Fall 2016 Newsletter

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Center Activities

TCRSS is tremendously grateful for the talented speakers, local leaders and community participants who have made each of these events a resounding success, and we look forward to our continued partnership in the coming year.

Community Health Dialogue
HEALTH in EQUITY – How Community Development can Raise Health Equity in Low Income Areas and Promote Better Healthcare for ALL

Miyong T. KimThis dialogue continued the conversation on the reginal health disparities in Travis County that was started nine months earlier. This time TCRSS Director Dr. Miyong Kim moderated a mixed panel of UT faculty and community organization leaders who each shared their expertise in the areas of research data, current resources, successful programs, and the social determinants of maternal, infant health. This brought some new perspectives to the table as well as a bit more specificity on what kind of long term effects these disparities have on a community. The Audience was engaged and showed a lot of interest in this issue and were eager to discuss ideas for action.

LaVerne Gallman Distinguished Lectureship in Nursing
How Patient-Clinician Partnership Changes What’s Possible

Dave deBronkartAfter beating stage IV kidney cancer in 2007 Richard Davies deBronkart known widely as “e-patient Dave” became a blogger, health policy advisor and international keynote speaker. He is now one of the world’s leading advocates for patient engagement. Urging patients to educate themselves and share knowledge with one another, while urging doctors to collaborate with patients. He believes informed self-care is critical for better health and makes for a richer, more collaborative partnership between physicians and their patients. This message was received by a multi-disciplinary audience of over 200 students, staff, faculty, alumni, and community members.

Community Health Dialogue
Place and Race Matter

Panel representatives and participantsThis event was a follow up to our previous community engagement forum focusing on health disparities in Austin/Travis County. This Dialogue was held at Huston-Tillotson University and attended by over 100 members of the community including city council members, health workers, students, and leaders of other CBO’s. This talk show style dialogue included a panel of representatives from GAVA, Latino Health Care Forum, Mama Sana/Vibrant Woman, and the Alliance for African American Health in Central Texas who engaged the audience in a solution focused dialogue on the next steps toward achieving equitable health for ALL members of our community. Time Warner Cable showed up to cover this event and ran the story later “Travis County Seeks To Promote Health Equity For Minorities” that night.

2016 St. David’s CHPR Conference
The Physical Environment’s Influences on Health

chpr2TCRSS was a proud co-sponsor of this year’s St. David’s CHPR conference focusing on the built environment and its influence on our health. Keynote speaker, Dr. Linda Mc Cauley, Dean of the Emory University Nell Hodgson Woodruff School of Nursing, brought her expertise on environmental and occupational health and shared results from her interdisciplinary study using participatory research models to study pesticide exposure among minority communities. This half-day event included poster presentations and highlighted the many transdisciplinary collaborative opportunities among researchers interested in health and the environment.

Gallman Summer Research Institute
Item Response Theory

Item Response Theory PicOur 4th annual Summer Research Institute for Best Practices in Health Promotion and Disease Prevention Research focused on Item Response Theory. To unpack the nuts and bolts of this complex concept we invited two very distinguished experts on the subject. Dr. Kitty Chan from Johns Hopkins Bloomberg School of Public Health who’s research focuses on measurement issues, particularly the application of phychometric techniques using IRT for the study of mental health, and Dr. Tam Nguyen from Boston College’s William F. Connell School of Nursing who also uses psychometrics to study health promotion/disease prevention in vulnerable/hard to reach populations. Over the course of this two and a half day workshop, these talented researchers led a group of 24 mostly nursing PhD students and a few faculty through IRT framework of modern measurement and improved scales using computer adaptive testing that can raise quality and efficiency while reducing respondent burden.

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HER Office Wins Gold for Sustainability

green ribbonHER participated in the launch of the Office of Sustainability’s Green Offices Program. The program is a points-based certification process that empowers members of UT faculty and staff to elicit change in their workspace. The student-led program, within the Campus Environmental Center, seeks to advance the University’s sustainability goals and commitment to being stewards of the environment.

After being accepted to the program, we were provided with a lengthy Certification Checklist that was broken up in categories of Awareness, Transportation, wellness, Energy & Water, Waste & Recycling, Purchasing, and Innovation. Each category contained a list of sustainable changes to implement in our office’s daily activities. Among these were minor changes such as posting information on Campus recycling policies and energy saving tips, as well as some major changes such as changing our primary transportation method from single person cars to walking, biking, or public transportation and scheduling walking meetings rather than the usual conference room. Points are awarded for each change, with the bigger changes earning higher points. At the end of the term, the amount of points you earn determines the level of certification you receive.

green longhornThe program also asked each participating office to designate a Green Office Steward to serve as the office’s representative and champion of the program. Our Center Coordinator Kelli Anne Royse was up to the task and quickly began going down the checklist and implementing both operational and cultural changes toward more sustainable practices. When the 4 month program ended, we had earned 84 points achieving the Gold level of certification!

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HER, Community Partners Award Health Equity Grants

msvwAUSTIN, Texas — The University of Texas at Austin School of Nursing and community partners Mama Sana/Vibrant Woman (MSVW) and the Alliance for African American Health in Central Texas (AAAHCT) will collaborate on projects designed to address health care inequalities after receiving two six-year grants totaling more than $3 million from the City of Austin. The health equity grants, the first ever awarded by the city, will address health disparities in underserved populations.

The collaboration is an outgrowth of efforts by the School of Nursing’s new Center for Health Equity Research (HER) and several local organizations to bring attention to a pressing health care crisis among the city’s low-income populations and develop community-driven solutions.

“As Austin has grown and prospered, not all of its residents have benefited,” said Miyong Kim, a professor in the School of Nursing and director of HER. “Although several community organizations have long been involved in this struggle to right the wrong of health disparities, funding has always been a struggle. We are grateful to the City Council for recognizing the barriers that many low-income individuals encounter as they try to obtain the health care they need and for providing the funds to help us help them overcome these barriers.”

The MSVW program uses the Maternal Justice Model, which brings together a culturally specific midwifery model with community organizing to address the root causes of racial health disparities in access, quality of care, and outcomes for mothers and babies in the community, Paula Rojas, a licensed midwife and community organizer with MSVW, explained.

This collaboration with HER at UT Austin will allow us to take to scale a program that has already shown success on a small scale with volunteer staff,” said Kellee Coleman, co-founder of MSVW. “We will now have the opportunity to prove that directly addressing social determinants of health will impact the health of pregnant women in a positive way.”

AAAHCTAfrican Americans in Travis County continue to have higher rates of mortality from cancer, heart disease and diabetes, and this disparity crosses economic lines. The AAAHCT project will address chronic disease among African Americans by providing a wellness program in which participants identify specific health goals they want to achieve and then receive individual and group coaching and connections to resources to assist them.

“Group support, increased accountability and resources will aid the participant in reaching the identified goal,” said Marva Overton, executive director of AAAHTC. “The success of the program will be measured not only by behavioral and biometric outcomes, but also by the ability to impact barriers that challenge people in being well.”

According to Dr. Kim, who is also associate vice president in the UT Austin Division of Diversity and Community Engagement, the School of Nursing will continue to work with various grass-roots community organizations and partners to implement community-driven solutions to underserved communities in Austin to reduce health disparity gaps.

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Community Health Workers (CHWs): Strong Bridges Between the “Digital Touch” and “Human Touch”

CHW is an umbrella term describing community members who assist individuals and communities to promote the adoption of better health behaviors. They may work for pay or volunteer in association with a local healthcare system. They usually share ethnicity, language, socioeconomic status and life experiences with community members they serve, and:

chw

  • Are selected by the community
  • Answer to the community
  • Have training in context of interventions
  • Have training recognized by health services and certification authorities
  • Do not necessarily have professional or paraprofessional certificated or degreed post-secondary education

CHWs and their duties are as diverse as the communities they serve, and are dependent on those communities for support. Evidence for the integration of CHWs into the delivery of primary and secondary prevention programs is quite strong, and the need to implement CHWs as part of collaborative intervention teams is critical, given the growing disparities in health care access, utilization, and quality, and the poor management of those affected by chronic diseases. While CHWs do not currently require in-depth education, optimizing the potential strengths of the CHW model in community settings such as chronic disease management for underserved ethnic minority communities requires systematic and rigorous training, including providing state-of-the-art tools, in order for them to be most effective.

Beyond clinical health services, CHWs are often in the positions of serving as community advocates and should also be trained in advocacy, outreach, and cultural competence so that they may communicate effectively to and on behalf of their vulnerable communities.

According to the United States Department of Labor’s Bureau of Labor Statistics’ May 2015 report, an estimated 48,130 people are employed as CHWs nationwide with a mean annual wage of $40,150. Texas is reported to employ about 3,670 CHWs at an annual mean wage of about $39,240 or about $18.87/hour. This is a wage that could boost economic mobility among unskilled workers eventually lifting them and their families out of poverty. Given the innate strengths of CHWs in brokering culture, evidence-based practices, and language in many disadvantaged communities, the CHWs may be the most ideal technological brokers, acting as strong bridges between the “digital touch” and “human touch.” The use of CHWs with proper training and coordination appears to be a viable means of reducing health disparities among members of underserved populations in this new technological arena.

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Pilot Studies (2015-2017)

About Pilot Study Program

HER provides junior and/or new investigators with funds to establish their programs of research in self-management interventions that are transdisciplinary in approach. Click here to learn more about the Pilot Study Program and list of ongoing studies.

Updates on New Pilot Studies

Heather CuevasHeather Cuevas, PhD, RN (PI)
Adapting a Cognitive Training Intervention for Diabetes Self-Management. (Sept. 2016 – Nov. 2017)

Type 2 diabetes mellitus (T2DM) increases the risk for cognitive impairment and doubles the rate of cognitive decline after diabetes is diagnosed. In turn, the presence of cognitive dysfunction can make diabetes self-management more difficult. Few interventions have attempted to focus on cognitive function in the context of diabetes and none, to date have tested an intervention to improve cognition in order to improve diabetes self-management. Therefore the aims of this project are: (1) to refine an existing cognitive rehabilitation intervention and tailor it for persons with T2DM by using current literature and interview data from 10 participants with T2DM and (2) to conduct a feasibility study of the adapted intervention with 20 participants with T2DM. The intervention consists of 8 weekly group educational sessions to teach compensatory cognitive strategies. Additionally, participants will use a web-based, game-like program to build on the didactic information and practice activities to improve cognitive health. The project will provide baseline data for further research on diabetes self-management in the context of cognitive dysfunction.

Tracie HarrisonTracie Harrison, PhD, RN, FNP, FAAN (PI)
Self-Management of Disablement and Aging in Mexican Americans with OA

Osteoarthritis (OA), a chronic degenerative disease of the joints, affects 27 million Americans and is the most common cause of disablement in aging Americans (Arthritis Foundation, 2008). Women and minorities have higher rates of OA than do non-Hispanic White (NHW) men, with worse functional limitations and disability. Currently, 3.1 million Latinos in the U.S. have arthritis, and this causes severe joint pain and limitations for at least one in five (Murphy et al., 2011). Therefore the aims of this study are: 1) To refine and validate an established tool that measures self-management outcomes in MA men and women with disabling OA in both Spanish and English; 2) To explore associations between disablement (impairment, function, and disability), self-management outcomes for relationships and gender differences; 3) To explore associations between disablement and biological, social, cultural, and psychological factors; and 4) To test whether self-management strategies predict self-management and disablement outcomes in men and women with OA, and whether self-management strategies moderate the relationships between disablement and related biological, cultural, and psychological factors. In this pilot study, Dr. Harrison will examine complex psychosocial influences on disablement by integrating a new means to understand pathways to better outcomes; i.e., self-management of disability.

Updates on Ongoing Pilot Studies

Julie ZunigaJulie Zuniga, PhD, RN (PI)
Self-Management of Diabetes for Persons with HIV (Sept. 2015 – Nov. 2016)

In her current pilot, Dr. Zuniga is testing 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 two 3 hour sessions of structured psych-behavioral group education utilizing gamification strategies. Six weekly telephone-counseling sessions will follow the 6-week group education. At this point in the study, the research team has completed recruitment (n=27). 25 participants who have completed the intervention and data collection is on track to be completed by the end of September. An abstract for the study was accepted as a podium presentation at the “American Public Health Association (APHA) Annual Meeting in Denver.”

Marge BenhammMarge Benham-Hutchins, PhD, RN (PI)
Bridging the Gap: Chronic Disease Self-Management Transitions (Sept. 2015 – Nov. 2016)

Dr. Benham-Hutchins’ 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. At this point in the study, all data collection has been completed and she is preparing transcripts for qualitative analysis (n=37). Qualitative analysis is in progress, and preliminary findings were presented at the Southern Nursing Research Society (SNRS) 31st Annual Conference, Dallas, TX.

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Director’s Corner

Miyong T. KimThe Center for Health Equity Research (HER) has had a productive and exciting 6 months since our last newsletter. We continue to work hard to achieve our core mission to (1) foster transdisciplinary collaborations between the community and academic departments, and (2) support HER pilot projects with innovative strategies to enhance self-management knowledge and behaviors and improve outcomes of chronic conditions.

We are actively creating and sustaining meaningful transdisciplinary and community partnerships. Within the University of Texas at Austin, we are collaborating with various health disciplines, including those represented by the School of Social Work, College of Pharmacy, Department of Nutritional Sciences, and Dell Medical School, as well as the Department of Computer Science and Moody College of Communication.

Our community partnerships also continue to grow. We are collaborating with two outstanding community organizations to address health care inequality issues in Austin: Mama Sana/Vibrant Woman and the Alliance for African American Health in Central Texas were awarded two 6-year grants totaling more than $3 million from the City of Austin. These two projects exemplify community-based participatory research, both in its relevance to the target community and in its credibility among the research and policy communities that we, as heath scientists, seek to influence. Both projects are based on community-driven solutions to health equity issues that each community has identified.

In line with our second mission, we continue to support pilot projects that employ innovative self-management strategies to improve outcomes of chronic health conditions. We have four pilot studies that incorporate transdisciplinary collaborations to promote patient self-management and improve health outcomes in people with chronic conditions such as heart failure, chronic kidney disease, diabetes, HIV, and cancer.

We have also sponsored and co-sponsored many networking and community events to foster new, sustainable partnerships between community organizations and UT academic partners. We have hosted several skills-building events on grant writing, informatics, and technological interventions and we will be hosting the LaVerne Gallman Distinguished Lecture in Nursing, where Dr. Shirley Moore, the Associate Dean for Research at Case Western Reserve University in Cleveland, Ohio, will discuss “Team Science: Building and Supporting Effective Research Teams.”

More information about all these developments can be found in this issue. Please feel free to contact us with ideas for collaboration or resources you might find helpful related to transdisciplinary and self-management science. On behalf of our HER team, we wish you a healthy and happy holiday season and new year!

 

Warm regards,

Miyong Kim