; health care service utilization; health determinants; health disparity; high risk; hospital readmission; housing instability; improved; improved outcome; innovation; insight; intervention mapping; low socioeconomic status; marginalized population; mortality; patient population; perceived stress; poor health outcome; predict clinical outcome; premature; primary outcome; programs; prototype; psychologic; research and development; research study; response; secondary outcome; smoking prevalence; social; social disparities; social health determinants; stress management; stress reduction; stressor; systemic inflammatory response; theories; therapy development

PROJECT SUMMARY The overall goal of this K23 proposal is to provide Trisha Parekh, D.O., with the career development and research experience necessary to allow her to become an independent researcher in chronic obstructive pulmonary disease (COPD) health disparities, with expertise in social care integration and psychological stress reduction in low-income communities using community health worker interventions. Disadvantages of social determinants of health, such as low socioeconomic status, are associated with adverse outcomes in COPD, including more frequent hospitalizations, early readmissions, and increased mortality. A majority of interventions to reduce readmission focus on addressing medical determinants of health, with a notable absence of addressing social needs that impede better health outcomes. The psychological stress associated with poverty and other disadvantages of social determinants of health can lead to negative downstream behavioral, psychological, and physiological effects. For COPD patients, these stress responses may include increased tobacco use, increased risk of anxiety or depression, or increased systemic inflammation, all of which are risk factors for acute exacerbations of COPD. Substantial knowledge gaps on the social determinants of health, their associated levels of perceived stress in COPD, and clinical outcomes associated with high levels stress in marginalized groups must be addressed in order to reduce health disparities and improve quality of life for these individuals. In this K23 proposal, under the guidance of an expert mentorship team, Dr. Parekh will conduct a mixed methods research study to inform the development of a targeted community health worker-led stress reduction intervention in low-income COPD patients that will focus on 1) addressing unmet social needs, 2) providing COPD disease education, and 3) promoting proactive coping behaviors. The specific aims for this research project are as follows: Aim 1: Identify modifiable social determinant of health predictors and clinical outcomes of perceived stress in COPD patients; Aim 2: Understand perceived stressful experiences in high-risk COPD patients; Aim 3: Develop and test the feasibility of a community health worker intervention to reduce stress in low-income COPD patients. At the completion of Aim 3, this intervention will be ready to be tested in a R-series grant funded randomized controlled pilot with the primary outcome of stress reduction and secondary outcomes of reduction in acute care use and tobacco use and improvement in quality of life. At the conclusion of this K23, Dr. Parekh will have the training and experience needed to transition to a successful independent investigator who has an expertise in COPD health disparities.

项目摘要 K23提案的总体目标是为Trisha Parekh，D.O.，随着职业发展， 必要的研究经验，使她成为一个独立的研究人员在慢性阻塞性肺疾病 肺疾病（COPD）的健康差异，具有社会护理整合和心理压力方面的专业知识 减少低收入社区使用社区卫生工作者干预措施。社会的缺点 健康的决定因素，如社会经济地位低，与COPD的不良结局相关， 包括更频繁的住院、早期再入院和增加的死亡率。大多数 减少再入院的干预措施侧重于解决健康的医疗决定因素， 没有解决妨碍改善健康结果的社会需求。相关的心理压力 与贫困和其他不利的社会健康决定因素可能导致负面的下游 行为、心理和生理影响。对于COPD患者，这些应激反应可能包括 增加烟草使用，增加焦虑或抑郁的风险，或增加全身炎症，所有这些 其是COPD急性加重的危险因素。在社会问题上存在巨大的知识差距 健康的决定因素，COPD患者感知压力的相关水平，以及相关的临床结果 必须解决边缘化群体的高度压力问题，以减少健康差距， 改善这些人的生活质量。在这个K23提案中，在专家指导的指导下， Parekh博士将进行一项混合方法研究，以了解有针对性的 社区卫生工作者主导的低收入COPD患者的减压干预，重点是1） 解决未满足的社会需求，2）提供COPD疾病教育，3）促进积极应对 行为。本研究项目的具体目标如下：目标1：确定可修改的社会 COPD患者感知压力的健康预测因素和临床结果的决定因素;目的2： 了解高危COPD患者的感知压力体验;目的3：开发并测试可行性 社区卫生工作者干预以减轻低收入COPD患者的压力。完成时 目标3，这种干预措施将准备在R系列赠款资助的随机对照试点中进行测试， 减轻压力的主要结果和减少急性护理使用和烟草的次要结果 使用和改善生活质量。在K23结束时，Parekh博士将接受培训， 需要具备成功过渡到具有COPD健康专业知识的独立研究者的经验 差距。