Support Methodologies for African American Women With Lupus - Comparing Three Methods' Effects on Patient Activation and Coping.

Ashley White,Hetlena Johnson,Leonard E Egede,Trevor D Faith,Jillian Rose,Aundrea Loftley,Viswanathan Ramakrishnan,Edith M Williams,Aissatou Ba,Clara L Dismuke-Greer,Jim C Oates

doi:10.3389/fpsyg.2021.734390

Abstract

Introduction: Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. While pharmaceutical therapies are an important part of disease management, behavioral interventions have been implemented to increase patients’ disease self-management skills, provide social support, and encourage patients to take a more active role in their care.Methods: Three interventions are considered in this study; peer-to-peer methodology, patient support group, and a patient navigator program that were implemented among largely African American women with SLE at the Medical University of South Carolina (MUSC). Outcomes of interest were patient activation and lupus self-efficacy. We used a Least Squares Means model to analyze change in total patient activation and lupus self-efficacy independently in each cohort. We adjusted for demographic variables of age, education, income, employment, and insurance.Results: In both unadjusted and adjusted models for patient activation, there were no statistically significant differences among the three intervention methodologies when comparing changes from baseline to post intervention. Differences in total coping score from baseline to post intervention in the patient navigator group (−101.23, p-value 0.04) and differences in scores comparing the patient navigator with the support group were statistically significant (116.96, p-value 0.038). However, only the difference in total coping from baseline to post intervention for the patient navigator program remained statistically significant (−98.78, p-value 0.04) in the adjusted model.Conclusion: Tailored interventions are a critical pathway toward improving disease self-management among SLE patients. Interventions should consider including patient navigation because this method was shown to be superior in improving self-efficacy (coping scores).

Highlights

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues
Our results provide evidence to support the implementation of patient navigators for improving self-efficacy and to account for age and education when measuring patient activation (Parchman et al, 2010; Hibbard and Greene, 2013)
Patient navigators allow for sustainable behavior change that is crucial for high-risk populations to avoid complications, prevent deterioration and maintain function (Farley, 2020)

Summary

Introduction

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease in which the immune system attacks healthy tissues. The disease is more severe among African American women when compared to other racial groups, with end stage organ involvement, depression and symptom flares frequently observed (Pons-Estel et al, 2017; Jordan et al, 2019). The study found that African American women were less likely to achieve LLDAS ≥ 50% despite adjustment for socioeconomic, serological and treatment variables. These data are compelling and indicate the need to investigate other treatment approaches, such as socio-behavioral interventions, that may be predictors of positive disease-response (Franklyn et al, 2016; Babaoglu et al, 2019)

Objectives

Methods

Results

Discussion

Conclusion