The Development and Implementation of a Culturally-Congruent Educational Film designed for PLWHIV to Address Patients' Trauma Histories, Barriers to Care, and CVD Risk Reduction

开发和实施专为艾滋病毒携带者设计的文化一致性教育电影，以解决患者的创伤史、护理障碍和降低心血管疾病风险

• 批准号: 10019763
• 负责人: ARLEEN F. BROWN
• 金额: $ 2.16万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10019763
• 关键词: Address; Adherence; Adoption; Affect; Anxiety; Attention; Award; Behavior; Behavioral; California; Cardiovascular Diseases; Caring; Chronic; Chronic Disease; Client; Clinic; Clinical; Cognitive; Color; Complex; Computers; Confounding Factors (Epidemiology); Data Collection; Development; Disease Outcome; Educational Curriculum; Effectiveness of Interventions; Emotional; Ensure; Environment; Ethnic Origin; Evaluation; Failure; Film; Focus Groups; Future; Gender Identity; Goals; Grant; Guidelines; HIV; HIV Infections; HIV Seropositivity; Health; Health system; Healthcare; Heart; Human; Hybrids; Infrastructure; Institutes; Intervention; Knowledge; Los Angeles; Manuscripts; Measures; Medical; Mental Health; Methods; Mind; Modeling; Monitor; Morbidity - disease rate; Neurosciences; Outcome; Parents; Participant; Patients; Phase; Posttraumatic growth; Provider; Publications; Quasi-experiment; Questionnaires; Race; Readiness; Recommendation; Recording of previous events; Research; Research Design; Risk Factors; Risk Reduction; Sampling; Services; Site; Statistical Data Interpretation; Symptoms; System; Telephone; Testing; Time; Training; Trauma; Trauma patient; Use Effectiveness; Writing; barrier to care; base; cardiovascular disorder risk; cardiovascular health; comorbidity; comparative efficacy; comparison intervention; depressive symptoms; design; dosage; effectiveness implementation study; efficacy testing; emotion regulation; ethnic minority population; experience; follow-up; healing; health disparity; implementation strategy; interest; member; mortality; multiple chronic conditions; novel; parent grant; post intervention; post-traumatic symptoms; programs; recruit; retention rate; satisfaction; symposium; therapy design; treatment adherence

Abstract/Project Summary (Parent Award) Cardiovascular disease (CVD) has emerged as an increasingly important cause of morbidity and mortality among people living with HIV (PLWHIV). Now that HIV is considered a manageable chronic disease, the identification and treatment of comorbid medical conditions including CVD are increasingly the focus of research and clinical attention. What is missing, however, is yet another critical component of care for PLWHIV: integrated care for histories of trauma. Experiences of trauma increase the likelihood of HIV infection as well as CVD risk, yet health care for PLWHIV is rarely coordinated to address these three intersecting issues of HIV, CVD, and trauma, particularly among those disproportionately affected by HIV, i.e., ethnic minority patients. Histories of trauma among PLWHIV are associated with inconsistent treatment adherence and non-adherence, and trauma history alone is associated with poor CVD outcomes. Failure to address trauma poses significant barriers to the adoption of CVD risk strategies among PLWHIV. Health systems that coordinate and integrate care across HIV and chronic conditions such as CVD may provide the infrastructure needed to address the complex interplay of these conditions and their therapies. We have designed a novel blended, culturally congruent, evidence-informed care model, “Healing our Hearts, Minds and Bodies” (HHMB), to address patients' trauma histories and barriers to care, and to prepare patients to engage in CVD risk reduction. Recognizing the need to ensure that PLWHIV receive CVD guideline- concordant care, we have also identified implementation strategies to prepare providers and clinics for addressing CVD risk among their HIV-positive patients. Therefore, using a hybrid type II effectiveness/implementation study design, the goal of this study is to increase both patient and organizational readiness to address trauma and CVD risk among PLWHIV. The Specific Aims are: (1) to assess and enhance organizational readiness for addressing trauma and CVD risk among ethnic minority PLWHIV; specifically, a phased approach will drive the use of implementation strategies designed to educate, monitor, and support providers and staff in adhering to CVD care guidelines; (2) using mixed methods, to (a) evaluate the use and effectiveness of implementation strategies over time, and (b) identify barriers and facilitators to organizational adoption of guidelines, provider adherence to guidelines, feasibility, and sustainability; and (3) to evaluate the effect of HHMB on cognitive-behavioral, emotional, and physical outcomes among 260 PLWHIV, specifically patient activation, engagement in care, knowledge of CVD risk, adherence to clinicians' recommendations, cardiovascular health, mental health symptoms, and satisfaction with care. We will use the RE-AIM framework to guide the evaluation and the Replicating Effective Programs (REP) Framework to guide the use of implementation strategies and the tailoring of the care model within our participating implementation settings.

摘要/项目总结（家长奖） 心血管疾病（CVD）已成为日益重要的发病原因 艾滋病毒感染者（PLWHIV）的死亡率。现在艾滋病毒被认为是一种 可管理的慢性病，共病医疗条件的识别和治疗 包括CVD在内的疾病日益成为研究和临床关注的焦点。缺少的是什么， 然而，艾滋病毒感染者护理的另一个关键组成部分是： 外伤创伤的经历增加了艾滋病毒感染的可能性以及心血管疾病的风险，但 艾滋病毒感染者保健很少得到协调， 心血管疾病和创伤，特别是那些不成比例地受到艾滋病毒影响的人，即，民族 少数民族患者艾滋病毒感染者的创伤史与不一致的 治疗依从性和不依从性以及创伤史与CVD不良相关 结果。未能解决创伤对采用CVD风险构成重大障碍 艾滋病毒/艾滋病感染者的战略。卫生系统协调和整合艾滋病毒和艾滋病的护理， 慢性疾病，如心血管疾病，可以提供所需的基础设施，以解决复杂的 这些疾病及其治疗的相互作用。我们设计了一种新颖的融合了文化 一致的，循证护理模式，“治愈我们的心，思想和身体”（HHMB）， 解决病人的创伤史和护理障碍，并准备病人参与 降低CVD风险。认识到有必要确保艾滋病毒感染者获得心血管指南， 我们还确定了实施战略，使提供者做好准备， 诊所，以解决他们的艾滋病毒阳性患者的心血管疾病风险。因此，使用混合型 II有效性/实施研究设计，本研究的目标是增加患者 和组织准备，以解决创伤和心血管疾病的风险，艾滋病毒感染者。具体 目的是：（1）评估和提高组织准备应对创伤和心血管疾病 少数民族艾滋病毒感染者的风险;具体而言，分阶段的方法将推动使用 实施战略，旨在教育，监测和支持供应商和工作人员， 坚持CVD护理指南;（2）使用混合方法，以（a）评估使用和 （B）确定执行战略的障碍和促进因素， 指导方针的组织采用情况、提供商对指导方针的遵守情况、可行性，以及 可持续性;（3）评估HHMB对认知行为，情绪和 260例PLWHIV患者的身体结局，特别是患者激活，参与护理， 心血管疾病风险的知识，遵守临床医生的建议，心血管健康， 心理健康症状和对护理的满意度。我们将使用RE-AIM框架来指导 评估和推广有效方案框架，以指导使用 实施战略和在我们的参与范围内调整护理模式 实施设置。