Hypertension Self-management in Refugees Living in San Diego

项目摘要 拟议的以患者为导向的导师研究职业发展奖(K23)旨在提供 具有培训和研究经验的候选人，这些经验将促进她作为独立人士的发展 临床医生-研究人员，特别强调高血压干预研究领域 控制，特别是自我管理(家庭血压监测和药物自我滴定)作为 处理与难民流离失所有关的心血管差异的工具。这次培训将为她提供 有机会发展以下方面的知识和技能：1)高血压流行病学和关注差异 关于移徙是健康的社会决定因素；2)获得理论、发展、 实施和适应理论驱动的社区干预措施，以改善血液状况 通过自我管理控制压力(BP)；3)掌握定性(社会网络分析)技能 纵向数据的多水平建模以评估干预效果和高血压自我 管理临床试验。培训活动将包括授课课程和特定的研讨会，指导 阅读资料，与导师一对一的教程，以及负责任地进行研究的指导 重点关注弱势群体。候选人将利用她以前的临床和研究成果 难民方面的经验，并利用由全球组成的培训委员会的指导 在心血管疾病差异、社区干预、高血压试验、社会领域的知名专家 移民健康的决定因素，以及高级生物统计学。目前的K23研究项目产生于 现有的研究基础设施和她的导师在心血管疾病自我管理试验中的丰富经验 差异，流行病学研究和临床试验，为我开辟了一个专门从事心血管疾病临床的利基市场 对难民和弱势移民的审判和预防。具体目标是进行有组织的 可行性研究通过：1)了解与自我管理有关的知识、态度和行为 难民中的高血压；2)发展、适应和实施文化敏感型高血压 对圣地亚哥难民的自我管理干预；以及3)确定影响可行性和 这种干预的可接受性，以估计未来将使用的效果大小和结果衡量标准 有动力的试验。这项工作将为首次难民随机临床试验奠定坚实的基础。 曾进行过高血压自我管理。虽然这项工作指定的初始目标是改编一个 循证高血压自我管理干预模式改编自最近的大型临床试验 假设这种干预在难民中是可行的；他们可以这样做，接受它，并为我们提供关于 设计一项未来的临床试验，以了解更多关于心血管疾病差异的科学和实施研究。这个 候选人的长期目标是发展必要的专业知识，以成为理解方面的领先试用者 以及解决心血管健康差距问题。

Project Summary The proposed Mentored Patient-Oriented Research Career Development Award (K23) is to provide the candidate with training and research experiences that will promote her development as an independent clinician-researcher, with particular emphasis in the field of intervention research addressing hypertension control, specifically self-management (home blood pressure monitoring and self-titration of medications) as a tool to deal with cardiovascular disparities related to displacement in refugees. This training will provide her with the opportunity to develop knowledge and skills in: 1) hypertension epidemiology and disparities focusing on migration as a social determinant of health,; 2) acquire knowledge in the theory, development, implementation, and adaptation of theoretically driven community-based interventions to improve blood pressure (BP) control through self-management; 3) acquire skills in qualitative (social network analysis) multilevel modeling of longitudinal data to assess the efficacy of interventions and hypertension self- management clinical trials. Training activities will include didactic coursework and specific workshops, directed readings, one-on-one tutorials with mentors, and instructions in the responsible conduct of research that focuses on vulnerable populations. The candidate will capitalize on her previous clinical and research experience with refugees, and leverage mentorship from a Training Committee comprised of globally renowned experts in the fields of CVD disparities, community interventions, hypertension trials, social determinants of immigrant health, and advanced biostatistics. The present K23 research project emerges from the existing research infrastructure and extensive experience of her mentors’ self-management trials in CVD disparities, epidemiological research and clinical trials, to carve out a niche for me to specialize in CVD clinical trials and prevention in refugees and vulnerable immigrants. The specific aims are to conduct a structured feasibility study through: 1) Understanding knowledge, attitudes and behaviors related to self-management of hypertension among refugees; 2) Developing, adapting and implementing a culturally-sensitive hypertension self-management intervention in refugees in San Diego; and 3) Identifying factors affecting the feasibility and acceptability of such an intervention to estimate effect sizes and outcome measures to be used in a future powered trial. This work will lay strong foundations for the first powered randomized clinical trial of refugee hypertension self-management ever conducted. While the specified initial goal of this work is to adapt an evidence-based hypertension self-management intervention model adapted from recent large clinical trials, we hypothesize that this intervention will be feasible in refugees; they can do it, accept it and give us leads on designing a future clinical trial to learn more about CVD disparities science and implementation research. The candidate’s longer-term goal is to develop expertise necessary to become a leading trialist in understanding and addressing cardiovascular health disparities.