First-Ever PCORI Award for College of Nursing
Jul 18, 2016 9:15 AM
For patients with Type 2 diabetes, an active lifestyle, balanced diet, and careful management of blood sugar levels are critical to remaining as healthy as possible. But for many patients in Utah’s Hispanic community, a lack of access to regular care and diabetes education can make information and support difficult to obtain. Type 2 diabetes is prevalent in the Hispanic community, and inadequate care can lead to serious complications including blindness, kidney failure, and amputation.
To combat this problem, a team of investigators co-led by Dr. Nancy Allen, PhD, ANP-BC, Assistant Professor at the University of Utah College of Nursing, brought together leaders from Salt Lake’s Hispanic community along with Hispanic diabetes patients to form a Community Advisory Board (CAB). The CAB has been working to understand the difficulties Hispanic people with Type 2 diabetes face regarding disease management, and to develop some potential solutions.
The team recently received an award from the Patient Centered Outcomes Research Institute (PCORI) for their project, which is titled “Community Partnership for Patient Centered Outcomes Research in Hispanics with Type 2 Diabetes.” This is a Pipeline to Proposal Award, and provides preliminary funding designed to help with capacity building, community engagement, and other preparations that lay the groundwork for a larger research proposal.
PCORI, an independent nonprofit, nongovernmental organization located in Washington, DC, was authorized by Congress in 2010. It funds comparative clinical effectiveness research with the goal of determining which of the many healthcare options available to patients and those who care for them work best in particular circumstances. Allen’s award is the first to go to the University of Utah College of Nursing, and one of only a handful to be awarded in Utah.
Identifying Barriers to Care
One of the key issues defined by the Community Action Board is that members of this community often work long hours at jobs where they are unable to leave for a doctor’s appointment or diabetes education course. The majority of the patients identified are also uninsured, and so the care they do receive often comes from free clinics or other community health centers that have long wait times for appointments, and where healthcare is delivered by volunteers who are not diabetes specialists.
Another problem the CAB is tackling is finding ways to provide culturally-sensitive support for patients who struggle to balance managing their diabetes with fulfilling their social obligations. “Their culture is very family based, and there’s a lot of pressure to go to parties and eat what’s served to them, even though it doesn’t go along with what’s healthy,” explains Allen.
Because patients have such busy schedules, the research team decided to focus on technology-based solutions (including sensors, mobile phones, and electronic health records) that don’t require in-person meetings. As part of the investigation, members of the Community Advisory Board are currently testing different assistive technologies including an iPad loaded with diabetes related applications, a Fitbit (activity and sleep monitor), and a real-time continuous glucose monitor. Participants are being asked to record their thoughts regarding these applications, and to keep a daily journal monitoring their stress levels. The team is also growing the membership in the CAB, inviting Hispanic community and health care leaders, diabetes educators, mental health providers, and church representatives. These leaders will provide new ideas and perspectives on the health care needs of their community, and can help identify community resources that may be beneficial to patients.
Allen’s team will apply next year for a research contract from PCORI to compare the effectiveness of in-person versus mobile phone or video-delivered diabetes education and support. Smartphone ownership is high in the Hispanic community, making online diabetes support and education and telemedicine programs, along with app-based technologies, attractive alternatives to in-person interventions. Allen’s eventual goal is to use this research to build a sustainable program that will be free to the community and will help better meet their health care needs. Or in Allen’s words, to make diabetes care “accessible when patients can access it.”
Dr. Allen was originally asked to partner on this project by Dr. Bryan Gibson, Assistant Professor of Biomedical Informatics at the University of Utah. Like Dr. Allen, Dr. Gibson is interested in the use of technology to help individuals prevent or manage chronic disease. Dr. Gibson led earlier phases of this project, while Dr. Allen and Jeannette Villalta are leading the current, third phase. Villalta is a trained community health worker, wellness coach for the Hispanic Health Care Task Force, member of Community Faces of Utah and Community Outreach worker for Alliance Community Services.
Two additional researchers recently joined the project. Dr. Ana Sanchez Birkhead, PhD, WHNP-BC, APRN, Associate Professor at the College of Nursing, is the Director of the Hispanic Health Care Task Force and is a board member on Community Faces of Utah which facilitates community based participatory research with minorities in Utah. Dr. Michelle Litchman, PhD, FNP, FAANP, Assistant Professor at the College of Nursing, is a diabetes provider in a diverse community health clinic and a diabetes specialty clinic.
Esther PomeroyInterim Communications SpecialistCollege of Nursing, Dean’s Suite(801) 213-6924