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

Spring 2018 Newsletter

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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)

Cara Calloway YoungDr. 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)

Tracie HarrisonDr. 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)

Heather CuevasDr. 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.

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Director’s Corner

Miyong T. KimToday, 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.