The proposed Mentored Patient-Oriented Research Career Development Award (K23) is to provide the candidate with training and research experiences that will promote her development as an independent clinician-researcher, with particular emphasis in the field of intervention research addressing hypertension control, specifically self-management (home blood pressure monitoring and self-titration of medications) as a tool to deal with cardiovascular disparities related to displacement in refugees. This training will provide her with the opportunity to develop knowledge and skills in: 1) hypertension epidemiology and disparities focusing on migration as a social determinant of health,; 2) acquire knowledge in the theory, development, implementation, and adaptation of theoretically driven community-based interventions to improve blood pressure (BP) control through self-management; 3) acquire skills in qualitative (social network analysis) multilevel modeling of longitudinal data to assess the efficacy of interventions and hypertension self- management clinical trials. Training activities will include didactic coursework and specific workshops, directed readings, one-on-one tutorials with mentors, and instructions in the responsible conduct of research that focuses on vulnerable populations. The candidate will capitalize on her previous clinical and research experience with refugees, and leverage mentorship from a Training Committee comprised of globally renowned experts in the fields of CVD disparities, community interventions, hypertension trials, social determinants of immigrant health, and advanced biostatistics. The present K23 research project emerges from the existing research infrastructure and extensive experience of her mentors? self-management trials in CVD disparities, epidemiological research and clinical trials, to carve out a niche for me to specialize in CVD clinical trials and prevention in refugees and vulnerable immigrants.
The specific aims are to conduct a structured feasibility study through: 1) Understanding knowledge, attitudes and behaviors related to self-management of hypertension among refugees; 2) Developing, adapting and implementing a culturally-sensitive hypertension self-management intervention in refugees in San Diego; and 3) Identifying factors affecting the feasibility and acceptability of such an intervention to estimate effect sizes and outcome measures to be used in a future powered trial. This work will lay strong foundations for the first powered randomized clinical trial of refugee hypertension self-management ever conducted. While the specified initial goal of this work is to adapt an evidence-based hypertension self-management intervention model adapted from recent large clinical trials, we hypothesize that this intervention will be feasible in refugees; they can do it, accept it and give us leads on designing a future clinical trial to learn more about CVD disparities science and implementation research. The candidate?s longer-term goal is to develop expertise necessary to become a leading trialist in understanding and addressing cardiovascular health disparities.
Uncontrolled hypertension has been associated with numerous effects on health resulting in a poor quality of life or even a fatal heart attack or stroke, $131 billions of dollars in national healthcare expenditures and worse outcomes that are most severe among the poor, disadvantaged, and racial and ethnic minorities such as refugees and immigrants. Since nothing is known about how refugees with hypertension manage their condition at home, we will look into barriers to that and feasibility of interventions to self-manage their hypertension as a critical step to the adaptation, implementation, and evaluation of evidence-based interventions that empower refugees to engage in self-managing their cardiovascular disease risk. In addition, the proposed project will allow the candidate to master a complex set of research skills in the development of novel hypertension interventions, and develop topical expertise required to fully characterize hypertension management challenges and intervene to reduce cardiovascular disease risk by researching special patient populations that are understudied and suffer disproportionately from hypertension, generating knowledge that can be applied to many other patients.