Development of a Values-Affirmation Intervention Targeting Medication Adherence in Older Adults with Heart Failure Completing Cardiac Rehabilitation

项目总结/摘要 老年人，特别是那些管理慢性疾病的人，面临着许多挑战， 角色和功能能力。心力衰竭（HF）在老年人中很普遍，需要复杂的、长时间的治疗。 术语疾病管理。再住院是常见的，往往是由于药物不足和- 赫伦斯。鼓励将服药与个人核心价值观联系起来， 药物使用是一种自我引导的努力，以从事个人有意义的生活。价值肯定（例如， 邀请患者反思重要的核心价值观）可以促进对健康行为改变的开放性， 可能是一个强大的激励工具，以加强教育和行为技能的坚持干预。这 一项申请提出开发一种新的价值肯定干预措施，以改善HF患者的药物依从性 参加心脏康复的患者。建议指导患者为导向的研究职业发展- 门特奖（K23）将提供博士艾米丽Gathright的发展和评估的关键培训 老年HF患者的行为自我管理干预。（1）生物心理社会方面的培训- （2）使用定性方法指导理论驱动的干预发展，（3）随机 对照试验（RCT）设计和执行，（4）RCT分析，（5）专业发展将桥梁 既往接受过HF预后的心理社会和行为决定因素的培训， 是为患有慢性病的老年人准备的。Gathright博士将受益于强大的导师支持 团队具有互补的优势和丰富的经验，领导联邦资助的研究。专家们- 将由衰老和认知、预防心脏病学、生物统计学、 统计学和方法学，行为干预，定性方法和药物流行病学。岑- 米里亚姆医院的行为和预防医学中心（Alpert Medi的卓越中心） 加州大学布朗分校）和阿尔珀特医学院的精神病学和人类行为系 提供令人印象深刻的培训环境，并有成功完成K奖的良好记录。迦特博士 right将通过三个目标开发一个价值肯定的药物依从性干预：（1）焦点小组 (6-8; N = 30-48），以确定与HF药物依从性最相关的核心价值， 指导制定一项价值观肯定和技能培养相结合的干预措施;（2）干预措施， 可行性和可接受性将在一个小型开放试验（N = 12）后进行评估和完善;（3）干预 可行性、可接受性和初步疗效将使用试点RCT（N = 50）进行检查， 干预组为未治疗对照组。该项目将为随后的RCT评估奠定基础- 吃的功效和作用机制。K23提案提供了明确和可实现的培训和研究 这些计划将使Gathright博士朝着成为一名独立的临床研究人员的目标前进， 新的和创新的方法，以改善疾病管理的老年人慢性病。

PROJECT SUMMARY/ABSTRACT Aging adults, particularly those managing a chronic illness, face numerous challenges navigating changing roles and functional abilities. Heart failure (HF) is prevalent among older adults and requires complex, long- term disease management. Rehospitalizations are common, and often result from inadequate medication ad- herence. Encouraging a connection between medication-taking and an individual’s core values may reframe medication use as a self-guided effort to engage in personally meaningful living. Values-affirmation (e.g., inviting patients to reflect on important core values) can promote openness to health behavior change, and may be a powerful motivational tool to enhance education and behavior skills adherence interventions. This application proposes to develop a novel values-affirmation intervention to improve medication adherence in HF patients enrolled in cardiac rehabilitation. The proposed Mentored Patient-Oriented Research Career Develop- ment Award (K23) will provide Dr. Emily Gathright critical training in the development and evaluation of behavioral self-management interventions for older adults with HF. Training in (1) biopsychosocial as- pects of aging, (2) use of qualitative methods to guide theory-driven intervention development, (3) randomized controlled trial (RCT) design and execution, (4) RCT analysis, and (5) professional development will bridge prior training in psychosocial and behavioral determinants of prognosis in HF to interventions that improve out- comes for older adults with chronic illness. Dr. Gathright will benefit from the support of a robust mentorship team with complementary strengths and extensive experience leading federally-funded research. Expert men- torship will be provided by leading scientists in the fields of aging and cognition, preventive cardiology, biosta- tistics and methodology, behavioral interventions, qualitative methods, and pharmacoepidemiology. The Cen- ters for Behavioral and Preventive Medicine at The Miriam Hospital (a Center of Excellence at the Alpert Medi- cal School of Brown University) and Alpert Medical School’s Department of Psychiatry and Human Behavior offer an impressive training environment with a strong record of successful completion of K awards. Dr. Gath- right will develop a values-affirmation medication adherence intervention through three aims: (1) Focus groups (6-8; N = 30-48) will be conducted to identify core values most relevant to HF medication adherence, and to guide the development of a combined values-affirmation and skills-building intervention; (2) Intervention feasi- bility and acceptability will be evaluated and refined following a small, open trial (N = 12); and (3) Intervention feasibility, acceptability, and preliminary efficacy will be examined using a pilot RCT (N = 50) comparing the intervention to a no-treatment control group. The project will lay the foundation for a subsequent RCT to evalu- ate efficacy and mechanisms of action. The K23 proposal provides clear and achievable training and research plans that will move Dr. Gathright toward her goal of becoming an independent, clinical researcher developing novel and innovative approaches to improve disease management for older adults with chronic illness.