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

项目摘要/摘要 老年人，特别是那些患有慢性病的人，面临着适应变化的无数挑战 角色和职能能力。心力衰竭(HF)在老年人中很常见，需要复杂、长期的 定期疾病管理。再次住院是很常见的，而且往往是由于药物治疗不足造成的。 赫伦斯。鼓励服药与个人核心价值观之间的联系可能会被重新定义 药物使用是一种自我引导的努力，以参与到个人有意义的生活中。价值观--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，以及 可能是加强教育和行为技能遵守干预的有力动机工具。这 APPLICATION建议开发一种新的价值肯定干预措施来改善心衰患者的用药依从性 接受心脏康复治疗的患者。建议的以患者为导向的导师研究职业发展-- MENT奖(K23)将为Emily Gathright博士提供关于发展和评估的关键培训 老年心力衰竭患者的行为自我管理干预。(1)生物、心理和社会方面的培训- 老龄化的观点，(2)用定性的方法指导理论驱动的干预发展，(3)随机 对照试验(RCT)的设计和执行，(4)RCT分析，(5)专业发展将成为桥梁 对心力衰竭患者预后的心理社会和行为决定因素进行事先培训，然后再进行干预，以改善预后。 适用于患有慢性病的老年人。加思赖特博士将受益于强有力的导师支持 具有互补优势和丰富经验的团队，领导联邦资助的研究。专家们- 将由衰老与认知、预防心脏病学、生物医学等领域的顶尖科学家提供研究成果。 组织学和方法学、行为干预、定性方法和药物流行病学。Cen- 米里亚姆医院的行为和预防医学专家(阿尔伯特医学院的卓越中心) 和阿尔伯特医学院的精神病学和人类行为学系 提供令人印象深刻的培训环境和成功完成K奖项的良好记录。加特博士- Right将通过三个目标制定价值肯定药物依从性干预：(1)焦点群体 将进行(6-8；N=30-48)，以确定与HF用药依从性最相关的核心价值观，并 引导制定价值观肯定和技能建设相结合的干预措施；(2)干预成功-- 在一项小规模的公开试验(N=12)之后，将评估和改进亲和性和可接受性；以及(3)干预 可行性、可接受性和初步效果将使用试验性随机对照试验(N=50)进行检查，比较 对非治疗对照组进行干预。该项目将为随后的RCT评估奠定基础-- ATE的疗效和作用机制。K23提案提供了明确和可实现的培训和研究 计划将推动Gathright博士朝着她的目标前进，成为一名独立的、正在开发的临床研究人员 改善患有慢性病的老年人的疾病管理的新的和创新的方法。

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.