St. David’s Foundation has launched Opportunity Grants to provide financial support for new approaches to improving community health. These grants seek proposals that include innovative, transformative ideas for making Central Texas the healthiest community in the world. Opportunity Grants are intended to support short-term projects that have the potential to lead to long-term, transformative impact, and may include (though not limited to) research, planning or testing of new models. Ten recipients received grants for two years of funding. The University of Texas at Austin School of Nursing, in collaboration with Cardea Services received one of these grants to develop online Continuing Education (CEs) modules for Community Health Workers (CHWs) to address women’s health, with a focus on rural communities. Certified CHWs in Texas are required to obtain 20 CE credits every two years to maintain certification, and are often looking for new content to enhance their learning.
CHW Institute
At present, there are several gaps preventing Community Health Workers (CHWs) in Texas from fully participating in the nation’s effort to transform the community health infrastructure. The quality of training across the state varies, and no central entity offers technical support, tools to enhance community health workers’ efforts, or connects them with work placement after training. While the flexibility of the current Texas CHW training delivery and certification process allows sites to serve the varying needs of diverse patient populations, this approach can lead to disparities between the training provided and the skills necessary to enter the workforce.
With generous funding through a grant from the Michael & Susan Dell Foundation, the Center for Trans-Disciplinary Collaborative Research in Self-Management Science (TCRSS), began an initiative to perform a comprehensive, multi-level workforce analysis within Central Texas and will join forces with existing agencies who are currently providing certified CHW training. The aim of the CHW Institute is to develop comprehensive health promotion training and continuing education, identify and connect trainees with work opportunities, and promote adequate reimbursement. Working collaboratively with other training and community organizations, this CHW initiative will provide education, resources and support to improve consistency of training quality and career readiness for this workforce across the state. This joint initiative will ensure that health workers develop high quality, comprehensive, and measureable skills to better address chronic disease management, prevention and other social determinants of health. This collaborative approach will also help us address ways to develop a more sustainable, fundable workforce that ultimately improves community health.
In its next phase, the Institute will offer continuing education and technological tools/support to strengthen community capacity for CHW employment and development enabling this essential workforce to serve as a catalyst to improve community health among underserved populations in Central Texas.
Center Activities (2017-2018)
Front Porch Gathering
Title: Health Disparities in Communities of Color and the Impact on Mental
April 18, 2017, Huston-Tillitson University
As the social and economic demographics in Central Texas continue to shift, the narrative surrounding health care access, community wellness and health equity for traditionally underserved populations is both complex and consequential. Health disparities reflect the differences in health status between different groups of people, and Austin continues to see inconsistency in the health and wellness of particular communities based on location. This event focused on the idea that changes in pre-determined access, policy and practice are essential to provide all Austin residents the opportunity to achieve comprehensive and holistic health regardless of race, ethnicity, sexual orientation, income, or immigration status.
Opportunity Forum
Title: After the Storm: Building Resilient and Equitable Communities
October 6, 2017, 12:00 pm – 1:30 pm, The University of Texas at Austin Law School Francis Auditorium (TNH 2.114) 727 E. Dean Keeton Street Austin, TX 78705
Now that the floodwaters have receded, the communities ravaged by Hurricane Harvey are beginning the long, hard road of rebuilding. Historically underserved populations—including low-income persons of color—face especially daunting challenges. What needs to be done to help the most vulnerable survivors rebuild their lives? How can we protect all residents from future flooding and exposure to other hazards? And what lessons have we learned from prior disasters to ensure that disaster recovery funds are spent more equitably and effectively? This event fostered a conversation on these questions and more, as we discussed how to build resilient and equitable communities after Hurricane Harvey.
St. David’s CHPR Conference
Title: Health Disparities in the Precision Health Era Across the Lifespan
Wednesday, February 21, 2018 11:30-4:30, Thompson Conference Center
Keynote Speaker: Usha Menon, PhD, RN, FAAN, Associate Dean for Research & Global Advances, University of Arizona, College of Nursing “From the Frontline: What Does Precision Health Mean to Me?”
St. David’s Center for Health Promotion and Disease Prevention Research in Underserved Populations (CHPR) in collaboration with TCRSS at The University of Texas at Austin School of Nursing is hosting its 7th annual conference. This conference brings together health care experts, innovators, nursing leaders, policy makers, caregivers and industry experts who are committed to the application of emerging technologies to promote health and decrease health disparities in underserved populations. Attendees will hear speakers from around the nation discuss important and innovative topics and be able to participate in discussions with the panel.
The LaVerne Gallman Distinguished Lectureship in Nursing
Title: Health Disparities in the Era of Precision Health: Will our new tools reduce or expand the gaps?
Wednesday, April 25, 2018, 3:30 pm – 5:00 pm, The Auditorium at the Edgar A. Smith Building (Blanton Museum) 200 E. Martin Luther King Jr. Blvd. Austin, TX 78712
Speaker: Mark R. Cullen, MD – Director, Center for Population Health Sciences, Senior Associate Dean for Research, Professor of Medicine (Primary Care and Population Health), of Biomedical Data Science, of HRP (Epidemiology) and Senior Fellow at SIEPR
Free and open to the public. A catered receiption will follow the lecture.
Innovative Technology
These days it would be hard to name an industry that hasn’t been impacted by innovative technology resulting in greater efficiency, convenience, and affordability. Health care, however, seems to be the exception. While health care keeps getting costlier, patient outcomes have gotten worse and management of chronic conditions such as diabetes are now responsible for 80% of total spending.
A recent article by Christensen in the Harvard Business Review (November 2017) examines the current business model and introduces ideas of how “disruptive innovation” in health care can drive down costs, improve health outcomes, and eventually help consumers play a more active role in their own health.
Photo Credit: Harvard Business Review Article
Pilot Updates (2016-2019)
About Pilot Study Program
TCRSS 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
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.
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.
Updates on Ongoing Pilot Studies
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.
Heather Cuevas, PhD, RN, ACNS-BC (PI)
Adaptation of a Cognitive Training Intervention for Diabetes Self-Management (Sept. 2016 – Jan. 2018)
Dr. Cuevas’ research interests include diabetes self-management in underserved populations with a focus on cognitive function. In her current pilot study she is testing 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.
Director’s Corner
Today, healthcare is at a defining moment, at the heart of macro-social transformation. U.S. demographics are radically shifting, and technological advances are spreading rapidly and widely. The core conditions of people’s daily lives are changing as well. It is thus difficult, for example, to ignore the remarkable penetration of new, persuasive technology into modern daily life, not only by commercial technological giants such as Amazon and Facebook, but also by small online merchants.
Health systems are in transition, as they begin to adopt new advances in medical technology. As we move closer to fully digitalized medical records, drug delivery, education, and even consultation health disparity researchers need to be asking ourselves a few questions:
- Will we see an equitable benefit across patient populations of different socio-economic backgrounds?
- Will certain communities or populations experience even wider health disparity due to this rapidly changing environment of advanced digital technologies?
- What should we do to move towards more equitable solutions?
At TCRSS, we have not only been thinking about these questions, but have been actively pursuing ways to utilize advanced technologies in managing and preventing chronic conditions in underserved populations. In collaboration with a number of transdisciplinary research colleagues at TCRSS, we have been developing a few technology-assisted intervention prototypes, tailored to the unique needs of traditionally underserved populations. From developing serious video games to educate self-management principles to underserved populations with chronic illness, creating flexible online and social media platforms for patient support and resource sharing, educating community health workers as technology brokers for socially isolated populations with limited resources, the list is rapidly expanding.
We are particularly proud of our work on community-engaged projects to improve community health infrastructures, such as our work in developing the role of community health workers (CHWs). With generous funding from Michael & Susan Dell Foundation, we are currently working on establishing a CHW Education and Technical Support Institute (the Institute) to better prepare and assist CHWs in their work to improve the quality of life and health outcomes of underserved populations/communities in Central Texas. We are in the process of completing a comprehensive CHW workforce analysis and developing several demonstration projects that will highlight the effects of community health workers on underserved populations such as socially, linguistically, or geographically isolated rural communities.
While the core of each intervention project has a different clinical focus such as cancer prevention, diabetes management, and “aging in place,” they each employee cutting edge-health technologies to address the unique needs of these priority populations.
Given the innate strengths of CHWs to weave language and culture into evidence-based practices in disadvantaged communities, CHWs may also be ideal technological brokers for health technologies, acting as strong bridges between “digital touch” and “human touch.” CHWs, with proper training, support and coordination, offer a viable way to reduce health disparities among members of underserved populations in this new technological arena.
We look forward to sharing the fruitful outcomes of these exciting projects in future newsletters, and to continued collaboration with our many community and academic partners, as we work hard to address these complex health and social issues.