The program project addresses clinical research studies designed to improve quality of life and delay or slow the progression of chronic conditions through the examination of self-management strategies which target adherence to treatment regimen, thus improving the effectiveness of care, with an overlapping objective of identifying factors necessary for successful translation. Chronic disorder regimens typically include a combination of medication, physical activity, dietary modification, and other lifestyle adjustments. Documented treatment effectiveness in the range of 30- 40% is not surprising given that adherence to prescribed treatment has been estimated at approximately 50%. The poor outcomes related to problems in the management of treatment regimens are a costly burden to patients, their caregivers, and the healthcare systems alike. The projects proposed in this application will examine interventions directed to the individual, the caregiver, or the health care provider. The projects will collect a common dataset to facilitate translation of interventions, including potential predictors of response;time to deliver interventions;training time for interventionists;acceptability of intervention to participants;and, quality of intervention delivery. Core assessments will be made available for pooling of data. Four projects are included in this program project proposal. Project 1 will examine a habit-training intervention capitalizing on automatic processes to improve medication adherence and to identify patients at risk of non-adherence. Project 2 will conduct a randomized controlled trial to examine the ability of self-efficacy to enhance adherence to lifestyle change therapy;as well as the role of self-efficacy and/or optimism in adherence to dietary and exercise changes. Project 3 will evaluate the effectiveness of a single-modality adherence intervention based on Concordance Therapy delivered by primary care nurses in a racially diverse sample of primary care patients with unipolar depression and comorbid diabetes mellitus or hypertension;this study will also evaluate whether improvement in adherence to antidepressant therapy is associated with improvement in adherence to oral medications for diabetes or hypertension. Project 4 will test a tailored medication management intervention grounded in social cognitive theory and delivered both in home and via telephone to the caregivers of community-dwelling patients with dementia;the study will examine the intervention's impact on health-related quality of life in both caregivers and patients and on adverse patient outcomes. A Translational Support Core will provide resources to all projects for subject recruitment, assessment, data management, and statistical analysis. The common data set to examine translational dimensions and the efficiency of shared core support could not be achieved outside a program project approach nor could an examination of diverse elements of self-management strategies for improving treatment management and their impact on quality of life amongst persons with chronic conditions.
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