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Rosenberger, Emily M and DeVito Dabbs, Annette J and DiMartini, Andrea F and Landsittel, Douglas P and Switzer, Galen E and Dew, Mary Amanda (2015) PSYCHOSOCIAL FACTORS AND MOBILE HEALTH INTERVENTION: IMPACT ON LONG-TERM OUTCOMES AFTER LUNG TRANSPLANTATION. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Identifying and intervening on modifiable risk factors may improve outcomes in lung transplantation (LTx), which, despite recent improvements, remain suboptimal. Evidence suggests that two modifiable risk factors, psychiatric disorders and nonadherence, may improve LTx outcomes in the short-term; however, neither has been explored in the long-term. Therefore, the overarching goal of this dissertation was to determine the long-term
impact of these modifiable risk factors and intervention to attenuate them. First, we examined the relationship of pre- and early post-transplant psychiatric disorders on LTx-related morbidity and mortality for up to 15 years post-LTx. Our sample included 155 1-year LTx survivors enrolled in a prospective study of mental health post-
LTx. We found that depression during the first year post-LTx increased risk of BOS, mortality and graft loss by nearly twofold, and that pre-transplant depression and pre- and post-transplant anxiety were not associated with clinical outcomes. Next, we examined the impact of a mobile health intervention designed to promote adherence to the post-LTx regimen, PocketPATH, on long-term LTx-related morbidity, mortality and nonadherence. We conducted two follow-up studies to the original yearlong
randomized controlled trial in which participants assigned to PocketPATH showed improved adherence to the regimen, relative to usual care. Among the 182 LTx recipients (LTxRs) who survived the original trial, we found that PocketPATH had a protective indirect effect on mortality by promoting LTxRs’ communication with the LTx team during the first year. Among the 104 LTxRs who completed the follow-up assessment, we found that PocketPATH’s adherence benefits over the first year were not sustained into the long-term, although LTxRs assigned to PocketPATH were more likely than LTxRs assigned to usual care to perform the home self-care tasks of the regimen at follow-up. Median time since LTx for participants in both follow-up studies was 4.2 years (range, 2.8-5.7 years). This dissertation presents an important first step toward identifying and intervening
on modifiable risk factors to improve long-term LTx outcomes. Mobile health technologies offer limitless potential to target these risk factors and others. More work is needed to determine specific features and long-term patient engagement strategies that will optimize and sustain intervention effectiveness.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Rosenberger, Emily Memr47@pitt.eduEMR470000-0001-6387-4950
DeVito Dabbs, Annette Jajdst42@pitt.eduAJDST420000-0003-3325-435X
DiMartini, Andrea Fdimartiniaf@upmc.eduAFDST80000-0003-4883-121X
Landsittel, Douglas Pdpl12@pitt.eduDPL12
Switzer, Galen Eswitzerge@upmc.eduGSWITZER0000-0001-8541-9449
Dew, Mary Amandadewma@upmc.eduDEW10000-0002-4666-1870
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairDew, Mary Amandadewma@upmc.eduDEW1
Committee MemberDeVito Dabbs, Annette Jajdst42@pitt.eduAJDST42
Committee MemberDiMartini, Andrea Fdimartiniaf@upmc.eduAFDST8
Committee MemberLandsittel, Douglas Pdpl12@pitt.eduDPL12
Committee MemberSwitzer, Galen Eswitzerge@upmc.eduGSWITZER
Date: 1 April 2015
Date Type: Publication
Defense Date: 19 March 2015
Approval Date: 1 April 2015
Submission Date: 1 April 2015
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 87
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Clinical and Translational Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: lung transplantation, adherence, psychosocial, depression, anxiety, mobile health
Date Deposited: 01 Apr 2015 13:33
Last Modified: 19 Dec 2016 14:42


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