A Mixed Methods Study of Chronic Kidney Disease (CKD) Self-Management

慢性肾脏病(CKD)是一种日益流行的疾病，影响着近15%的美国人口，而且是一种 进展性，有心血管疾病和终末期肾脏疾病的潜在致命并发症。 CKD的定向治疗具有挑战性，因为CKD是一种病因通常无法确定的综合征。 缺乏针对疾病的干预措施。然而，有一些横切的方法是 广泛有益于慢性肾脏病患者，并被当前的慢性肾脏病管理指南推荐，该指南 包括建议患者进行自我管理行为(例如，监测血压、保持 体力活动，避免吸烟)。到目前为止，关于自我管理的研究还很有限。 透析CKD。少数发表的研究表明，人们对推荐的自我管理行为的理解很差。 IOR，这强调了需要1)了解不符合标准的原因 2)开发和评估改善CKD自我管理的新方法。莎拉·施劳本， 医学博士，肾病学家，将在她提议的K23奖中瞄准这一未被研究的领域。施劳本医生是 准备利用这一奖项在富裕的环境中启动独立资助的研究职业生涯 她在宾夕法尼亚大学完成了临床流行病学硕士学位，通过 她在流行病学、生物统计学、研究设计方面获得了经验，在她的博士后研究期间， 在一个大型CKD观察队列中进行了自我管理行为的初步研究，以及 参加了定性和混合方法研究方面的正式培训。她提议的K23工作将在- 深入访谈慢性肾脏病患者，了解参与健康行为和认知的影响。 FY相关因素的设计和实施自我管理支持干预(目标1)。在一个 Schrauben博士将研究大量CKD患者的潜在预测因素 管理行为参与，以确定对自我管理支持重要的患者特征 干预(目标2)。利用这些信息，她将在以下方面发展以患者为中心的自我管理支持- 发明利用健康行为理论和移动健康(MHealth)技术，然后试验其可行性-- 城市(目标3)。通过她计划的职业发展，她寻求获得1)临床试验设计、IM-1)方面的技能。 实施和评价，2)混合研究方法，3)高级统计分析，包括长期的 来自试点试验的纵向数据分析，同时获得4)实施科学和5)健康方面的专业知识 行为研究。为了实现这些目标，Schrauben博士组织了一个多学科的导师 由肾脏流行病学、生物统计学、临床试验、混合研究方法、IM等领域的国家专家领导的团队。 实施科学、健康行为研究和利用mHealth的干预措施。在完成后 这些K23活动，Schrauben博士将准备进行由R01拨款支持的RCT，利用她 培训以提高慢性肾脏病患者的自我管理能力。

Chronic kidney disease (CKD) is a growing epidemic, affecting close to 15% of the US population, and is gen- erally progressive, with potentially fatal complications of cardiovascular disease and end-stage kidney disease. Directed treatment of CKD is challenging because CKD is a syndrome with causes that are often not identifia- ble and a dearth of disease-specific interventions. However, there are some cross-cutting approaches that are broadly beneficial for people with CKD, and are recommended by current CKD management guidelines, which include advising patients to engage in self-management behaviors (e.g., monitor blood pressure, maintain physical activity, and avoid tobacco). To date, there has been limited research on self-management in pre- dialysis CKD. The few published studies demonstrate poor uptake of recommended self-management behav- iors, which highlights the need to 1) understand the reasons for substandard engagement in recommended behaviors, and 2) develop and evaluate new approaches to improve CKD self-management. Sarah Schrauben, MD, MSCE, a nephrologist, will target this understudied area in her proposed K23 Award. Dr. Schrauben is positioned to use this award to launch an independently funded research career in the rich environment at the University of Pennsylvania, as she has completed a Masters degree in clinical epidemiology, through which she gained experience in epidemiology, biostatistics, study design, and during her post-doctoral fellowship, conducted a preliminary study on self-management behaviors in a large CKD observational cohort, as well as participated in formal training in qualitative and mixed methods research. Her proposed K23 work will utilize in- depth interviews with CKD patients to understand the influences of participating in health behaviors and identi- fy relevant factors for the design and implementation of a self-management support intervention (Aim 1). In a large cohort of individuals with CKD, Dr. Schrauben will investigate potential predictors of recommended self- management behavior engagement to identify patient characteristics important for a self-management support intervention (Aim 2). Using this information, she will develop a patient-centered self-management support in- tervention harnessing health behavior theory and mobile health (mHealth) technology and then pilot its feasibil- ity (Aim 3). Through her proposed career development, she seeks to gain skills in 1) clinical trial design, im- plementation, and evaluation, 2) mixed research methods, 3) advanced statistical analyses, including the longi- tudinal data analyses from the pilot trial, while garnering expertise in 4) implementation science, and 5) health behavior research. To achieve these objectives, Dr. Schrauben has assembled a multi-disciplinary mentorship team led by national experts in renal epidemiology, biostatistics, clinical trials, mixed research methods, im- plementation science, health behavior research, and interventions leveraging mHealth. Upon completion of these K23 activities, Dr. Schrauben will be poised to conduct a RCT supported by a R01 grant, leveraging her training to improve self-management among persons with CKD.