The overall goal of this K23 proposal is to provide Trisha Parekh, D.O., with the career development and research experience necessary to allow her to become an independent researcher in chronic obstructive pulmonary disease (COPD) health disparities, with expertise in social care integration and psychological stress reduction in low-income communities using community health worker interventions. Disadvantages of social determinants of health, such as low socioeconomic status, are associated with adverse outcomes in COPD, including more frequent hospitalizations, early readmissions, and increased mortality. A majority of interventions to reduce readmission focus on addressing medical determinants of health, with a notable absence of addressing social needs that impede better health outcomes. The psychological stress associated with poverty and other disadvantages of social determinants of health can lead to negative downstream behavioral, psychological, and physiological effects. For COPD patients, these stress responses may include increased tobacco use, increased risk of anxiety or depression, or increased systemic inflammation, all of which are risk factors for acute exacerbations of COPD. Substantial knowledge gaps on the social determinants of health, their associated levels of perceived stress in COPD, and clinical outcomes associated with high levels stress in marginalized groups must be addressed in order to reduce health disparities and improve quality of life for these individuals. In this K23 proposal, under the guidance of an expert mentorship team, Dr. Parekh will conduct a mixed methods research study to inform the development of a targeted community health worker-led stress reduction intervention in low-income COPD patients that will focus on 1) addressing unmet social needs, 2) providing COPD disease education, and 3) promoting proactive coping behaviors.
The specific aims for this research project are as follows:
Aim 1 : Identify modifiable social determinant of health predictors and clinical outcomes of perceived stress in COPD patients;
Aim 2 : Understand perceived stressful experiences in high-risk COPD patients;
Aim 3 : Develop and test the feasibility of a community health worker intervention to reduce stress in low-income COPD patients. At the completion of Aim 3, this intervention will be ready to be tested in a R-series grant funded randomized controlled pilot with the primary outcome of stress reduction and secondary outcomes of reduction in acute care use and tobacco use and improvement in quality of life. At the conclusion of this K23, Dr. Parekh will have the training and experience needed to transition to a successful independent investigator who has an expertise in COPD health disparities.
The public health burden of COPD-related healthcare utilization is high, and low-income individuals contribute significantly with increased frequency of hospitalizations and early readmissions. Incorporating social care into healthcare delivery by addressing disadvantages of social determinants of health and associated stressors that are commonly experienced by low-income populations has become a priority for national agencies, including the Institute of Medicine and the National Academies of Science, Engineering, and Medicine. The project described in this career develop K23 application will use a mixed methods research design to develop and test a theory-driven community health worker-led stress reduction intervention that will focus on reducing psychological stress by addressing social determinants of health, providing COPD disease education, and promoting proactive coping behaviors.
