Document text
Principal Investigator: Gayenell Smith Magwood
Organization: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
Fiscal Year: 2024
Award: $648,398
Funding agency: National Institute of Nursing Research
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.
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health disparities><Diabetes Mellitus><Discrimination><Disparities><Disparity><Economically Deprived Population><Environment><Exposure to><Family><Family Care Giver><Family Caregiver><Family Relations><Family Relationship><Fatigue><Focus Groups><Future><Goals><Health><Health Benefit><Health Care Providers><Health Care Systems><Health Inequity><Health Personnel><Health Promotion><Health Status><Health disparity mitigation><Health disparity reduction><Healthcare Providers><Healthcare Systems><Healthcare worker><Hospital Admission><Hospitalization><Hypertension><Illness Behavior><Impairment><Individual><Individuals from minority><Individuals of minority><Inequalities in Health><Inequities in Health><Inequity><Information Management><Institutional Racism><Intervention><Intervention Strategies><Interview><Lack of Energy><Level of Health><Linear Models><Link><Literature><Lower health disparities><Measures><Mental Health><Mental Hygiene><Methods><Minority><Minority Groups><Minority People><Minority Population><Minority individual><Mitigate health disparities><Modeling><Nurses><Older Population><Outcome><Pain interference><Patient Care><Patient Care Delivery><Patients><Pattern><PhenX Toolkit><Phenotypes and eXposures Toolkit><Phenx><Psychological Health><Psychosocial Factor><Public Health><QOL><Qualitative Methods><Quality of life><Race><Races><Recovery><Reduce health disparities><Research><Risk><Role><SARS corona virus 2><SARS-CO-V2><SARS-COVID-2><SARS-CoV-2><SARS-CoV-2 associated death><SARS-CoV-2 associated fatality><SARS-CoV-2 associated mortality><SARS-CoV-2 death><SARS-CoV-2 epidemic><SARS-CoV-2 fatality><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 induced death><SARS-CoV-2 induced fatality><SARS-CoV-2 induced mortality><SARS-CoV-2 infection><SARS-CoV-2 mortality><SARS-CoV-2 pandemic><SARS-CoV-2 related death><SARS-CoV-2 related fatality><SARS-CoV-2 related mortality><SARS-CoV-2 survivors><SARS-CoV2><SARS-CoV2 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coronavirus 2 pandemic><Severe acute respiratory syndrome related corona virus 2><Sick Role><Social Environment><Social Identification><Social Identity><Social status><Social support><Socioeconomically disadvantaged><Stress><Stroke><Survivors><Symptoms><System><Systematic Racism><Systemic Racism><Testing><Trauma><Treatment Efficacy><Underserved Population><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Wuhan coronavirus><access to health care><access to healthcare><accessibility of health care><accessibility to health care><accessibility to healthcare><adulthood><ages><arm><attentional control><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><brain attack><cardiovascular disorder><care delivery><care for patients><care of patients><caring for patients><cerebral vascular accident><cerebrovascular accident><chronic disorder><chronic kidney disease><co-morbid><co-morbidity><community health worker><community intervention><community 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disadvantage><socioeconomically underprivileged><socioenvironment><socioenvironmental><stressor><stroke patient><stroked><strokes><structural determinants><structural factors><structural health determinants><survive COVID-19><survive SARS-CoV-2><telehealth><theories><therapeutic efficacy><therapy design><therapy efficacy><trauma exposure><treatment design><treatment provider><under served community><under served group><under served individual><under served minority><under served people><under served population><underclass><underserved community><underserved group><underserved individual><underserved minority><underserved people>