Mentored Research on Improving Alcohol Brief Interventions in MedicalSettings

描述（由申请人提供）：这是根据PA-11-194（原PA-10-060），指导患者导向研究职业发展奖（家长K23），题为“改善医疗环境中酒精短暂干预的指导研究”的重新提交。该候选人是一名临床心理学家和有前途的初级面向患者的研究人员，专注于在医疗环境中开发、测试和实施简短的酒精干预。我的教育、临床和研究经历为我提供了咨询方法和定量RCT方法的强大知识基础。我的短期职业目标是扩大我的研究范围，包括混合方法的第一阶段治疗开发研究，增加对医学文化和研究的了解，这将通过这次K23提案的获奖来实现。这将使我能够将我的行为研究背景转化为医疗环境，在医疗环境中，迫切需要精通循证咨询策略和独特实施问题的研究人员。通过在这些领域的培训和指导研究经验，我将能够成功过渡到独立，并成为NIH R01资助的有竞争力的申请人。我的长期职业目标是通过对酒精滥用和其他危险行为的行为干预的严格研究，以及经验验证的治疗保真度仪器和培训、传播和实施实践的发展，对公共卫生产生重大和持续的影响。我在弗吉尼亚大学精神病学和神经行为科学系的工作环境非常适合主持这个K23奖项。弗吉尼亚大学医学院拥有完善的研究环境，支持高质量的以患者为导向的成瘾临床研究，并因其对早期职业研究者发展的承诺而受到国际认可。我是神经生物学研究部门的一员，这是一个专注于成瘾研究的教师小组，也是成瘾研究与教育中心（CARE）的所在地。我们的部门有超过15名美国国立卫生研究院资助的教师，他们使用基因、生物、药理学、动物模型和行为策略来研究成瘾。该中心拥有丰富的跨学科合作和转化研究机会，并致力于青年教师的发展。我的主要导师是英格索尔博士他在指导年轻研究人员走向独立方面有着悠久的历史。我们已经通过她在NIH资助下的工作，共同撰写论文，以及她对K23应用程序开发的支持，展示了我们富有成效的合作潜力。此外，我的导师团队的其他成员，包括dr。Saitz， Velasquez和Lum将通过定期咨询和对他们各自的研究项目进行参与式观察访问的机会进一步改善我的学习环境。除了精神病学和神经行为科学系的机构支持外，我还与普通医学部和大学医学协会（UMA）密切合作，以实现这个项目的研究目标。Nadkarni博士是该项目的顾问，也是UMA的医学主任，他密切参与了当前提案的制定，并高度致力于研究目标和我作为一名独立的以患者为导向的研究人员的发展。需要提高医疗环境中对危险酒精使用的简短干预措施的功效和效率。对照试验的高度异质性和较差的内部效度值得使用混合方法治疗发展研究来确定短期干预措施的有效成分或作用机制，并开发明确定义的、经验生成的短期干预措施。动机性访谈（MI）是一种咨询方法，通常被整合到简短的干预措施中，然而，很少有人知道哪些动机性访谈的组成部分可能会提高有效性，值得为培训和实施所需的大量时间和资源。我提出了一项分为两个阶段的混合方法研究，其主要目标是1)系统地评估MI行为和交互技术对标准PI协议的影响，以及2)使用这些信息与常驻干预专家一起对经验知情的BI进行试点测试。还将评估所测试的干预措施对患者的可接受性，并使用两项研究的录音简短干预措施进行作用机制分析。最后，将评估常驻提供者BI知识、态度和行为的变化。这项研究，连同我的培训计划，将有助于我的培养目标，获得混合方法的第一阶段的研究技能和经验，在医学文化和研究。

DESCRIPTION (provided by applicant): This is resubmission under PA-11-194 (formerly PA-10-060), Mentored Patient-Oriented Research Career Development Award (Parent K23), titled Mentored Research on Improving Alcohol Brief Interventions in Medical Settings. Candidate The candidate is a clinical psychologist and promising junior-level patient-oriented researcher focused on developing, testing, and implementing brief alcohol interventions in medical settings. My education, clinical, and research experiences have provided me with a strong knowledge base of counseling approaches and quantitative RCT methodology. My short-term career goals, which would be realized with award of this K23 proposal, involve expanding my to include mixed-methods Stage 1 treatment development research and increase understanding of medical culture and research. This would allow me to translate my background of behavioral research into medical settings, where researchers who are well versed in both evidence-based counseling strategies and the unique implementation issues faced in medical settings are desperately needed. With training and mentored research experience in these areas, I would be able to make a successful transition to independence and be a competitive applicant for NIH R01 funding. It is my long-term career objective to make a significant and sustained public health impact through the rigorous study of behavioral interventions for alcohol misuse and other risky behaviors and the development of empirically validated treatment fidelity instrumentation and training, dissemination, and implementation practices. Environment My environment at the University of Virginia, Department of Psychiatry and Neurobehavioral Sciences is ideal for conducting this K23 award. The University of Virginia School of Medicine has a well-established research environment that supports high quality patient-oriented clinical research in addictions and is internationally recognized for its commitment to the development of early career investigators. I am a member of the Division of Neurobiological Studies, a faculty group focused on addiction research and home to the Center for Addiction Research and Education (CARE). Our division has over 15 NIH-funded faculty members researching addictions using genetic, biological, pharmacological, animal model, and behavioral strategies. The center is rich with interdisciplinary collaboration and translational research opportunities and is committed to the development of junior faculty. My primary mentor is Dr. Ingersoll who has a long track record of mentoring young researchers to the point of independence. We have already demonstrated our potential for productive collaboration through our work on her NIH funded grants, coauthoring papers, and her support in the development of this K23 application. In addition, the rest of my mentorship team, including Drs. Saitz, Velasquez, and Lum will further promote my learning environment through regular consultation and opportunities to conduct participatory observation visits to their respective research programs. In addition to the institutional support that I will receive in the Department of Psychiatry and Neurobehavioral Sciences, I work with closely with the Department of General Medicine and University Medical Associates (UMA) to conduct the research aims of this project. Dr. Nadkarni, who is an advisor on this project and the Medical Director of UMA has been closely involved in the development of current proposal and is highly committed to both the study aims and my development as an independent patient-oriented researcher. Research Improvements in the efficacy and efficiency of brief interventions for risky alcohol use in medical settings are needed. High levels of heterogeneity and poor internal validity of controlled trials merit the use of mixed- methods treatment development research to identify the active components or mechanisms of action of brief interventions and the development of a clearly defined, empirically generated brief intervention. Motivational interviewing (MI) is a counseling approach that is commonly integrated into brief interventions, however, little is know about which MI components might drive effectiveness and merit the extensive time and resources required for training and implementation. I propose a mixed methods study in 2 phases, the primary aims of which are 1) systematically evaluate the impact of MI behaviors and interaction techniques on a standard PI protocol, and 2) use this information to pilot test an empirically informed BI with resident interventionists. The acceptability of the tested interventions to patients will also be evaluated and mechanisms of action analyses will be conducted with audio-recorded brief interventions from both studies. Lastly, changes in resident provider BI knowledge, attitudes, and behavior will be evaluated. The proposed research, along with my training plan, will contribute to my training goals of gaining mixed-methods Stage I research skills and experience in medical culture and research. PUBLIC HEALTH RELEVANCE: This project will systematically evaluate the impact of brief intervention components on risky drinking behavior among primary care patients and use this information to develop and pilot test an empirically informed brief intervention. This study holds the promise to improve treatment effectiveness for the nation's more than 16 million risky drinkers. Lessons learned could hasten the development of brief interventions for other chronic diseases in the U.S.