The University of Texas at Austin School of Nursing Center for Health Equity Research

Newsletter

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Summer 2021 SoNStar Recipient The University of Texas at Austin School of Nursing

The SoNStar for the Summer 2021 session is Angela Bigham, a Lay Health Worker for the AMEN program and a Community Health Network Leader for The Alliance for African American Health in Central Texas. Congratulations Angela Bigham!

Angela received several nominations. She has a contagious sweet spirit, is outgoing, caring, ready to jump in and support others in any way they can at all times, and serves with a genuine heart. She takes the time to communicate ideas and opportunities to UTSON faculty/staff on how to engage with the community to ensure that individuals being served are supported based on their needs. She follows up with people in need, ensures that the solutions provided are maintained, and works to offer practical, sustainable solutions when more support is needed.

Angela works tirelessly to support the community both within and beyond the AMEN program – VaxNow and VAMOS initiatives. She has dedicated numerous hours each day calling community members to schedule their COVID vaccination appointments, assists at the mobile clinics to ensure that people have a positive experience, and offers education and reassurance to those who are uncertain or fearful about getting vaccinated.

Angela has gone above and beyond her duties, such as driving to congregant’s homes to drop off supplies, assisting with home care needs, and ensuring that individuals have access to healthcare providers. She has gone to great lengths to ensure congregants receive calls, education, and have access to local resources. Angela also runs a community garden, offer healthy cooking classes for the community, and delivers fresh produce to homebound adults. She spearheaded an event during COVID to cook greens from the garden and deliver a warm meal to homeless residents in the community.

Angela readily steps up to do needed tasks, works hard to learn the designed system, streamlines it, makes it more achievable, and constantly adapts to the work that needs to be accomplished. Her energy and willingness to serve is infectious and inspires other team and community members to join her efforts. She inspires us all when we get weary.

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Faculty Spotlight

We talked to Gayle M. Timmerman, a researcher at the University of Texas at Austin School of Nursing about her latest research and how she contributes to the mission of HER.

Gayle M. Timmerman, PhD, CNS, FNAP, FAAN is a professor and associate dean at the University of Texas at Austin School of Nursing. She is also a lead researcher for HER. We talked to her about her latest research and how she contributes to the mission of HER.

Until recently, Gayle Timmerman didn’t really think of herself as a self-management scientist. She is best known in the academic community and popular press for her seminal research on mindful restaurant eating in perimenopausal women who wanted to lose weight. “This research is really about guiding people through a process of behavior change. In this case, we helped study subjects learn to slow down and think about what they were eating and why they were eating it. For example, are you finishing the French fries on your plate because they taste good and you want them, or just because they happen to be sitting there?” explains Dr. Timmerman. Then, she was approached by Miyong Kim, PhD, director of HER, to pilot a study on dietary self-management in chronic kidney disease (CKD) patients. “I’d never studied kidney disease—I’d always thought of myself as a food and behavior change researcher. But it occurred to me that implementing an intervention that provides study participants with tools and information they can use to make better decisions about managing their disease is about behavior change—and ultimately, a part of self-management science.” Her article appeared in the Journal of Behavioral Medicine; click the image to access the article.

Chronic kidney disease affects 31,000,000 Americans. In its early stages, it is often without symptoms, so many people are diagnosed when the disease has already caused end organ damage. It often occurs with other chronic illnesses–obesity, hypertension, and Type 2 diabetes—all of which negatively impact kidney function. “Dietary adjustments are often aimed at better managing chronic diseases that contribute to CKD. Common changes are reducing sodium and adjusting protein intake. Some patients may need to watch their potassium intake—others may not, so recommendations are not going to be the same for all,” says Dr. Timmerman. Another goal of dietary change in renal disease is to reduce wear and tear on the kidneys by limiting amount of filtered waste. For example, altering protein intake to fit body size and kidney function reduces the amount of waste processed through the renal (kidney) system. Decreasing sodium intake also lessens renal workload. It may also lower hypertension, which strains the renal vascular system.

But changing habits—dietary or otherwise—is never a straightforward process. That’s where self-management and mindfulness come in. The purpose of self-management in chronic illness is not only to educate patients, but to provide them with a sense of control and empowerment that allows them to implement changes on their own. Mindfulness is the practice of bringing one’s attention to the present moment; for the purpose ofthis study, its aim was to assist clients in dietary decision making. The two concepts naturally support each other—mindfulness supports the patient in making beneficial self-management decisions.

Dr. Timmerman collaborated with local providers and colleagues from the University of Texas at Austin’s schools of pharmacy and nutrition to devise a six-session nutritional education intervention designed for 19 early stage CKD patients. Outcome measures included weight, body mass index (BMI), eGFR (a measure of kidney function), and serum carotenoid levels (a measure of fruit and vegetable intake). The intervention had several components: information and problem-solving strategies on how to improve dietary practices, behavioral change strategies to improve self-management activities, such as reading food labels, as well as mindful eating and mindful eating meditations.

Dr. Timmerman developed the education modules and conducted the sessions herself. “Participants really seemed to enjoy the sessions—only 10 percent left the study. And the outcome measures demonstrated some positive change, particularly in terms of weight and body mass index (BMI). Nearly half of participants lost an average of 8.4 pounds, and plasma carotenoid levels reflected a significant increase in fruit and vegetable consumption.” More research is needed to determine the generalizability of the intervention, but this study is paving the way for further exploration in helping people with CKD to help themselves.

To learn more about Dr.Timerman’s research visit:

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Staff Highlight

Paige MenkingPaige Menking is a graduate student at the LBJ School of Public Affairs who joined our team last year to work as a GRA on our Community Health Worker (CHW) Institute. As a health policy student and a certified CHW and CHW Instructor, Paige has proven herself invaluable when it comes to looking at ways to empower this workforce and enhance their presence as part of a holistic health team. She has been selected as our Staff Highlight and shared some of her history and vision for better health care delivery.

 

Q: What made you decide to go back to school for a master’s degree in Public Affairs?
A: After working for years at non-profits and state agencies, I wanted to get a bird’s eye view of our health care delivery systems to increase my impact. LBJ offers a great combination of thinking big picture but also getting into the weeds. I hope that combination will help me make better decisions at a system level and make positive changes in terms of health care delivery and policy.

Q: What kinds of changes do you feel are the most needed in health care policy and delivery
A: What’s become most clear to me is that there is no silver bullet. Health care is huge, it’s an economic engine and it has so many moving parts. I think the conversation is starting to focus around the intersections of access, quality and patient experience but we can do more to humanize systems of care and CHWs are a big part of that. We need physicians and hospital administrators to center decisions around population health and the social determinants like poverty, housing, trauma, etc. And on a national scale, payment models need to incorporate a realistic view of what affects people’s health and the healthcare system at large. We can’t just think about paying doctors for one specific thing; we need to be thinking about how to have payment models that allow medical providers to address social determinants of health.

Q: What has your experience been like working with TCRSS?
A: Well, besides the healthy snacks that are always available, I feel fortunate to have found a way to continue my work with Community Health Workers while I’m in school. This was the luckiest situation I could have come across, because the CHWs model of providing culturally competent, access to health and social services is something that is really important to me. Dr. Kim and the TCRSS team are focused on innovative and collaborative ways to address health disparities and so my knowledge and skill set just fit right in with the team’s mission and the work they were already doing. I also appreciate the support and guidance from Dr. Kim and the TCRSS team, who value and foster excellent scholarship. They really empower and support me in developing strong skills in the scientific method, including survey development and implementation, delivering presentations and writing for publication.

Q: Where do you see the Community Health Workers fitting in to a new more holistic model of health care delivery?
A: I think CHWs are key to bridging the gap between the health care system and communities who have been traditionally isolated from and mistrustful of that delivery system. There is still no silver bullet, and we need some large structural changes to really ensure health equity, but CHWs are uniquely qualified to address patients’ real issues today. They can help people navigate this really complicated system; they do the hard work of getting people access, and they inject compassion into a sometimes scary situation for a lot of folks.

Q: What kind of policy changes do you think could empower the movement of this work force?
A: Well, we need to figure out how to pay them sustainable and living wages. We need to also figure out how to have career ladders for folks who are doing this work and how to have them grow in their work, so that they don’t have to stay in the same position for 30 years without movement. Figuring out the payment model is the biggest challenge we face now, so when we think of how we are designing a health care system and how Medicaid, Medicare and other insurance plans compensate physicians and hospitals – CHWs and other folks who address population health and social determinants need to be a part of that conversation.

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Health Point Mini Grant

In 2015, TCRSS conducted a wellness survey to gather feedback about which healthy living initiatives would meet the needs and interests of School of Nursing (SON) employees and students. Our goal was to raise awareness about the ways nursing students, faculty and staff perceive their current health, and to identify health-promoting activities and resources the SON community would like to access, it also provided a process to help create an ongoing strategic plan within SON.  As part of this initiative, in May 2016, TCRSS applied for and received a HealthPoint mini-grant from the University and received $1,500 to fund new activities to address concerns raised in the survey. More specifically, this mini grant focused on providing outlets to improve mental health and physical activity, in addition to raising awareness about ways to incorporate wellness throughout the work day. The grant paid for yoga mats to be used during group yoga classes that are hosted at SON, and yoga and meditation DVDs that employees can check out for personal use. We received additional funding to paint the main stairwell in bright colors to promote lifestyle physical activity through use of the stairs, instead of the elevator, while in the building.

“It’s been fun working with the School of Nursing,” said Claire Hahn, Work-Life Balance and Wellness manager. “It’s gratifying working with individuals dedicated to the health of their colleagues and the establishment of a culture of wellness in the workplace.”

Click here learn more about the School of Nursing’s wellness initiatives.

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St. David’s 2017 Opportunity Grant Recipient

St. David's Foundation logo

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.

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CHW Institute

Community Health Worker Institute logoAt 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.