Full Text PA-97-048
NIH GUIDE, Volume 26, Number 9, March 21, 1997
PA NUMBER:  PA-97-048
P.T. 34

  Health Promotion 

National Institute on Aging
National Institute of Nursing Research
The National Institute on Aging (NIA) and National Institute of
Nursing Research (NINR) invites qualified researchers to submit
applications to investigate the nature, use, and outcomes of self-
care activities.  For the purposes of this Program Announcement,
self-care is defined broadly.  "Self-care" includes positive steps
taken by individuals to either prevent disease or promote general
health status through health promotion or lifestyle modification;
medical self-care for the identification or treatment of minor
symptoms of ill-health or the self-management of chronic health
conditions; and steps taken by laypersons to compensate or adjust for
functional limitations affecting routine activities of daily living.
Research is encouraged on issues pertaining to the nature and extent
of self-care practice by older adults; on stability and change of
self-care behaviors over time; on the social, behavioral, and
technological factors which facilitate or impede the development and
maintenance of self-care; on the impact of self-care practice on
health outcomes, including the potential for independent living and
the relationship of self-care practice to the types and costs of
formal health care utilization; and on the effectiveness of
interventions to promote self-care, in response to acute conditions,
and for the management of chronic illnesses and disabilities.
The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This program
announcement, Self-Care Behaviors and Aging, is related to the
priority area of age-related objectives for adults and older adults.
Potential applicants may obtain a copy of "Healthy People 2000" (Full
Report:  Stock No. 017-001-00474-0) or "Healthy People 2000" (Summary
Report:  Stock No. 017-001-00473-1) through the
Superintendent of Documents, Government Printing Office,
Washington, DC 20402-9325 (telephone 202-783-3238).
Applications may be submitted by domestic and foreign for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.
Applications may be submitted by single institutions or by a
consortia of institutions.
Women and minority investigators are encouraged to apply.  Foreign
institutions are not eligible for First Independent Research Support
and Transition (FIRST) (R29) awards, but may submit applications for
individual research project grants (R01).
This program announcement will use the NIH investigator-initiated
research project grant (R01) and FIRST (R29) award mechanisms.
Research on self-care behaviors is one of the limited numbers of
topics identified in the NIA small grant program.  It is anticipated
that the size of an award will vary due to the nature and scope of
the proposed research, with the R01 award averaging $250,000 in total
(direct plus indirect) costs per year.
In 1983, the World Health Organization (WHO) defined self-care as
referring to "activities individuals, families, and communities
undertake with the intention of enhancing health, preventing disease,
limiting illness, and restoring health.  These activities are derived
from knowledge and skills from the pool of both professional and lay
experience.  They are undertaken by lay people on their own behalf,
either separately or in participative collaboration with
professionals." Rather than being viewed as a failure of the
individual to use medical services, self-care is seen as a continuum
of self-initiated behaviors which may enhance the health and
independent functioning of individuals as they age.
The contemporary notion of aging and health is one in which the later
years of life are significantly determined by patterns of living
established in middle and younger adulthood.  Thus, one of the goals
of research on self-care is to relate specific health behaviors to
important health outcomes, such as reduction in morbidity and
mortality, and improvements in functional status.  Other important
goals include understanding the nature and extent of self-care in the
general population, and identifying factors which activate the use of
self-care practices.  Finally, research must consider factors
influencing changes in self-care patterns and practices throughout
the adult years.
A National Invitational Conference on Research Issues Related to
Self-Care and Aging was convened in 1994 to conceptualize the scope
of these issues and to begin to formulate research objectives.
Experts attending this conference recommended that self-care
behaviors be classified as one of three broad types, as follows.
Healthy lifestyle behaviors intended to promote health and prevent
disease.  These practices include maintenance of good dietary and
sleeping habits, avoidance of smoking and inactivity, promotion of
environmental and home safety, and maintenance of good personal
hygiene habits.  The continuity of these lifestyle practices
throughout adulthood defines one's overall health regimen and most
likely has a bearing on the emergence of risk factors affecting
later-life morbidity and mortality.
Medical self-care behaviors that occur in association with symptoms
and treatment.  Included here are the phases of symptom detection and
recognition, and self-initiated practices aimed at reducing
discomfort and alleviating pain.  Additional research is needed on
the limits of self-care and when it may be harmful to substitute
self-care for more formal health care.
Behaviors engaged in to compensate for decrements in physical or
cognitive function, or to adjust to limitations imposed by chronic
illness.  These purposive behaviors are intended to improve quality
of life and are often targeted to basic activities of daily living
and other instrumental activities.  These efforts are adaptive
responses to functional changes which are intended to prevent further
disabling limitations.
It may be important to further distinguish behaviors known as "self-
care" from other behaviors.  Research on "self-care" practices has a
strong foundation in the study of volitional behavior.  That is, the
individual is presumed to have a deliberate and purposeful intention
to act or to avoid acting in the practice of a self-care behavior.
This characteristic of the behavior under investigation distinguishes
"self-care" research from survey research which attempts to establish
prevalence of behaviors regardless of intention. An individual may,
for example, engage in particular eating or sleeping behaviors
without regard for their health outcomes.  Thus, prevalence research
on a self-care practice is not necessarily the same as behavioral
epidemiologic surveys to establish population prevalence (regardless
of intention behind the behavior).
Applications appropriate to this PA are not restricted to any
specific discipline, but should be focused on well-articulated
theoretical approaches and methodologies in aging to elucidate issues
specifically related to self-care behaviors.  Research is encouraged
that specifies conceptual approaches within aging research and would
give the field a strong base of scientific methodologies and data.
Researchers are urged to design innovative strategies for this
emerging area of study that may include qualitative approaches, use
of available data sets, or targeted survey strategies.  Of particular
value would be studies comparing older age groups because self-care
may vary with the age and aging-related circumstances of the older
individual.  When supported by empirical data from prior research,
applications that include theory-based intervention projects may be
The following are offered as illustrations of appropriate topics for
research.  Applications need not, however, be limited to these
issues. Accepted referral guidelines will be followed in assigning
applications to NIA, NINR, or to other Institutes.
o  Nature and Extent of Self-Care Practices by Older Adults
Does the range of self-care practices vary by age, gender, education,
minority status or the degree to which priorities are socially or
culturally embedded?
Are there secular changes which may have a bearing on the healthy
lifestyle and self-care practices of different cohorts as they age?
What are the intra-individual patterns of self-care practice?  For
example, are individuals who respond effectively to minor symptom
detection the same people who use effective coping strategies in
response to major life threats?  Are these patterns of self-care
stable over the life course?
How are decisions regarding self-care made?  Are decisions to engage
in self-care automatic or reactive, or is there an elaborate decision
making process through which information is sorted while actions are
planned accordingly?
o  Factors which Facilitate or Impede the Development and
Maintenance of Self-Care
Along with gender, educational level, and marital status, what other
psychosocial variables affect how people view self-care and whether
they are disposed to engage in it?  For example, when are personality
and attitudes, degree of lay medical knowledge, or history of
management of illness predictive of self-care as people age?  How
does readiness and acceptance of self-care vary by cultural, racial,
and other demographic variables?  And when do contextual factors,
such as availability of social supports or presence of life stresses,
become important determinants of the activation and maintenance of
self-care behaviors?
What are the sources of information about self-care practices and how
do these vary by the nature of the symptoms/illness or
characteristics of the user?
Are there differential factors affecting the initiation of self-care
behaviors as compared to the long-term maintenance of such
o  Impact of Self-Care Practice on Health Outcomes
What is the relationship of self-care to other aspects of health
behavior and attitudes?  How does the relationship of self-care at
different points in the life course affect short- and long-term
health outcomes?
Can it be determined which elements of self-care regimens are
effective, and which might have unexpected or harmful effects for
specific disease/conditions as well as for general health and well
When is reliance on self-care harmful?  Under what conditions are
illness symptoms likely to be misinterpreted and potentially life-
threatening practices engaged in?
o Interventions to Promote Self-Care
How can interventions be designed to match individuals readiness to
adopt a new strategy (e.g., precontemplation, contemplation,
preparation) and/or the nature of their symptoms or condition?
How can intervention efforts be most effectively targeted?  How do
psychosocial, demographic, and cultural factors determine the most
effective intervention strategy to affect self-care practices?
What is the role of organizations in the effective communication of
self-care information to older people and their families?
o  Relationship of Self-Care Practice to Formal Health Care
What is the role of medical, nursing, and other professionals in the
initiation and maintenance of self-care behaviors?
Does the effectiveness of professionals depend upon whether the
purpose of self-care is to maintain health, respond to acute
symptoms, or manage chronic illness?
Are there some conditions or situations in which older people rely
more on medical knowledge versus lay knowledge in determining the
appropriate response to symptoms?
o  Methodological and Conceptual Issues
How can self-care indices such as delay in use of self-care or
appropriateness of care-seeking behavior be best conceptualized and
How are self-care practices measured?  Are these methods valid and
Can hypothesized causal relationships between self-care activities
and health outcomes be tested using multivariate and multilevel
statistical models and techniques?
How can data from large national longitudinal databases be used to
address issues relating to self-care practices, health, and aging?
It is the policy of the NIH that women and members of minority groups
and their sub-populations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This policy results from
the NIH Revitalization Act of 1993 (Section 492B of Public Law
All investigators proposing research involving human subjects should
read the "NIH Guidelines for Inclusion of Women and Minorities as
Subjects in Clinical Research," which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14512), and in the
NIH Guide for Grants and Contracts, Volume 23, Number 11, March 18,
Applications are to be submitted on the grant application form PHS
398 (rev. 5/95) and will be accepted at the standard application
deadlines as indicated in the application kit.  Applications kits are
available at most institutional offices of sponsored research and may
be obtained from the Division of Extramural Outreach and Information
Resources, National Institutes of Health, 6701 Rockledge Drive, MSC
7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email:
ASKNIH@odrockm1.od.nih.gov.  The number and title of this program
announcement must be typed in Section 2 on the face page of the
Applications for the FIRST (R29) award must include at least three
sealed letters of reference attached to the face page of the original
application.  FIRST (R29) award applications submitted without the
required number of reference letters will be considered incomplete
and will be returned without review.
The complete original and five permanent, legible copies must be sent
or delivered to:
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD 20892-7710
BETHESDA, MD 20817-7710 (for express/courier service)
Applications received under this program announcement will be
assigned to an appropriate Initial Review Group (IRG) in accordance
with established NIH Referral Guidelines.  The IRG, consisting
primarily of non-Federal scientific and technical experts, will
review the applications for scientific and technical merit in
accordance with standard NIH review procedures.  As part of the
initial merit review, a process may be used by the initial review
groups in which applications will be determined to be competitive or
non-competitive based on their scientific merit.  Applications judged
to be competitive will be discussed and be assigned a priority score.
Applications determined non-competitive will be withdrawn from
further consideration and the Principal Investigator and the official
signing for the applicant organization will be notified.
Notification of the review recommendations will be sent to the
applicant after the initial review.  Applications recommended for
further consideration and receiving sufficiently high priority will
receive a second-level review by an appropriate National Advisory
Council, whose review may be based on policy considerations as well
as scientific merit.
Applications that deal primarily with health services research,
especially in the context of primary care and managed care systems,
may be referred to the Agency for Health Care Policy and Research
(AHCPR) for possible funding or co-funding.  The requirements of
AHCPR are similar to those of NIH, except applicants must be non-
profit institutions.
Applications recommended by a National Advisory Council will be
considered for funding on the basis of overall scientific and
technical merit of the research as determined by peer review, program
needs and balance, and availability of funds.
Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.  Further information
about NIA priorities and procedures can be found on the NIA Home Page
Direct inquiries regarding programmatic issues to:
Dr. Marcia G. Ory
Behavioral and Social Research Program
National Institute on Aging
Gateway Building, Room 533
7201 Wisconsin Avenue MSC 9025
Bethesda, MD 20892-9205
Telephone: 301-402-4156
FAX:  301-402-0051
Email: Marcia_Ory@NIH.GOV
Dr. Lynn M. Amende
Director, Division of Extramural Activities
National Institute of Nursing Research
Building 45, Room 3AN12
Bethesda, MD 20892-6300
Tel: 301-594-6906
Fax: 301-480-8260
Email: LAMENDE@ep.ninr.nih.gov
Email contact preferred
Direct inquiries regarding fiscal matters to:
Ms. Crystal Ferguson
Grants Specialist
Grants Management Office
National Institute on Aging
Gateway Building, Room 2N212
Bethesda, MD 20892
Tel: 301-496-1472
FAX:  301-402-3672
Email: Crystal_Ferguson@NIH.GOV
Mr. Jeff Carow
Grants Management Officer
National Institute of Nursing Research
Building 45, Room 3AN12
Bethesda, MD 20892-6301
Tel: 301-594-6869
Fax: 301-480-8260
Email: JCAROW@ep.ninr.nih.gov
Direct inquiries regarding AHCPR programmatic issues to Ms. Linda
Siegenthaler, MA, Senior Economist, Center for Primary Care Research,
AHCPR, email: lsiegent@ahcpr.gov
This program is described in the Catalog of Federal Domestic
Assistance No. 93.866.  Awards are made under authorization of the
Public Health Service Act, Title IV, Part A (Public Law 78-410, as
amended by Public Law 99-158, 42 USC 241 and 285) and administered
under PHS grants policies and Federal Regulations 42 CFR 52 and 45
CFR Part 74.  This program is not subject to the intergovernmental
review requirements of Executive Order 12372 or Health Systems Agency
The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.  In addition, Public Law 103-227, the Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routine education,
library, day care, health care or early childhood development
services are provided to children.  This is consistent with the PHS
mission to protect and advance the physical and mental health of the
American people.

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