Poor health outcomes of chronically ill low-income adults are costly in both fiscal and human terms. Although advances have been made in understanding how nurse case management (NCM) can contribute to improve self-management (SM) behaviors, the factors that contribute to sustained SM behaviors in low-income AA populations are not well understood. This study will examine the impact of Ecological Nurse Case Management (ENCM) on self-management behaviors, health status, and self-efficacy of poor, chronically ill, African American adults. In addition, we will explore moderating effects to determine if the ENCM intervention is differentially effective based on gender or perceived stress. The study will use ACHIS, a relational EHR, to document the individualized ECNM intervention and dose of the intervention. The specific study aims are to: 1) examine differences between an ENCM treated group and a comparison group on self-efficacy, SM behaviors, and health status to establish effect sizes needed for a future large randomized controlled trial; 2) explore the dose-response of specific elements of the ENCM intervention; and, 3) Examine moderating effects of gender and perceived stress on the intervention effect. This is a two-group nonequivalent pretest-posttest quasi-experimental study with repeated measurements. Clients in the treatment group (n = 25) will receive the individualized ENCM and those in the comparison group (n = 25) will receive usual clinic care. Data will be collected at baseline, 1, 3 and 6 months to capture the immediate, short and longer term effects of the intervention. Acknowledging the small sample size, mixed models for repeated measures data (at baseline and M1, 3, and 6 post-intervention) will be fit to each outcome to test for a time by treatment group interaction. We will then check for interactions involving moderating variables of gender and stress. The ENCM intervention draws on evidence that given the proper tools (i.e. knowledge, skills and support), individuals can learn to better self-manage their symptoms on a day to day basis and better utilize the health care resources available to them.
Low-income African American adults face life situations complicated by limited resources, high environmental and social risks, a high burden of stress and limited access to healthcare. Potential changes in practice through this translational program of research could have significant impact on public health through evolving systems of chronic illness care that are efficacious and affordable.
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