R01NR020127

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

University Of South Carolina

NURSES UNDERSTAND THAT IMPROVING HEALTH AND WELL-BEING MEANS ADDRESSING PEOPLE'S NEEDS IN MULTIPLE SETTINGS, CONTEXTS, AND OVER THE WHOLE LIFE COURSE. SCIENCE SUPPORTED BY THE NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) USES THIS HOLISTIC PERSPECTIVE TO IMPROVE INDIVIDUAL AND POPULATION HEALTH AND ADVANCE HEALTH EQUITY. NINR-SUPPORTED RESEARCH PROMOTES HEALTH AND WELL-BEING BY ADDRESSING NEEDS AT MULTIPLE LEVELS INDIVIDUAL, FAMILY, COMMUNITY, AND SOCIETAL LEVELS AND DEVELOPING TREATMENT AND PREVENTION STRATEGIES THAT ARE RESPONSIVE TO THE REALITY OF PEOPLE'S LIVES. NURSES KNOW PEOPLE, AND PEOPLE TRUST NURSES. PATIENT AND FAMILIES INTERACT WITH NURSES MORE THAN ANY OTHER CLINICIANS. NURSING SCIENCE USES THIS SPECIAL RELATIONSHIP TO BETTER UNDERSTAND PATIENTS, FAMILIES, AND COMMUNITIES AND THE MANY FACTORS THAT INFLUENCE THEIR HEALTH. NURSING SCIENCE SUPPORTED BY NINR USES THIS KNOWLEDGE TO DEVELOP STRATEGIES FOR IMPROVING HEALTH AND WELLNESS ACROSS POPULATIONS, HEALTH CARE SETTINGS, AND THE LIFESPAN, WITH AN EMPHASIS ON ACHIEVING HEALTH EQUITY. NINR-SUPPORTED SCIENTISTS HAVE DEVELOPED INTERVENTIONS FOR: SUPPORTING PARENTS OF PREMATURE INFANTS, PROMOTING HIV PREVENTION IN UNDERSERVED POPULATIONS, IMPROVING TRANSITIONAL CARE LEADING TO BETTER OUTCOMES AND COST-SAVINGS, AND HELPING INNER-CITY CHILDREN MANAGE ASTHMA. NURSING SCIENCE TRANSCENDS THE BOUNDARIES OF DISEASE AND RESEARCH DISCIPLINES TO BETTER UNDERSTAND THE EXPERIENCES OF INDIVIDUALS AND FAMILIES LIVING WITH ILLNESS AND TO DEVELOP PERSONALIZED APPROACHES THAT MAXIMIZE HEALTH AND WELL-BEING FOR INDIVIDUALS AT ALL STAGES OF LIFE, ACROSS DIVERSE POPULATIONS AND SETTINGS. NINR-SUPPORTED SCIENCE USES NURSING SCIENCE'S UNIQUE, PATIENT AND COMMUNITY-FOCUSED PERSPECTIVE AND WIDE REACH ACROSS CLINICAL AND COMMUNITY SETTINGS TO ADVANCE OUR UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH: THOSE FACTORS THAT ARE AT THE ROOT OF THE INEQUITIES THAT WE SEE, SUCH AS FOOD INSECURITY AND ACCESS TO HEALTHCARE. NINR RESEARCH EFFORTS IN WELLNESS INVESTIGATE THE KEY BIOLOGICAL, BEHAVIORAL, AND SOCIAL FACTORS THAT PROMOTE LONG-TERM HEALTH AND HEALTHY BEHAVIORS AND PREVENT THE DEVELOPMENT OF ILLNESS ACROSS HEALTH CONDITIONS, SETTINGS, AND THE LIFESPAN. RESEARCH IN WELLNESS IS ALSO FOCUSED ON DEVELOPING AND TESTING CULTURALLY APPROPRIATE INTERVENTIONS TO PROMOTE HEALTH AND PREVENT ILLNESS IN MINORITY AND UNDERSERVED GROUPS. NINR ALSO SUPPORTS SCIENCE TO ASSIST INDIVIDUALS, FAMILIES, AND HEALTH CARE PROFESSIONALS IN MANAGING ADVANCED, SERIOUS ILLNESS, AND PLANNING FOR END-OF-LIFE DECISIONS. IN ADDITION, NINR PROMOTES TECHNOLOGICAL ADVANCEMENTS THAT ADDRESS A RANGE OF HEALTH CARE CHALLENGES AND FACILITATE THE DELIVERY OF REAL-TIME PERSONALIZED INFORMATION TO INDIVIDUALS AND FAMILIES, HEALTH CARE PROVIDERS, AND COMMUNITIES. FINALLY, NINR HAS A LONGSTANDING AND CONTINUING COMMITMENT TO DEVELOPING THE NEXT GENERATION OF NURSE SCIENTISTS: THOSE INDIVIDUALS AND TEAM MEMBERS WHO WILL CARRY THE FIELD OF NURSING SCIENCE INTO THE FUTURE. IN ORDER TO PREPARE AN INNOVATIVE, DIVERSE, AND TALENTED NEXT GENERATION OF NURSE SCIENTISTS, NINR SUPPORTS A VARIETY OF TRAINING OPPORTUNITIES FOR SCIENTISTS AND TRAINEES AT ALL CAREER LEVELS, PARTICULARLY THOSE AT AN EARLY CAREER STAGE WHO ARE SO CRITICAL TO SUSTAINING THE FUTURE OF INNOVATIVE RESEARCH AND HIGH QUALITY HEALTH CARE.

93.361 - Nursing Research

National Institute of Nursing Research (NINR) [HHS - NIH]

Columbia, South Carolina 292083403 United States

Single Zip Code

Community Interventions to Address the Consequences of the COVID-19 Pandemic among Health Disparity and Vulnerable Populations (R01- Clinical Trial Optional) (PAR-20-237)

Amendment Since initial award the total obligations have increased 433% from $686,141 to $3,658,552.