Self-management behaviors among COPD patients with multi-morbidity

多种疾病的慢性阻塞性肺病患者的自我管理行为

• 批准号: 8976686
• 负责人: Alex D Federman
• 金额: $ 80.9万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-03 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8976686
• 关键词: Academic advising; Acute; Adherence; Adult; Affect; Anxiety; Attention; Behavior; Belief; Chicago; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Cities; Cognitive; Cohort Studies; Comorbidity; Complex; Counseling; Data; Diabetes Mellitus; Disease; Education; Emotional; Fatigue; Future; Goals; Health; Health behavior; Hospitalization; Hypertension; Illness impact; Individual; Informal Social Control; Intervention; Interview; Knowledge; Major Depressive Disorder; Mediating; Medical; Mental Depression; Methods; Modeling; Morbidity - disease rate; Neurobehavioral Manifestations; New York City; Outcome; Pathway interactions; Patients; Perception; Pharmaceutical Preparations; Plant Roots; Prospective Studies; Recruitment Activity; Research; Research Design; Self Care; Self Management; Symptoms; Testing; Time; Translating; asthmatic patient; base; behavioral outcome; clinical care; cognitive change; cognitive process; compliance behavior; depressed patient; depressive symptoms; design; illness perceptions; improved; interest; medication compliance; programs; prospective; prototype; public health priorities; public health relevance; response; theories

 DESCRIPTION (provided by applicant): Outcomes for patients with multi-morbidity (MM) are often poor, in part because of low adherence to self-management behaviors (SMB).Research has identified key determinants of SMB for individual diseases and shown the powerful influence that illness representations and medication beliefs have on these behaviors. Yet, little is known about the impact of illness representations in the context of MM where beliefs about one illness and its treatments may be at odds, or symbiotic, with those for comorbidities. Without this knowledge, our ability to provide optimal self-management support for MM patients is limited. The goal of this study is to determine how beliefs about chronic illness and their treatments affect SMB in the context of MM and to translate this information into self-management support counseling modules for use in future interventions. We will focus on patients with chronic obstructive pulmonary disease (COPD), a disabling and costly health problem, and evaluate the impact of 3 comorbid conditions that differ in level of self-management complexity and symptomatology: hypertension (HTN), diabetes (DM),and depression. The study design is rooted in the Self Regulation Model (SRM), a theory of health behaviors that has been used to develop interventions, but has only been applied to research on behaviors around single diseases. Depression is of great interest in the study of the SRM because patients with depression often have maladaptive representations and perceptions of illness. By understanding the interplay of illness representations and medication beliefs and their impact on SMB in the context of comorbidities, we will advance both the SRM and the clinical care of patients with MM. The Specific Aims are to: 1) Examine the interactive effects of COPD, HTN, and DM related cognitive and emotional illness representations and medication beliefs on patients' self-management of these conditions over time; 2) Assess the association of major depression with COPD SMB over time and evaluate the pathways, via illness representations and medication beliefs, mediating this relationship;(3) Guided by findings from Aims 12 and the SRM, develop and pilot test education and counseling modules for COPD patients with MM to promote adherence to SMB. We will conduct a mixed methods prospective cohort study of 400 COPD patients with HTN or DM in NY City and Chicago and interview them every 3 months for 15 months. We will also conduct interviews during and after COPD exacerbations to assess changes illness representations and their impact on SMB. For Aim 3, we will conduct qualitative interviews with patients who have good or low medication adherence to understand cognitive processes that guide SMB and to identify the self-management strategies they use. We will then create counseling modules to improve self-management and pilot them among 100 patients. The study will expand the SRM to MM, elucidate how patients respond to varying beliefs in the context of MM, and provide prototype self-management support counseling modules for application to a future, fully developed intervention to improve SMB and outcomes for adults with MM.

 描述（由申请人提供）：多发病（MM）患者的结局通常很差，部分原因是对自我管理行为（SMB）的依从性较低。研究已经确定了个体疾病SMB的关键决定因素，并显示了疾病陈述和用药信念对这些行为的强大影响。然而，鲜为人知的是，在MM的情况下，对一种疾病及其治疗的信念可能是不一致的，或共生的，与那些共病的疾病陈述的影响。如果没有这些知识，我们为MM患者提供最佳自我管理支持的能力是有限的。本研究的目的是确定 关于慢性疾病及其治疗的信念如何影响MM背景下的SMB，并将此信息转化为自我管理支持咨询模块，供未来干预使用。我们将重点关注慢性阻塞性肺疾病（COPD）患者，这是一种致残且代价高昂的健康问题，并评估3种自我管理水平不同的共病状况的影响 复杂性和病理学：高血压（HTN）、糖尿病（DM）和抑郁症。这项研究的设计植根于自我调节模型（SRM），这是一种健康行为理论，已被用于开发干预措施，但仅被应用于围绕单一疾病的行为研究。抑郁症是SRM研究的一大兴趣，因为抑郁症患者往往有适应不良的陈述和疾病的看法。通过了解疾病陈述和药物信念的相互作用及其在合并症背景下对SMB的影响，我们将推进SRM和MM患者的临床护理。具体目标是：1）检查COPD，HTN，和糖尿病相关的认知和情绪疾病的陈述和药物信念对患者的自我管理这些条件随着时间的推移随着时间的推移，评估重度抑郁症与COPD SMB的相关性，并通过疾病陈述和药物信念评估介导这种关系的途径（3）以目标12和SRM的发现为指导，为患有MM的COPD患者开发和试点测试教育和咨询模块，以促进对SMB的依从性。我们将在纽约市和芝加哥对400例COPD伴HTN或DM患者进行一项混合方法前瞻性队列研究，并每3个月对他们进行一次访谈，持续15个月。我们还将在COPD急性加重期间和之后进行访谈，以评估疾病表征的变化及其对SMB的影响。对于目标3，我们将对药物依从性良好或较低的患者进行定性访谈，以了解指导SMB的认知过程，并确定他们使用的自我管理策略。然后，我们将创建咨询模块，以改善自我管理，并在100名患者中进行试点。该研究将SRM扩展到MM，阐明患者如何在MM背景下对不同信念做出反应，并提供原型自我管理 支持咨询模块应用到未来，充分开发的干预措施，以改善SMB和MM成人的结果。