This Mentored Patient-Oriented Research Career Development Award will enhance my ability to achieve my long-term career goal of becoming an independent cardiovascular nurse researcher in the area of heart failure (HF). It will allow me to develop and test interventions to improve medication adherence and health outcomes in patients with HF, especially patients with low health literacy. Heart failure is a serious public problem. Up to 50% of patients are readmitted within six months of discharge for HF exacerbations. The natural history of HF can be modified by appropriate therapy but medication adherence is essential to realize this benefit. About 50% of HF patients now have sub-optimal medication adherence with serious consequences including frequent hospitalizations, enormous expense to individuals and society, and poor quality of life. Several interventions have led to improved medication adherence in patients with HF, but, their effects decreased after completion of the intervention. Thus, there is a need for a new approach. My mentoring team (Drs. Michael Pignone, Sandra Dunbar, Darren DeWalt, Carol Golin, and George Knafl) and I have formulated a comprehensive training program of workshops, short courses, and seminars, and a research project that will prepare me for a research career focusing on improving medication adherence in HF. In the proposed project of the K23 award, I will pilot test an integrated family-focused and literacy-sensitive intervention that has the potential to effectively improve medication adherence in patients with HF and enable patients to sustain the improvement. A total of 36 HF patients with sub-optimal medication adherence and their family members will be randomized to intervention or usual care groups. If the study demonstrates the feasibility and efficacy of a clinically practical, nurse-delivered, family-focused and literacy-sensitive intervention to improve medication adherence in patients with HF, the next step will be to develop a larger, more definitive test of the intervention. Interventions to improve medication adherence may decrease the risk of hospitalization and death among patients with HF who have sub-optimal medication adherence.

Public Health Relevance

People with heart failure (HF) who do not consistently take their prescribed medications are at higher risk of hospital admissions and death. The intervention proposed in this project will: 1) encourage patients and family members to work together to improve medication adherence, and 2) educate patients and family members until they understand HF medicines and regimen. The knowledge gained from the project will help meet the need for more effective interventions to improve medication adherence, lower risks of hospitalization and decrease health care costs in HF.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Mentored Patient-Oriented Research Career Development Award (K23)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Huss, Karen
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University of North Carolina Chapel Hill
Schools of Nursing
Chapel Hill
United States
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Wu, Jia-Rong; Moser, Debra K (2018) Medication Adherence Mediates the Relationship Between Heart Failure Symptoms and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 33:40-46
Al-Noumani, Huda; Wu, Jia-Rong; Barksdale, Debra et al. (2018) Health Beliefs and Medication Adherence in Omanis With Hypertension. J Cardiovasc Nurs 33:518-526
Wu, Jia-Rong; Lennie, Terry A; Dunbar, Sandra B et al. (2017) Does the Theory of Planned Behavior Predict Dietary Sodium Intake in Patients With Heart Failure? West J Nurs Res 39:568-581
Wu, Jia-Rong; Lennie, Terry A; Moser, Debra K (2017) A prospective, observational study to explore health disparities in patients with heart failure-ethnicity and financial status. Eur J Cardiovasc Nurs 16:70-78
Lekavich, Carolyn L; Barksdale, Debra J; Wu, Jia-Rong et al. (2017) Measures of Ventricular-Arterial Coupling and Incident Heart Failure With Preserved Ejection Fraction: A Matched Case-Control Analysis. J Card Fail 23:659-665
Wu, Jia-Rong; Lee, Kyoung Suk; Dekker, Rebecca D et al. (2016) Prehospital Delay, Precipitants of Admission, and Length of Stay in Patients With Exacerbation of Heart Failure. Am J Crit Care 26:62-69
Wu, Jia-Rong; Moser, Debra K; DeWalt, Darren A et al. (2016) Health Literacy Mediates the Relationship Between Age and Health Outcomes in Patients With Heart Failure. Circ Heart Fail 9:e002250
Wu, Jia-Rong; Lennie, Terry A; Frazier, Susan K et al. (2016) Health-Related Quality of Life, Functional Status, and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 31:236-44
Wu, Jia-Rong; Song, Eun Kyeung; Moser, Debra K (2015) Type D personality, self-efficacy, and medication adherence in patients with heart failure-A mediation analysis. Heart Lung 44:276-81
Jones, Christine D; Holmes, George M; DeWalt, Darren A et al. (2014) Self-reported recall and daily diary-recorded measures of weight monitoring adherence: associations with heart failure-related hospitalization. BMC Cardiovasc Disord 14:12

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