Enhancing Self-Management After Traumatic Brain Injury: An Implementation-Focused Approach

This proposal outlines a five-year research career development program aimed at improving the utilization of self-management training to enhance the health and quality of life for individuals with Traumatic Brain Injury (TBI). TBI is a chronic condition due to its long-lasting effects, impacts on multiple body systems, and association with the development of other health conditions. Effective self-management is crucial to long-term health and wellness in individuals with chronic conditions such as TBI. However, care for individuals with TBI often focuses on the acute and subacute phases, and training in self-management is not part of standard practice. Self- management involves managing the medical, psychosocial, and behavioral changes required to live with a chronic condition. Self-management training consists of learning specific skills that support effective self- management. This proposal involves a pilot implementation-effectiveness hybrid study. By using a hybrid implementation-effectiveness approach, the proposal will address the need for evidence on self-management training effectiveness in TBI populations learning about the barriers that can slow the transition of evidence- based practices to routine care. Aim 1 will leverage electronic health record data from a large integrated health system to examine characteristics associated with inefficient healthcare use to identify individuals who may benefit from self-management training. Aim 2 will used a mixed methods approach to identify self-management needs and training priorities among individuals with TBI. Aim 3 will collect pilot data to assess the effectiveness of an established community-based self-management training program for individuals with TBI, while gathering information on barriers and facilitators to engaging in the training. The work conducted will specifically inform the selection of targeted implementation strategies, identify the need for diagnosis-specific adaptations, and serve as a foundation for future testing in a hybrid type II implementation-effectiveness study. The candidate is a physical therapist and health services research with extensive clinical experience working with individuals with TBI and expertise using observational and administrative data. The outlined proposal builds on the candidate's experience by providing additional training in mixed-methods research, implementation science, embedded clinical research, and chronic care management through didactic training, professional development activities, and mentorship from an experienced interdisciplinary mentorship team. She will benefit from the robust interdisciplinary research environment at Boston University and Sargent College, with access to support from the BU Clinical & Translational Science Institute and the BU Center for Implementation & Improvement Science. The experience and training gained through this career development award will support her transition to independence and place her in a strong position to lead a research agenda focused on implementing evidence- based practices in healthcare and community settings to improve care and quality of life for individuals with TBI. Project Number: 1K23HD115860-01A1 | Fiscal Year: 2026 | NIH Institute/Center: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) | Principal Investigator: Emily Evans | Institution: BOSTON UNIVERSITY (CHARLES RIVER CAMPUS), BOSTON, MA | Award Amount: $166,752 | Activity Code: K23 | Study Section: Special Emphasis Panel[ZRG1 CCHI-N (52)] View on NIH RePORTER: https://reporter.nih.gov/project-details/1K23HD11586001A1