Improving the Collaborative Health of Minority COVID-19 Survivor & Carepartner Dyads Through Interventions Targeting Social and Structural Health Inequities

项目总结/摘要 来自服务不足社区的有色人种（POC）患COVID-19相关疾病的风险增加 和死亡率由于各种社会和结构性健康决定因素（SSDH;例如，保健障碍 以及糖尿病、高血压和心血管疾病等慢性疾病的发病率较高 疾病此外，与种族主义/歧视经历有关的压力因素（个人和系统性） 疫情对社区的影响可能会使恢复和管理工作进一步复杂化， 少数COVID-19幸存者的潜在慢性疾病，破坏了身心健康， 只有病人，但护理伙伴谁提供关键的支持。这项研究测试了远程医疗的有效性- 增强，RN-社区卫生工作者（CHW）提供的二元干预，ICINGS FAM（整合 护士指导下的社区干预与家庭），生活质量（QoL）和健康- 相关结果在脆弱的非洲裔美国人（AA）成人与既存慢性疾病和他们的非正式 护理伙伴（IC）。改编自我们之前在AA卒中患者中测试的WISSDOM CINGs模型，关键 这一干预措施的特点包括： 消除种族和流行病相关压力的战略 由COVID-19幸存者和IC;和B）将幸存者/IC二元组合作为分析单位，以更好地 了解人际关系和相互依赖关系如何影响健康和健康相关结果， 都是合伙人我们假设接受干预的幸存者/IC二联体（即，教练相关 COVID-19风险缓解、慢性病管理信息和医疗保健导航帮助 系统）将证明与注意力相比， 对照组接受每月一次的一般健康促进。iCINGS FAM的目标是加强 作为一个综合单位的二分体管理疾病行为的功效和代理，称为“二分体疾病 管理在目标1中，我们将与主要社区持份者进行访谈和焦点小组讨论， iCINGS FAM组件到个人，人际，社区，社会环境和SSDH 学习二元体的资产/障碍。在目标2中，我们将采用随机对照试验设计来测试干预对以下生活质量的疗效： 成年AA幸存者和预先存在慢性健康状况的IC（250对）。干预效果 还将调查症状、二元信心和社会支持（目标2.1）。在目标3中，我们将确定 个人和家庭层面的社会和结构性种族创伤暴露和家庭疾病管理 与降低/改善的生活质量和健康结果相关的行为（n=50）。最后为 进一步将研究结果置于背景中，在探索性目标4中，我们将研究结果之间的关联 和社区水平的SSDH使用PhenX结构决定变量。这种干预有可能 减少健康差距，增加对SSDH、社会人口和心理社会因素的了解 影响少数民族患者的生活质量和疾病管理行为。

PROJECT SUMMARY/ABSTRACT Persons of color (POC) from underserved communities are at increased risk of COVID-19 related morbidity and mortality due to a variety of social and structural health determinants (SSDH; e.g., barriers to health care access) and higher rates of underlying chronic diseases such as diabetes, hypertension, and cardiovascular disease. Additionally, stressors associated with experiences of racism/discrimination (personal and systemic) and the impact of the pandemic on their communities may further complicate the recovery and management of underlying chronic diseases for minority COVID-19 survivors, undermining the mental and physical health not only of the patient but carepartners who provide critical support. This study tests the efficacy of a telehealth- enhanced, RN-Community Health Worker (CHW) delivered dyad intervention, ICINGS FAM (Integrating Community-based Intervention Under Nurse Guidance with Families), on quality of life (QoL), and health- related outcomes in vulnerable African American (AA) adults with preexisting chronic illness and their informal carepartners (IC). Adapted from our previous WISSDOM CINGs model tested in AA stroke patients, key features of this intervention include a) strategies to address racial- and pandemic-related stressors perceived by COVID-19 survivors and ICs; and b) incorporation of the survivor/IC dyad as a unit of analysis to better understand how interpersonal and interdependent relationships impact health and health related outcomes for both partners. We hypothesize that survivor/IC dyads receiving the intervention (i.e., coaching related to COVID-19 risk mitigation, chronic disease management information, and assistance navigating the health care system) will demonstrate improved QoL and health-related secondary outcomes compared to the attention control arm receiving monthly general health promotion. The objective of iCINGS FAM is to strengthen the efficacy and agency of the dyad to manage illness behaviors as an integrated unit, termed "dyad illness management. In Aim 1, we will conduct interviews and focus groups with key community stakeholders to refine iCINGS FAM components to the individual, interpersonal, community, social environment, and SSDH assets/barriers of study dyads. In Aim 2, we will employ an RCT design to test intervention efficacy on QoL of adult AA survivors and ICs (250 dyads) with pre-existing chronic health conditions. Intervention effects on symptoms, dyadic confidence, and social support will also be investigated (Aim 2.1). In Aim 3, we will identify individual - and family - level social and structural racial trauma exposures and family illness management behaviors associated with reduced/improved QoL and health outcomes on a subset of dyads (n=50). Finally, to further contextualize study findings, in Exploratory Aim 4 we will examine associations between outcomes and community-level SSDH using PhenX structural determinant variables. This intervention has the potential to reduce health disparities and increase understanding of SSDH, sociodemographic and psychosocial factors that affect QoL and dyadic illness management behaviors in minority patients.