Patients' Views on Exchanges regarding Diabetes (PAVED)
Diabetes management can decrease the many complications associated with this condition, but treatment adherence among Type 2 diabetes patients is often inadequate due to a variety of factors. Among these factors are diabetes-related stigma and fear of hypoglycemia. The objective of this study is to continue to validate the CDSS-15, a survey designed to be used as a measure of diabetes-related stigma, and to measure diabetes-related stigma, fear of hypoglycemia, and glycemic control in a population of adults diagnosed with T2DM. In furthering our understanding of the effect of diabetesrelated stigma and fear of hypoglycemia on treatment adherence and ultimately, clinical outcomes, in diabetes patients, we hope to provide guidance for the development of more focused interventions in this population.
Culturally Sensitive Tactics to Address Dialysis Adherence in African Americans (Cultivate)
African Americans have a persistent four-fold higher ESRD prevalence rate, an unacceptably high re-hospitalization rate and higher rates of non-adherence. It is hypothesized that novel patient and provider factors will predict hemodialysis treatment adherence in African American ESRD patients and could potentially be targets for effective intervention. This proposal tests the association between dialysis treatment adherence and autonomy-centered factors, apathy, and optimism as well as the association between treatment adherence and dialysis providers' cultural competency.
Peer Mentorship to Improve Outcomes in Hemodialysis (PEER)
PEER HD is a peer mentoring program that helps patients on dialysis increase successful self-care. This program was designed by the staff of the study with help from other Peer Mentorship programs and their resources. In a pilot study, similar to this, a peer mentorship program increased patients' knowledge, self-efficacy, perceived social support, and decreased missed minutes of dialysis treatment in mentees.
Testing Organizational Communications in Hemodialysis (TORCH)
Patient-centered communication is particularly important for dialysis patients. Dialysis is a complex treatment typically delivered to patients on a three days per week, four hours per day schedule. Multidisciplinary staffs including physicians, nurses, technicians, dietitians, social workers, and administrators, contribute to care. Communication is critical within this team in order to successfully promote effective patient self-care of daily dialysis, dietary, and medication schedules. Our previous work among dialysis patients has found that barriers to engagement with healthcare and in self-care behaviors, such as low health literacy, are strong predictors of mortality. However, patient factors do not fully explain the variation in health outcomes. This study will address the existing gap in understanding by examining the role of the healthcare system in communication climate.
Community-base evaluation of APOL1 Genetic Testing in African Americans (APOL1)
Endstage renal disease (ESRD) or kidney failure affects over 500,000 persons in the United States and disproportionately affects racial and ethnic minority populations. Compared to whites, African Americans are 2-4 times more likely to develop ESRD, and represent 32% of the ESRD population, while only representing 13% of the US population. Individuals receiving donor kidneys from deceased individuals with two risk variants experience shorter kidney transplant survival. It is not known whether everyone with high-risk genotypes will develop ESRD; the exact mechanism of injury for APOL1-related risk or its relation to environmental exposures; or whether those with co-morbid conditions are more likely to develop ESRD. To address these uncertainties, research that includes assessment of APOL1 status will be needed. The successful completion of this project will provide community-based guidance to researchers, clinicians, and policy makers regarding the return of APOL1 results to research participants, the use of APOL1 testing in clinical care and renal transplant programs, and gather ongoing community input as knowledge about APOL1 and kidney disease evolves.
Fatalism in Coping with Chronic Kidney Disease (FACING CKD)
The illness experience of living with advanced chronic kidney disease (CKD) is stressful for patients and living with CKD and leads to depression and poor perceptions of quality of life. Religious beliefs and behaviors are associated with decreased stress and improved perceptions of quality of life among those with chronic illness and are particularly prevalent among those of lower socioeconomic strata.
This proposal uses qualitative interviews to more deeply explore if, how, and why religious beliefs and behaviors are beneficial to individuals as they face CKD, and the study is being conducted at Vanderbilt University Medical Center, Meharry Medical College, and the Siloam Family Health Center.
Funding:
Vanderbilt Center for Effective Health Communication Pilot Funding Award
Vanderbilt Institute for Clinical and Translational Research Pilot Grant (NCATS/NIH: UL1TR002243)