Self-management behaviors among COPD patients with multi-morbidity

 描述(由申请人提供)：多发病(MM)患者的预后通常很差，部分原因是对自我管理行为(SMB)的坚持程度较低。研究已经确定了SMB对个别疾病的关键决定因素，并表明疾病表现和药物信念对这些行为具有强大的影响。然而，关于疾病陈述在多发性骨髓瘤背景下的影响知之甚少，在这种情况下，对一种疾病及其治疗的信念可能与对共病的信念不一致或共生。如果没有这些知识，我们为多发性骨髓瘤患者提供最佳自我管理支持的能力是有限的。这项研究的目标是确定 关于慢性病及其治疗的信念如何影响MM背景下的中小企业，并将这些信息转化为自我管理支持咨询模块，以便在未来的干预中使用。我们将重点关注慢性阻塞性肺疾病(COPD)患者，这是一种致残性和昂贵的健康问题，并评估3种不同自我管理水平的并存疾病的影响。 复杂性和症状：高血压(HTN)、糖尿病(DM)和抑郁症。这项研究设计植根于自我调节模型(SRM)，这是一种健康行为理论，已被用于开发干预措施，但仅应用于围绕单一疾病的行为研究。抑郁症是SRM研究中的一个重要方面，因为抑郁症患者通常具有不适应的表征和疾病认知。通过了解疾病表现和用药信念的相互作用及其在合并症背景下对SMB的影响，我们将推进MM患者的SRM和临床护理。具体目标是：1)检查与COPD、HTN和DM相关的认知和情绪疾病表现和用药信念对患者随着时间的推移对这些情况的自我管理的交互影响;2)评估随着时间的推移严重抑郁与COPD SMB的关联，并通过疾病表现和用药信念评估通路，调节这种关系;(3)由AIMS 12和SRM的结果指导，为患有MM的COPD患者开发和试点测试教育和咨询模块，以促进对SMB的依从性。我们将在纽约和芝加哥对400名患有HTN或DM的COPD患者进行前瞻性队列研究，并在15个月内每3个月对他们进行一次访谈。我们还将在慢性阻塞性肺病加重期间和之后进行访谈，以评估变化、疾病表现及其对中小企业的影响。对于目标3，我们将对服药依从性良好或较低的患者进行定性访谈，以了解指导SMB的认知过程，并确定他们使用的自我管理策略。然后，我们将创建咨询模块来改善自我管理，并在100名患者中进行试点。这项研究将把SRM扩展到MM，阐明患者如何在MM的背景下对不同的信念做出反应，并提供原型自我管理 支持应用于未来的咨询模块，全面发展的干预措施，以改善中小型企业和成人MM患者的预后。

 DESCRIPTION (provided by applicant): Outcomes for patients with multi-morbidity (MM) are often poor, in part because of low adherence to self-management behaviors (SMB).Research has identified key determinants of SMB for individual diseases and shown the powerful influence that illness representations and medication beliefs have on these behaviors. Yet, little is known about the impact of illness representations in the context of MM where beliefs about one illness and its treatments may be at odds, or symbiotic, with those for comorbidities. Without this knowledge, our ability to provide optimal self-management support for MM patients is limited. The goal of this study is to determine how beliefs about chronic illness and their treatments affect SMB in the context of MM and to translate this information into self-management support counseling modules for use in future interventions. We will focus on patients with chronic obstructive pulmonary disease (COPD), a disabling and costly health problem, and evaluate the impact of 3 comorbid conditions that differ in level of self-management complexity and symptomatology: hypertension (HTN), diabetes (DM),and depression. The study design is rooted in the Self Regulation Model (SRM), a theory of health behaviors that has been used to develop interventions, but has only been applied to research on behaviors around single diseases. Depression is of great interest in the study of the SRM because patients with depression often have maladaptive representations and perceptions of illness. By understanding the interplay of illness representations and medication beliefs and their impact on SMB in the context of comorbidities, we will advance both the SRM and the clinical care of patients with MM. The Specific Aims are to: 1) Examine the interactive effects of COPD, HTN, and DM related cognitive and emotional illness representations and medication beliefs on patients' self-management of these conditions over time; 2) Assess the association of major depression with COPD SMB over time and evaluate the pathways, via illness representations and medication beliefs, mediating this relationship;(3) Guided by findings from Aims 12 and the SRM, develop and pilot test education and counseling modules for COPD patients with MM to promote adherence to SMB. We will conduct a mixed methods prospective cohort study of 400 COPD patients with HTN or DM in NY City and Chicago and interview them every 3 months for 15 months. We will also conduct interviews during and after COPD exacerbations to assess changes illness representations and their impact on SMB. For Aim 3, we will conduct qualitative interviews with patients who have good or low medication adherence to understand cognitive processes that guide SMB and to identify the self-management strategies they use. We will then create counseling modules to improve self-management and pilot them among 100 patients. The study will expand the SRM to MM, elucidate how patients respond to varying beliefs in the context of MM, and provide prototype self-management support counseling modules for application to a future, fully developed intervention to improve SMB and outcomes for adults with MM.