Project Summary Outcomes for adults with multiple chronic medical conditions 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 and medication beliefs have on these behaviors. Yet, little is known about the impact beliefs have in the context of multi-morbidity (MM) where beliefs about one illness and its treatments may be at odds, or symbiotic, with those for one or more comorbidities. Without this knowledge our ability to provide optimal self-management support for adults with MM 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 highly prevalent 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 prominent theory for understanding health behaviors that has been used widely to develop interventions, but has only been applied to research on behaviors around individual diseases. Depression is of great interest in the study of the SRM because patients with depression often have maladaptive beliefs and perceptions of illness and symptoms. By understanding the interplay of multiple illness and treatment beliefs and their impact on SMB in the context of MM, 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 illness and medication beliefs on patients’ self-management of these conditions over time; (2) Assess the effect of major depression on the pathways linking COPD-illness and medication beliefs with COPD SMB; (3) Apply findings from Aims 1 and 2 to develop and pilot test a patient education and counseling strategy for COPD patients with MM that is designed to promote SMB. We will conduct a mixed methods prospective cohort study of 400 COPD patients in New York City and Chicago and interview them every 3 months for 15 months. We will also conduct interviews after COPD exacerbations to assess changes beliefs and their impact on SMB at times of acute illness worsening. 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, both successfully and unsuccessfully. 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.
|Effective start/end date||8/3/15 → 5/31/17|
- Icahn School of Medicine at Mount Sinai (0255-8783-4609//R01HL126508-02)
- National Heart, Lung, and Blood Institute (0255-8783-4609//R01HL126508-02)
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