Improving the Collaborative Health of Adults with Chronic Conditions & Carepartner Dyads Through Interventions Addressing Social and Health Self-Management Needs - People living in rural regions are more likely to be at increased risk of morbidity and premature mortality because of underlying chronic diseases such as diabetes, hypertension, and cardiovascular disease. Additionally, various stressors (e.g., limited health care access, lack of social support, social isolation and economic instability) experienced within rural communities may further complicate the management of chronic diseases, thus undermining the mental and physical health not only of the patient but carepartners who provide critical support. This study tests the efficacy of a telehealth-enhanced, RN-Community Health Worker (CHW) delivered dyad intervention, ICINGS FAM (Integrating Community-based Intervention Under Nurse Guidance with Families), on quality of life (QoL), and health-related outcomes in rural dwelling adults with preexisting chronic illness and their informal carepartners (IC). Adapted from our previous WISSDOM CINGs model tested in adult stroke patients, key features of this intervention include a) strategies to address various forms of stress perceived by patients and ICs; and b) incorporation of the patient/IC dyad as a unit of analysis to better understand how interpersonal and interdependent relationships impact health and health related outcomes for both partners. We hypothesize that patient/IC dyads receiving the intervention (i.e., coaching related to health promotion, chronic disease management information, and assistance navigating the health care system) will demonstrate improved QoL and health-related secondary outcomes compared to the attention control arm receiving monthly general health promotion. The objective of iCINGS FAM is to strengthen the efficacy and agency of the dyad to manage illness behaviors as an integrated unit, termed dyad illness management. In Aim 1, we will conduct interviews and focus groups with key community stakeholders to refine iCINGS FAM components to the individual, interpersonal, community, social environment, and other health-related social needs for dyad illness management. In Aim 2, we will employ an RCT design to test intervention efficacy on QoL of adult patients and ICs (250 dyads) with pre-existing chronic health conditions. Intervention effects on symptoms, dyadic confidence, and social support will also be investigated (Aim 2.1). In Aim 3, we will identify individual - and family - level determinants of health (e.g. economic stability, education, food security social support and social isolation)and family illness management behaviors associated with reduced/improved QoL and health outcomes on a subset of dyads (n=50). Finally, to further contextualize study findings, in Exploratory Aim 4 we will examine associations between outcomes and community-level risk and protective factors influence on dyad health and QOL. This intervention has the potential to reduce poor health outcomes and increase understanding of determinants of health that affect QoL and dyadic illness management behaviors in rural patients living with chronic diseases.
