2020 – 2018
Heather Cuevas, PhD, RN, ACNS-BC (PI)
Dr. Cuevas recently received $250,000 from NIH/NINR for her new project, Cognitive Training for Diabetes Self-Management. Dr. Cuevas’ research interests include diabetes self-management in underserved populations with a focus on cognitive function. This new funding builds on her most recent her most recent pilot study, Adaptation of a Cognitive Training Intervention for Diabetes Self-Management (Sept. 2016 – Jan. 2018), she tested the feasibility of a cognitive training intervention for people with diabetes. Development included (1) adaptation of prior established, tested interventions; (2) interviews with stakeholders; and (3) integration of course content based on the established interventions and interviews. This intervention addresses diabetes self-management, complications of diabetes, and cognitive functioning. It is an 8-week cognitive rehabilitation training program that combines group sessions for increasing knowledge and building self-efficacy for new cognitive compensatory strategies with individual home-based online practice of those skills. This study forms the basis for a subsequent project to expand the findings by examining the effects of cognitive training on self-management adherence and neural activity.
Valerie Danesh, PhD, RN,FCCM
Peer Support for Post Intensive Care Syndrome (PS-PICS)
Dr. Danesh is an Assistant Professor of Adult Health Nursing and Director of the Critical Care Research Lab. Her research program focuses on nursing surveillance across the continuum of care (e.g., acute, subacute, home health) with a current focus on the sequelae, or “after effects” of hospitalization in adults with prolonged Intensive Care Unit (ICU) stays. Known as Post-Intensive Care Syndrome (PICS), new onset or worsening symptom clusters including depression, anxiety, post-traumatic stress disorder (PTSD), cognitive impairment, and/or physical frailty often influence the recovery and rehabilitation of ICU survivors. In contrast to traditional in-person approaches for peer support and self-management coaching for rehabilitation, Dr. Danesh is exploring the impact of a tailored, telephone-based intervention to overcome the transportation- and/or fatigue-related barriers associated with PICS.
Funded by the TCRSS Pilot Core, the Peer Support for Post Intensive Care Syndrome Survivors (PS-PICS) feasibility trial is a peer-led self-management intervention. PS-PICS connects new survivors with those who have made successful recoveries. Our approach broadens existing chronic care intervention models for application to ICU survivors wherein peer support mentors are trained in motivational interviewing to engage mentees in goal setting and emotional management. The aims of PS-PICS are to:
- Examine the impact of ≥8 days in the ICU on health-related quality of life, functional status, and healthcare utilization after discharge,
- Determine the feasibility of a 90-day phone-based peer support intervention, with motivational interviewing, in the early post-discharge period for ICU survivors, and
- Explore trends in peer support intervention outcomes of social isolation, depression, functional status, and self-management behaviors.
The Peer Support for Post Intensive Care Syndrome Self-Management (PS-PICS) Pilot was modified twice during the funding period. First, the study protocol was revised to prioritize the focus on Peer Mentor recruitment and training due to feasibility challenges associated with conflicting IRB review requirements. The protocol was revised again to incorporate the impact of COVID-19 on ICU survivorship, peer support interventions, and the influence of social isolation and other sequelae during the ICU recovery period.
Seven (7) participants were recruited and consented. Two (2) participants have completed all study interventions, including follow-up visits. Five (5) participants have follow-up visits pending.
This study is consistent with NIH initiatives to focus on self-management to address symptoms, treatments, lifestyle changes, and psychosocial consequences associated with one or more chronic conditions. This feasibility study is guiding the development of a clinical trial to evaluate peer support interventions for ICU survivors in the early post-discharge period. Visit clinicaltrials.gov website for protocol information and current enrollment status updates for the PS-PICS trial.
Ashley Henneghan, PhD, MSN, BSN, RN (PI)
Effects of Meditation on Biomarkers of Cellular Aging in Cancer Survivors
Dr. Henneghan is an Assistant Professor in the UT Austin School of Nursing. Her research integrates multiple levels of scientific investigation including biobehavioral methods, cognitive science, and patient reported outcomes. Her lab now focuses on both understanding the underlying mechanisms of cancer-related cognitive impairment and evaluating targeted interventions to improve cognition following cancer treatment. Her lab embraces multi-disciplinary research teams and are eager to collaborate.
Dr. Henneghan’s clinical experience has focused on alleviating unwanted symptoms and optimizing wellness for persons with chronic diseases including cancer. Her research focuses on both understanding the underlying mechanisms of cancer-related cognitive impairment and evaluating targeted interventions to improve cognition following cancer treatment. This pilot study enrolled 31 breast cancer survivors (ages 21-75), and compared the cognitive effects of a daily 12-minute meditation program to a classical music program over the course of 16 weeks. Preliminary analyses indicated that both intervention programs are feasible, acceptable, and cost-effective interventions that may be beneficial for survivors’ cognition and psychological symptoms after 8 weeks. Both interventions were easy to learn, low cost, and required just 12 min/day. Analysis of long-term outcomes (16 weeks) and biological outcomes are still underway.
Nico Osier, PhD, BSN, BS, RN (PI)
An Exploratory Study of Allostatic Load and its Impact on Response to an 8-Week Self-Management Program for Multiple Sclerosis
Dr. Osier is an Assistant Professor and holds joint appointments in the School of Nursing and Dell Medical School. To-date, Dr. Osier’s program of research has centered on using both pre-clinical and clinical research to promote understanding the molecular and genomic underpinnings of health, disease, and injury recovery. Their current research focuses on understanding the pathology associated with traumatic brain injury. Their ultimate goal is to harness this information to predict individuals at highest risk for poor outcomes and ultimately to inform precision care initiatives.
The goal of this exploratory study is to evaluate the complex role of stress in MS, and to create a composite measure of allostatic load. This study aims to examine the association between biomarkers (IL-15, IL-23, melatonin) & PSS score while controlling for confounders (e.g. age, inflammatory comorbidities), Determine the degree to which biomarkers (IL-15, IL-23, melatonin) are predictive of responsiveness to a self-management + acupuncture intervention, and Combine novel biomarker analysis with other biomarkers and self-reported data to create a composite measure of allostatic load for further evaluation. The Analysis Processes includes quantifying biomarker levels and examine potential associations with self-reported symptoms, and determine which biomarkers predict response to self-management and acupuncture interventions.
2019 – 2017
Cara Calloway Young, PhD, RN, FNP-C (PI)
Integrated Self-Management Intervention for Adolescents with Polycystic Ovary Syndrome (Sept. 2017-Jan. 2019)
Dr. Young is an expert on adolescent health with a particular focus on mental health promotion and prevention of mental illness in primary care. Her primary research has examined factors associated with the development of depressive and anxiety symptoms as well as contextual issues that impact effective treatment of mental health disorders. In this current pilot study, she is working to refine her previous successful intervention using mindfulness training (MT) and develop an integrated self-management intervention specifically designed for adolescents with Polycystic Ovary Syndrome (PCOS).
This feasibility study will include 10 adolescents (ages 14- 18) diagnosed with PCOS and conduct individual exit-interviews to further refine the HL-MT intervention. She will also recruit 10 adolescents (ages 14-18) into an enhanced usual care control condition (EUC). She expects to determine:
a. Feasibility of research methods including recruitment strategy response rate, retention of participants across the intervention, ability to deliver the intervention in a clinical setting, acceptability of intervention components, and ability to measure self-report and biological study variables.
b. Preliminary effects of the HL-MT vs. EUC on nutrition self-efficacy, physical activity, medication adherence, psychological well-being (i.e., depressive/anxiety symptoms, perceived stress, self-esteem) and HRQL.
2018 – 2016
Tracie Harrison, PhD, RN, FNP, FAAN (PI)
Self-Management of Aging-Related Bio-Behavioral Decline in People with Osteoarthritis (OA) (Sept. 2016 – Jan. 2018)
Dr. Harrison’s research interests include the intersection between age related change and impairment and its effect on social role performance and health outcomes. Her current pilot study is a mixed-methods sequential study examining the effect of self-management strategies on bio-psychosocial disablement outcomes in Mexican Americans with OA-related disabilities. This study builds on our previous 4-year ethnographic study (R01 NR010360;? PI: T. Harrison) of disability-related health disparities in Mexican Americans (MAs) with mobility impairment and expands our science to include self-management as a mechanism for intervention. This study is based on a theoretical model of disablement outcomes that was developed in our research on aging and disability. We will adapt a self-management outcome measure using qualitative data that will be refined in the quantitative portion of the study, which will include biological indicators of stress as a mechanism for co-morbidity development. The resulting explanations of outcomes will inform an intervention based on the best ways to help MAs pace themselves using assistive devices appropriate for their mobility needs. This study will lead to both an R01 and an R21 submission. First, the longitudinal testing of relationship trajectories is essential to providing a test of the wear and tear argument that explains how disablement can lead to further disease processes for people with disabilities, and how self-care management may alleviate that pathway. Second, the intervention to test self-management in a manner that will be acceptable to the MA population of men and women with disabilities, using both ethnic and gender tools, will be developed based on our findings.
2017 – 2015
Marge Benham-Hutchins, PhD, RN (PI)
Bridging the Gap: Chronic Disease Self-Management Transitions (Sept. 2015 – Jan. 2017)
Dr. Benham-Hutchins’ research is guided by the principles of Complexity Science and Social Network Analysis. Her current pilot builds on previous work while shifting from a provider centric to a patient centric focus through incorporation of patient perspectives. This includes patient participation in the research process and a focus on patient identified information requirements to support self-management of chronic conditions across care settings. This study will help identify key information content for effective, transdisciplinary patient-centered handoffs during hospitalization as well as priorities to support transitional self-management.
Conclusions from this study revealed that hospitalized patients want to be included during provider discussions, such as nursing bedside handoff and medical rounds. While this very highly educated and highly activated sample expressed a desire to “know it all” further research is needed to investigate if there are differences in hospitalized patients desire for information based individual factors, such as education or activation level. Future research is needed to explore how providers can accurately determine the readiness and desire for information on the individual patient level.
Participants identified provider behaviors that interfered with communication processes and led to concern about the completeness and accuracy of the shared information. Research is needed to learn more about provider perceptions, barriers, and facilitators to including patients in care discussions. Targeted interventions to improve how providers communicate with and care for patients – for example, around health literacy (Kripalani et al., 2006; Mackert, Ball, & Lopez, 2011; Truglio-Londrigan, Slyer, Singleton, & Worral, 2012) – have been developed to address areas for improvement in the delivery of care. Such interventions could be used as a model for future educational efforts aimed at training providers to better consider, understand, and act on an understanding of patients’ health information needs.
Visit the Bridging the Gap: Chronic Disease Self-Management Transitions web page.
Julie Zuniga, PhD, RN (PI)
Self-Management of Diabetes for Persons with HIV (Sept. 2015 – Jan. 2017)
Dr. Zuniga’s research interests include self-management of stigmatized illnesses in conjunction with co-morbid conditions, with a focus on HIV and diabetes. In her current pilot, she will test the efficacy of an intervention to improve self-management in persons living with a dual diagnosis of HIV/AIDS and Type 2 Diabetes (T2DM). After receiving feedback and input from a focus group of patients with HIV-T2DM, Dr. Zuniga, guided by her transdisciplinary team, will adapt an evidence-based intervention consisting of 6 weeks of structured psychobehavioral group education utilizing gamification strategies. Six weekly telephone-counseling sessions will follow the 6-week group education.
- At baseline data highlighted the need for an intervention to improve diabetes and HIV self-management skills for PLWH+T2DM:
- Participants had low knowledge scores of HIV and DM
- Participants reported very few daily DM self-management behaviors.
- Only about half of the participants had controlled diabetes, and 60% had controlled HIV.
- At follow up, the pilot was feasible, acceptable, and partially effective.
- Attendance was low to the in-person intervention (36% completed all 6 hours of the educational sessions).
- Participation in the phone support was better than in-person class attendance (60% received at least 3 phone calls).
- Mean of diabetes self-management activities scores increased by 34%.
- Participants significantly improved their rate of checking their shoes
- No significant changes in knowledge of HIV or diabetes
- Small sample size = low power = no significant changes in knowledge or diabetes self-management behaviors from baseline.
2016 – 2014
Kavita Radhakrishnan, PhD, RN (PI)
Interactive Digital E-Health Game for Heart Failure Self-management (Sept. 2014 – Jan. 2016)
Dr. Radhakrishnan is a nurse scientist with a background in electrical engineering and public health nursing. She is collaborating with the Department of Computer Science to develop an interactive digital e-health game (IDEG) prototype to improve self-management knowledge and behaviors among individuals living with heart failure (HF). The IDEG uses a mobile and portable platform that adapts to the knowledge level of individuals with HF and is tailored to their self-management goals. Based on community nurse feedback, they decided to use a casino game genre with slot machines. Usability testing of the digital game was conducted with 8 participants, and revisions were made, based on their suggestions. Beta testing is currently underway among 25 older adult participants with heart failure from 4 Austin-based community clinics. Data collection will be completed in December 2015.
During usability testing, with 7 participants, 100% found the game easy to play, 100% found it enjoyable, and 86% found it helpful for learning about HF. In the subsequent functionality testing, with 19 participants, 89% found the game interesting, enjoyable, and easy to play. Playing the game resulted in a significant improvement in HF knowledge (p = 0.007), a non-significant improvement in HF self-maintenance (p = 0.11), and no difference in HF self-confidence scores. Participants with lower education level and age preferred games to any other medium for receiving information (p = 0.02).
Related Article: Casino Style Game Helps Patients with Heart Failure
Gayle Timmerman, PhD, RN, FAAN (PI)
Self-Management of Dietary Intake for Chronic Kidney Disease. (Sept. 2014 – Jan. 2016)
Janet Morrison, PhD, MSN, RN (PI)
A Cognitive Self-Management Intervention for Persons with Multiple Sclerosis: Adapting Web-based Technology
In this current pilot study Dr. Morrison is developing and pilot testing an innovative cognitive self-management intervention for People with Multiple Sclerosis (MS) delivered via web-based video conferencing. This will be done in two phases: Phase 1: (a) Conduct interviews with people with MS to gather data to guide the adaptation of a tailored, cognitive self-management intervention delivered via web-based video conferencing, (b) Develop an adapted version of the 8-week Memory, Attention, and Problem-Solving Skills in MS (MAPSS-MS) intervention guided by the analysis of the interview data.
Phase 2: Conduct a feasibility study of the adapted MAPSS-MS cognitive self-management intervention using objective and self-report data from community-residing people with MS. Process outcomes include success with recruitment, ability to deliver the intervention using web-based video conferencing, and ability to measure study outcomes.
The pilot study is significant because it: 1) addresses a relatively unstudied amalgam of symptoms related to cognitive impairment in people with MS, which has a negative impact on quality of life; and 2) lays the foundation for a future study aimed at providing an evidence-based intervention designed for people with MS who experience cognitive changes.