Virtually all cardiovascular and most pulmonary diseases are chronic in nature, and require complex andlife-long self-management. Current statistics elaborating the impact of chronic cardiovascular and pulmonaryconditions ' illustrate the importance of targeting self-management research specifically to cardiovascular andpulmonary diseases. Chronic cardiac or pulmonary diseases comprise 3 of the top 4 causes of death (i.e.,heart disease, cancers, stroke, and chronic lower respiratory diseases). Worldwide, cardiovascular disease(CVD) is the most common cause of death and morbidity, and in most developed countries is the single largesthealthcare expenditure.2'3 At least one in three Americans lives with chronic CVD; this percentage increaseswith age, and ultimately, one in two dies of CVD, usually after living years with the challenge of engaging inself-management of the chronic condition.2'3 The World Health Organization (WHO) estimates thatchronic lower respiratory diseases share 4th and 5th places with HIV/AIDS as causes of deathworldwide. There were more than 3 million deaths worldwide from chronic obstructive pulmonary disease in2005, which corresponds to 5% of all deaths globally. As with CVD, most patients with chronic lowerrespiratory diseases live years with the associated self-management challenges. As people accumulate CVDand pulmonary risk factors, develop chronic CVD and pulmonary illnesses or grow older, the process of selfmanagementbecomes exponentially more complex, demanding and time-consuming. In fact, it is preciselywhen people could benefit most from self-management, that self-management efforts fail, are abandoned, orare not even attempted.4'15 thus, research aimed at improving self-management skills and efforts should havea measurable impact on the public and personal burden from cardiac and pulmonary conditions.16'In order to address this significant problem, we propose to establish an exploratory research center, theCenter for Biobehavioral Research on Self-Management of Cardiopulmonary Disease, at the University ofKentucky, College of Nursing (UKCON). The short-term goal of the Center is to provide both new andexperienced investigators with the support and resources necessary to conduct pilot/feasibility work usingbiobehavioral measures to investigate self-management related to cardiopulmonary conditions. The long-termgoal of the Center is to facilitate faculty use of data from these studies to develop sustained interdisciplinaryprograms of self-management research and to support more established investigators in the continuation,expansion or redirection of current research programs. The Center will be composed of an Administrative Corethat oversees the Center and the two additional Cores: 1) Self-Management Pilot/Feasibility and BiobehavioralOutcomes Core; and 2) Research Program Development, Data Analysis and Dissemination Core.
The specificaims for the Center are listed below. Strategies for achieving these aims and associated evaluation criteria areoutlined in the Evaluation section.1. Develop the research infrastructure at the UKCON to promote and support research on processes,interventions, and outcomes of self-management of cardiovascular and pulmonary diseases byestablishing an exploratory research Center for Biobehavioral Research on Self-Management ofCardiopulmonary Disease.2. Expand the quality and quantity of self-management research projects using biobehavioralmethods by centralizing methodological resources.3. Expand the number of nurse investigators doing interdisciplinary self-management research bysupporting interdisciplinary exchange and linkages.4. Contribute to the scientific foundation for self-management by promotion and dissemination ofsystematic investigations of self-management processes, interventions, and outcomes.5. Plan for and develop sustainability of interdisciplinary self-management research programs bybuilding active and growing partnerships inside and outside of the University of Kentucky.Given existing research strengths in the UKCON, our initial pilot/feasibility studies will focus on improvingself-management in patients with heart failure. However, the focus will expand to improvement of selfmanagementof other cardiopulmonary conditions. We will publish calls, once the Center is funded, forpilot/feasibility studies in all areas of CVD and pulmonary disease self-management.The initial focus on heart failure self-management interventions will be innovative in that each studyproposes a different self-management skill target and focuses on a different process or processes. The projectproposed by Dr. Chung will target a full range of heart failure self-management skills, and will focus on the roleof family members as partners in the self-management process who can either help or hinder the process.Dr. Peden's proposal focuses on depression, a major co-morbidity in heart failure that markedly impairs heartfailure self-management,20'21 using a cognitive restructuring intervention to manage depression and enhancepatient's self-management skills. Dr. Welsh's project will include a test of a theory-based intervention aimed atimproving one particularly intractable behavior among patients with heart failure, following a low-sodium diet.Because fluid overload related to sodium diet nonadherence is thought to be one of the major proximatecauses of rehospitalization in patients with heart failure, improvement of self-management in this one areacould have a substantial impact on rehospitalization outcomes.22'23Research Base for Self-Management. There are 5 separate, ongoing R01's at the UKCON directly related toself-management. Dr. Debra Moseris PI on one NIH NINRR01, and site PI on two other NIH NINRROIs. Dr.Terry Lennie is PI on one NIH NINR R01; and Dr. Ellen Hahn is PI on a NIH NHLBI R01 (see biosketches fordetails of these 5 grants). The R01 s encompass the range of self-management from the individual (Drs. Moserand Lennie's 4 grants that address self-management in patients with heart failure or CVD) to the community(Dr. Hahn's R01 that addresses the impact of state-wide smoke-free policy development on smokingcessation) levels as defined by the WHO (see Evaluation section for definition).
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