Basic Needs Navigation Intervention to Address Multidimensional Adversity in African Americans with Diabetic Kidney Disease

项目总结 约1/3的成人糖尿病患者有慢性肾脏疾病，通常称为糖尿病 肾病(DKD)。在美国，DKD是终末期肾病的主要原因。非洲 美国人是一个脆弱的亚群，因为他们更有可能患上2型糖尿病，有22% 罹患慢性肾脏疾病(CKD)的风险更高，进展为 ESRD与非西班牙裔白人(NHW)的比较。此外，慢性肾脏病在非洲的流行不成比例。 美国人生活在贫困中，他们患ESRD的风险是NHW的四倍。 生活在贫困中的挑战包括多方面的逆境，其定义是有三个或更多的社会 住房不稳定、粮食不安全、交通需求、公用事业需求、人际安全、 和财政压力。多维度逆境对DKD的复杂自我管理产生负面影响 影响健康结果。生活在贫困中，身为非裔美国人，患有DKD和 多维的逆境会导致糟糕的结果。患者教育与自我管理行为 包括自我监测、改变生活方式(例如饮食和锻炼习惯)和服药依从性 是管理和优化DKD患者临床结果的基石。研究 展示了精心设计的教育干预措施改善了知识、自我管理和患者结果。 然而，有证据表明，非裔美国人不太可能进行自我管理行为 与NHW相比，旨在改善自我管理行为的干预措施可能会有变化 多维逆境带来的成效。有证据表明，患者导航程序可能是 有希望的战略，以改善健康结果和应对个人中的多层面逆境 生活在贫困之中。一个重要的悬而未决的问题是，基本型飞机是否需要导航干预 与耐心教育和生活方式指导相结合，应对多方面的逆境 改善临床和以患者为中心的结果。此外，我们不知道整合社会 将逆境纳入干预研究有助于减少慢性病临床结果中的健康差异 在少数族裔人群中。来自我们小组的初步数据表明，一种结合了DKD的新型干预措施 应对多维逆境的教育、基本需求导航和生活方式指导可能是 在这群人中很有效。因此，使用随机对照试验，这项R21建议将解决一个数字 在患有DKD的低收入非裔美国人中，我们目前的知识差距有多维 逆境。它还将为大规模适当功率的随机临床试验提供初步数据 (R01)专注于患有DKD的非裔美国人的多维逆境。这个项目的长期目标是 是确定有效的策略，以改善DKD危险因素控制和减缓DKD的进展 经历多重社会逆境的非裔美国人。

PROJECT SUMMARY Approximately 1 in 3 adults with diabetes have chronic kidney disease commonly referred to as diabetic kidney disease (DKD). DKD is the leading cause of end stage renal disease in the United States. African Americans are a vulnerable subgroup, as they are more likely to develop type 2 diabetes mellitus, have a 22% higher risk of developing chronic kidney disease (CKD) and are almost four times more likely to progress to ESRD compared to non-Hispanic whites (NHW). In addition, CKD is disproportionately prevalent in African Americans living in poverty and they have a four-fold higher risk of developing ESRD compared to NHW. Challenges of living in poverty include multidimensional adversity, defined as having three or more social adversities such as housing instability, food insecurity, transportation needs, utility needs, interpersonal safety, and financial strain. Multidimensional adversity impacts the complex self-management of DKD and negatively impacts health outcomes. The constellation of living in poverty, being African American, having DKD and multidimensional adversity results in poor outcomes. Patient education and self-management behaviors including self-monitoring, lifestyle changes (e.g., eating and exercise habits) and medication adherence represent the cornerstone of managing and optimizing clinical outcomes in individuals with DKD. Research shows well-designed educational interventions improves knowledge, self-management, and patient outcomes. However, evidence suggests that African Americans are less likely to perform self-management behaviors compared to NHW and that interventions designed to improve self-management behaviors may have variable effectiveness due to multidimensional adversity. Evidence suggests patient navigation programs may be a promising strategy to improve health outcomes and address multidimensional adversity among individuals living in poverty. An important unanswered question is whether a basic needs navigation intervention that addresses multidimensional adversity in combination with patient education and lifestyle coaching leads to improved clinical and patient-centered outcomes. In addition, we do not know whether integrating social adversity into intervention studies can help reduce health disparities in clinical outcomes for chronic diseases in minority populations. Preliminary data from our group suggest a novel intervention that incorporates DKD education, basic needs navigation, and lifestyle coaching to address multidimensional adversity may be effective in this population. Therefore, using a randomized control trial this R21 proposal will address a number of gaps in our current knowledge in low-income African Americans with DKD experiencing multidimensional adversity. It will also provide preliminary data for a large-scale appropriately powered, randomized clinical trial (R01) focused on multidimensional adversity in African Americans with DKD. The long-term goal of this project is to identify effective strategies for improving DKD risk factor control and slowing the progression of DKD in African Americans experiencing multiple social adversities.