Implementing Health Care Interventions for Hispanics with Serious Mental Illness

描述（由申请人提供）：与大多数患有严重精神疾病（重度精神疾病，如精神分裂症）的白人相比，患有重度精神疾病的少数种族/民族患心血管疾病（CVD）的风险更高。虽然有希望的治疗方法（例如，护理经理干预）存在，以改善重度精神分裂症患者的健康，但对使这些干预措施与西班牙裔重度精神分裂症患者文化相关的过程以及促进其在公共精神卫生系统中的应用的关注有限。这项指导研究科学家发展奖（K01）的目标是培养候选人成为实施研究的独立研究者，以解决服务不足的重度精神障碍少数群体在身体保健方面面临的差异。一个指导团队，由博士领导。Lewis-Fernandez和Druss将指导候选人实现以下培训目标：1)获得实施研究方面的培训，重点是将社区参与式研究（CBPR）方法作为一种转化战略；2)为重度精神障碍患者提供整合身心保健的专业知识；3)掌握使用干预制图和定性方法为干预研究提供信息的新技能；4)接受临床试验方法学和纵向数据分析方面的培训。该应用程序集成了课程工作，来自已建立的调查人员的指导，并指导研究活动。研究计划采用了一个协作式干预计划框架，该框架融合了CBPR和干预绘图的原则，以修改和评估现有护理经理干预的可行性和可接受性。这项为期12个月的干预措施的重点是提高病人的积极性以及门诊精神卫生诊所和初级保健之间的医疗保健协调。拟议的项目采用由候选人培训计划支持的多阶段方法。在第一阶段，将组建一个由研究人员和利益相关者组成的社区咨询委员会，以了解和审查干预措施并进行初步修改。在第二阶段，将使用定性方法——患者焦点小组和利益相关者访谈——以确保所有利益相关者都能接受这些修改。在第三阶段，使用第二阶段的结果进一步修改干预措施，制定实施计划，并就修改后的干预措施培训两名护理管理人员。第4阶段包括一项为期12个月的开放式试点研究（N = 30），以评估改进干预措施的可行性和可接受性，并探讨其效果。最后，第五阶段将重点分析试点研究数据和准备R01提案。该研究计划将为后续的R01提供试点数据，以进行随机对照试验，以测试改进干预措施的有效性和实施情况。

DESCRIPTION (provided by applicant): Compared to majority whites with serious mental illness (SMI; e.g., schizophrenia), racial/ethnic minorities with SMI are at higher risk for cardiovascular disease (CVD). Although promising treatments (e.g., care manager interventions) exist to improve the health of people with SMI, limited attention has been paid to the process of making these interventions culturally relevant to Hispanics with SMI and to promote their use in the public mental health system. The objective of this Mentored Research Scientist Development Award (K01) is to prepare the candidate to become an independent investigator in implementation research to address the disparities in physical health care faced by underserved minorities with SMI. A mentoring team, led by Drs. Lewis-Fernandez and Druss, will guide the candidate in achieving the following training objectives: 1) obtain training in implementation research, focusing on community-based participatory research (CBPR) approaches as a translational strategy; 2) develop expertise on the integration of physical and mental health care for people with SMI; 3) acquire new skills in using intervention mapping and qualitative methods to inform intervention research; and 4) obtain training in clinical trial methodology and longitudinal data analysis. The application integrates course work, mentorship from established investigators, and mentored research activities. The research plan uses a collaborative intervention planning framework that blends principles of CBPR and intervention mapping to modify and assess the feasibility and acceptability of an existing care manager intervention. This 12-month intervention focuses on improving patient activation and the coordination of medical care between outpatient mental health clinics and primary care. The proposed project uses a multiphase approach supported by the candidate's training plan. In Phase 1, a community advisory board composed of researchers and stakeholders will be assembled to learn and review the intervention and make initial modifications. During Phase 2, qualitative methods - patient focus groups and stakeholder interviews - will be used to ensure that the modifications are acceptable to all stakeholders. In Phase 3, results from Phase 2 are used to further modify the intervention, develop an implementation plan, and train two care managers on the modified intervention. Phase 4 consists of a 12-month open pilot study (N = 30) to assess the feasibility and acceptability of the modified intervention and explore its effect. Lastly, Phase 5 will focus on analysis of pilot study data and preparation of an R01 proposal. The research plan will yield pilot data for a subsequent R01 to conduct a randomized controlled trial to test the effectiveness and implementation of the modified intervention.