PhD Nursing Research Programs

"MUSC Nurses Change Lives"

Currently Funded Research Projects


Principal Investigator Title (click each link for more info) Sponsor / Type
Amella, Elaine Feeding in Elderly Late-Stage Dementia: The FIELD Trial NIH/NIA R21
Nutrition and Food Safety Education Targeting Rural... Clemson/USDA
Bissinger, Robin L. Advanced Nursing Education Expansion (ANEE) HRSA
Nurse Faculty Loan Program HRSA
Helene Fuld Health Trust Scholarship Fund for Baccalaureate... Helene Fuld Health Trust
   
Duffy, Nancy D. RWJF New Careers in Nursing: Mentoring Future Nurse... RWJF
Gilden, Gail A. Advanced Nursing Education Grants: Growing the Next... HRSA
Jenkins, Carolyn H. REACH U.S. Southeastern African American Center of... CDC
REACH U.S. SEA-CEED CTG... National REACH Coalition
  Southeastern Virtual Institute ... - Project 10 US Army/USAMRAA
Kelechi, Teresa J. Preventing Venous Leg Ulcers with Cryotherapy... WOCN Society
Magwood, Gayenell S. Personalized Bio-behavioral Weight Loss Intervention for... NIH/NINR K01
Nemeth, Lynne S. Synthesizing Lessons Learned Using Health... AHRQ R03
Newman, Susan D. A Peer Navigator Intervention for Individuals with Spinal... NIH/NICHD K23
Pope, Charlene A. Communication Intervention for Adolescent Immunizations... HRSA/MCHR R40
Spruill, Ida J. Ethno-Cultural Barriers to Health Literacy/Disease... NIH/NINR R01
Treiber, Frank A. Sociodemographic Regulation of CV Function and Structure NIH/NHLBI R01
Smartphone Medication Adherence to Stop Hypertension... The Duke Endowment
Technology Applications Center for Healthful Lifestyles SmartState SC Centers
Enhancing Kidney Donation Through Live Organ Video... (LOVED) NIH/NIDDK
Smartphone Management of Hypertension and Diabetes (SMOHAD) Verizon Foundation
   
Williams, Pamela H. A Community Partnership Approach For Advancing Burden... PCORI
Measuring and Comparing Social Impact of AATD Alpha-1 Foundation
Williamson, Deborah C. "Abrazos" CCSD
PASOs in South Carolina: Promoting Prevention and Bridging the... The Duke Endowment
Teen Health Advocate Leadership Program CPSC/NLM
Early Intervention to Reduce Domestic Violence MUSC Fdn.
Education, Outreach and Advocacy to Reduce Health... NMF Fund
Charleston PASOs - Improving Access to Health Services... MUSC Foundation/TUW


Nutrition and Food Safety Education Targeting Rural Older Adults: A Volunteer-Based Train-the-Team Approach
Sponsor/Type: Clemson University/USDA
Projects Dates: 09/01/2010 - 04/30/2013
Elaine Amella, PhD, GNP-BC, FAAN & Martina Mueller, Ph.D. (Co-I)

This subcontract with Clemson University will examine the feasibility of using a volunteer-based, train-the-team approach to reach rural older adults with information about how to make safe and healthy food choices and to use safe and healthy preparation practices. Two pre-existing volunteer groups will serve as the model for the train-the-team approach - the SC Family and Community Leaders (SCFCL) and the South Carolina chapter of the American Association of Retired Persons (AARP). The study will build on current evidence, capitalize on the potential contribution of pre-existing community-based groups as a source of volunteers to reach older adults with information about food safety and nutrition, and extend the focus to minority populations in an effort to eliminate health disparities. The findings will contribute to the evidence base of effective train-the-team programs and their potential effects over time and might offer a way to shift the current nutrition and food safety education paradigm by offering a way to extend the knowledge base of Clemson Extension, which is usually channeled directly from Extension Agents to the public to a new model, Extension Agents to volunteers to the public.

For more information contact Dr. Amella at  amellaej@musc.edu
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Advanced Nursing Education Expansion (ANEE)
Sponsor/Type: HRSA (Health Resources and Services Administration)
Project Dates: 09/30/2012 - 09/29/2015
Robin L. Bissinger, PhD, APRN, NNP-BC

This award is to support students enrolled in the newly implemented online Doctor of Nursing Practice/ Master of Science in Nursing (DNP/MSN) primary care Nurse Practitioner (NP) program. The objective of this ANEE Project is to maintain the high number of full time nurse practitioner (NP) students who are enrolled in this program by providing additional funding for full time enrollment. The second objective is to offer strong MSN students who apply part-time an opportunity to come into the program in a full time position with financial support.

For more information contact Dr. Bissinger at bissinrl@musc.edu
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Nurse Faculty Loan Program
Sponsor/Type: HRSA (Health Resources and Services Administration)
Project Dates: 07/01/2012 - 06/30/2013
Robin L. Bissinger, PhD, APRN, NNP-BC

This grant is for financial loan support for students enrolled in a Doctor of Philosophy in Nursing (PhD), Doctor of Nursing Practice (DNP) program (both post-BSN and post-MSN options) and students enrolled in a Master of Science in Nursing (MSN) degree program at the College of Nursing, Medical University of South Carolina, a school accredited by CCNE and ACNM.

For more information contact Dr. Bissinger at bissinrl@musc.edu
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Helene Fuld Health Trust Scholarship Fund for Baccalaureate Nursing Students
Sponsor/Type: Helene Fuld Health Trust
Project Dates: 09/01/2010 - 08/31/2013
Robin L. Bissinger, PhD, APRN, NNP-BC

The primary mission of the Helene Fuld Health Trust is to support and promote the health, welfare and education of student nurses. The first priority of the Trust is financial aid to nursing students. This grant is made exclusively to fund financial aid for students enrolled in the Baccalaureate degree nursing program here in the College of Nursing.

For more information contact Dr. Bissinger at bissinrl@musc.edu
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RWJF New Careers in Nursing: Mentoring Future Nurse Leaders
Sponsor/Type: Robert Wood Johnson Foundation (RWJF)
Project Dates: 09/01/2010 - 08/31/2013
Nancy D. Duffy, DNP, RN, CEN, CNE

This grant supports one of 55 nursing schools selected for funding through a competitive application process. The program will provide scholarships to non-nursing college graduates enrolled in accelerated baccalaureate and master's nursing programs. The intent is to support students and offset expenses encumbered as a result of participating in an accelerated degree program. Students may use their scholarship funds to pay tuition, academic fees or a subsidy to living expenses to reduce their financial burden while in school. The school will report on the progress of scholarship recipients during the academic year. As a result of this program, the nursing school is expected to increase: 1) student enrollment capacity or increase diversity in its accelerated program(s); and 2) the number of students from disadvantaged backgrounds that enroll and graduate from the program. Con received 15 scholarships for BSNs.

For more information contact Dr. Duffy at duffynd@musc.edu
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Advanced Nursing Education Grants: Growing the Next Generation of Nursing Leaders (NGNL)
Sponsor/Type: HRSA
Project Dates: 07/01/2011 - 06/30/2014
Gail A. Gilden, RN, ScD

The goal of this project is to grow the next generation of young nurse leaders from our Medical University of South Carolina (MUSC) online PhD and DNP programs, who will be the vanguards in solving health care disparities among rural and underserved populations in our complex health care environment. Our aim is to produce a nursing leadership workforce that is 1) early career 2) diverse and culturally competent and 3) adept in interprofessional team research skill sets. We will attract early career Post-BSN students to the PhD and DNP Online programs through creative recruitment, innovative marketing and focused mentoring strategies that encourage a younger and diverse applicant pool to study at our programs. Once admitted, we will bolster the skills sets of younger, disadvantaged, and minority online students to navigate doctoral level coursework using the Next Generation of Nursing Leaders Program (NGNL). With the guidance of a nationally recognized consultant on cultural competence, faculty will evaluate and expand the DNP and PhD curricula and clinical experiences to ensure the cultural competencies of our graduates for use with rural and underserved populations. To develop graduates with interprofessional team research skill sets, the faculty will utilize the online environment to construct interdisciplinary group learning experiences that supplement the traditional model of one-on-one research mentorship. Faculty will first map the core concepts of interest among the DNP and PhD students and faculty, and then create what we will call Scholarly Communities of Practice (SCOP). We will use SCOP forums to organize and scaffold research and clinical projects of the DNP and PhD students and faculty, so that the full continuum of knowledge development to knowledge dissemination in a particular topic is readily shared. Each group, led by experienced faculty mentors, will model and practice core teamwork skills in their interaction on projects. Online PhD and DNP students will engage in collaborative efforts of scholarly production with faculty and peers of like interests, learning to work in teams with a common interest but composed of diverse talents and perspectives. Invited interdisciplinary and international guests will be encouraged to collaborate within the SCOP forums.

For more information contact Dr. Gilden at barbosag@musc.edu
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REACH U.S. Southeastern African American Center of Excellence for Eliminating Disparities (SEA-CEED)
Sponsor/Type: Centers for Disease Control
Project Dates: 09/30/2007 - 09/29/2012
Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, RNC, FAAN

The SEA-CEED partnership will expand the Charleston-Georgetown Diabetes Coalition's focus to include prevention and risk reduction related to HTN and stroke in African Americans at risk or with diabetes. Additionally, successful and ongoing community and systems change, increased advocacy, and policy change strategies will be modified to include intergenerational activities to reduce modifiable risks. Previous and current community development strategies will be defused via the Legacy Projects which will expand the coverage area to counties in SC, GA, and NC. The Carolinas and Georgia Chapter of the American Society of Hypertension, American Association of diabetes Educators, Public Health Practice Group, Urban League, Alpha Kappa Alpha Sorority, and Black Nurses Association have expanded our partnership in high-risk areas in the region. Additionally, we will network with the American Diabetes Association for programmatic activities and guidelines for diabetes care.

The central Coordinating Organization is the Medical University of South Carolina. The community action plan is guided by a collaborative model which stresses identification of change agents, involvement in health organizations and other community organizations, with a focus on ploicy and systemes change to enable and encourage individual behavior change. Strong science is applied within a tailored and culturally appropriate community context--as evidenced in specific protocols for community programs and health organization quality improvement initiatives. A logic model identifies levels of activity and change with parallel plans for monitoring achievement of multi-level of objectives. Legacy projects in the tri-state area are awarded to local groups in the tri-state area.

The SEA-CEED a) addresses a geographic area with high burden and great disparity for African Americans, b) builds on the success of previous REACH coalitions, c) capitalizes on a broad network of academic and community partners which have worked effectively with mutual respect, d) represents rigorous application of community based participatory action principles and application of evidence based guidelines, and e) has the infrastructure and recognized leadership to work effectively at the local, state, and multistate levels, and with the Centers for Disease Control and other CEEDs.

For more information contact Dr. Jenkins at
jenkinsc@musc.edu
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Reach U.S. SEA-CEED CTG (Community Transformation Grant)
Sponsor/Type: National REACH Coalition
Project Dates: 06/01/2012 - 09/30/2013
Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, RNC, FAAN

The Community Leadership Team (CLT) of the Georgetown CORE Group was formed in 1997 and has been a beacon of healthy light in the Georgetown Community since that time.  The identified mission and vision is to create awareness of diabetes and related diseases and support diabetes health care by providing community based resources for fitness and nutrition education.

The African American communities have effectively responded to the CORE model to provide Community, Outreach, Resource, and Education and it is our hope that we can expand to model hypertension control efforts in the clinical and medical home sites.

As a part of the REACH SEA-CEED communities that focused initially on improving diabetes, the CTL realized that overall healthy lifestyles and control of A1C, blood pressure, and cholesterol were important to the overall health and reduction of illness, disability and deaths in the community.  Improvements in health come with community changes at all levels of the socio-ecological model and all levels of prevention. The group started with assessment of needs and assets and has since expanded to SWOT and MAPP.  The assessments have led to community actions including:  building a health center and "one stop shop" with health care, alcohol and drug, public health, social services/Voc. Rehab, day care, health and fitness center, computer training, community track, and now a swimming pool and Head Start Center are under construction; community library with training for community residents on how to use library; literacy and GED training; community gardens (in 2 communities); food distribution with emphasis on fruits and vegetables (in 1 center); walking trails, medication and housing assistance programs; and selection of the county as an "All American County" because of their significant improvements in community organization and race relations.  However, health disparities are still evident and improvements are needed.

For more information contact Dr. Jenkins at jenkinsc@musc.edu
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Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) - Project 10
Sponsor/Type: US Army/USAMRAA
Project Dates: 07/01/2010 - 06/30/2013
Sabra Slaughter, PhD & Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, RNC, FAAN (Project 10 Project Director)

The goal of this cooperative agreement with the United States Department of Defense is to develop educational and outreach programs and conduct community-based research on health disparities and to address the high rates of disease occurrence, disability and mortality in rural, low-income or minority communities.

For more information contact Dr. Jenkins at jenkinsc@musc.edu
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Preventing Venous Leg Ulcers with Cryotherapy: A Randomized Clinical Trial
Sponsor/Type: NIH/NINR
Project Dates: 03/07/2011 - 12/31/2014

Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN

The R21 Pilot Project (NINR—1R21NR010604-01) “Cryotherapy for Venous Disorders: A Pilot” demonstrated that cooling inflamed skin affected by venous disorders significantly reduced blood flow after a four-week intense cryotherapy intervention. This new trial will assess the efficacy of this home-based cryotherapy intervention by adding sequenced tapered cooling after a 30-day intense cooling period. The goal is to reduce skin blood flow of chronically inflamed skin, decrease the incidence of venous leg ulcers and pain, and improve quality of life. A myriad of surgical, pharmacologic, and non-pharmacologic therapies such as compression bandages are often tried, many with limited success. More than 70% of patients with venous disorders such as insufficiency develop edema, skin damage, and ulcers. Ulcer prevention is warranted because of the significant socioeconomic implications in terms of lost workdays and wages, decreased productivity and increased health care costs. Clinicians focus on the multiple treatment approaches, often without consideration of how patients can contribute to their own self-care. Our 9-month intervention is based on principles of heat transfer and cryotherapy theories involving microcirculation. With input from a cryotherapy expert and participants who completed the R21 pilot, we propose a sequenced intervention strategy, where cooling will be dosed daily for 30 minutes for the first month, and then decreased to twice weekly dosing in months 2–3, once weekly in months 4–6, then prn in months 7–9. We will measure blood flow, skin temperature, pain, quality of life, and the incidence of leg ulcers after months 1, 3, 6 and 9. Eligible participants will be randomized to treatment (low compression cooling wrap) or usual care (low compression non-cooling “sham” wrap). Participants in both groups will receive all study related materials including standardized instruction, skin thermometer, specially designed low compression wraps, leg elevator pillow, and compression stockings, and during an in-depth orientation session. We hypothesize that cryotherapy will enhance the largely ineffective non-pharmacologic self-care usual care model, that is, telling patients to wear compression stockings, elevate the legs, and get more exercise. These strategies are generally inadequate in achieving sustained change. Among our research methods we include rigorous process, impact and outcome monitoring. In an era of expectation for technological and pharmaceutical “fixes”, this self-care strategy, if efficacious, could be an economical way to decrease morbidity and pain for thousands of patients, frequently viewed as non-responsive to self care. Prevention of ulcers is also a major potential source of saved medical dollars. This trial is significant due to the burden of venous disorders, the complex physical characteristics of the population including excessive obesity and co-morbidity and the need to reach patients with a feasible, motivational, and supportive strategy to promote self-care. The objective is to establish a new practice standard for prevention.

For more information contact Dr. Kelechi at kelechtj@musc.edu
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Personalized Bio-behavioral Weight Loss Intervention for African American Women
Sponsor/Type: NIH/NINR K01
Project Dates: 07/18/2012 - 06/30/2015
Gayenell S. Magwood, PhD, RN

This K01 Mentored Research Scientist Development Award proposal is designed to provide the scholarly training, mentorship, and resources necessary for the candidate to develop expertise in bio-behavioral research. The candidate's primary career goal is to become a funded independent investigator and recognized leader in the field of obesity prevention/treatment with expertise in developing personalized bio-behavioral weight loss interventions for African American (AA) women.  To achieve this goal, a focused career development plan is proposed to:

  1. Obtain knowledge and skills in understanding how genetic variants may be related to adiposity; modulate influence of lifestyle behaviors (i.e.PA, diet) upon changes in adiposity, and how these genotypes may eventually be used to help personalize behavioral interventions for obese AA women;
  2. Obtain knowledge and skills in complex quantitative research methods, including bio-behavioral research designs and analyses, and advanced intervention development; and,
  3. Enhance grant and scholarly writing skills, and manuscript production while continuing to build interdisciplinary collaborations with other researchers in the field of genetics, obesity and prevention research.

The Medical University of South Carolina provides a comprehensive training environment that includes senior scientists with expertise in bio-behavioral interventions, genetics, and health disparities research.  The candidate has a strong interprofessional and inter-institutional mentoring team with complementary expertise in the development of community based randomized controlled trials (RCT), genetics, obesity prevention and treatment, bio-behavioral interventions, biostatistics and epidemiology.

The research plan, which builds on the training objectives, is directly responsive to the National Institute of Nursing Research's (NINR) mission of integrating the biological and behavioral sciences, employing new technologies to research questions, improving research methods, and developing the scientists of the future.  The broad goal of this research is to identify key components for development of efficacious socio-culturally tailored behavioral interventions for long-term weight loss in low socioeconomic status (SES) obese AA women. The socio-cultural preferences will be incorporated into behavioral change strategies, the communication of genetic information, and the adaptation of the format and delivery of the evidence-based Diabetes Prevention Program materials and approaches to promote weight loss. To meet this goal, the candidate will conduct an exploratory study using genetic database secondary data analyses. Secondly, an intervention development phase, with 80 obese AA women living in public housing neighborhoods in the Charleston, SC region, to integrate new knowledge and skills from genetics while advancing skills in bio-behavioral research intervention development and methodology. The results of the proposed preliminary studies will inform a larger, adequately powered and resourced community based RCT for obese AA women, that incorporates the use of genetic information and socio-cultural preferences to prescribe tailored weight loss strategies and promote long-term weight loss outcomes.

For more information contact Dr. Magwood at magwoodg@musc.edu
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Synthesizing Lessons Learned Using Health Information Technology
Sponsor/Type: AHRQ R03
Project Dates: 05/01/2010 - 04/30/2013
Lynne S. Nemeth, PhD, RN

This proposed research addresses the use of health information technology (HIT) to improve health care decision-making by evaluating how quality of care is improved while using EMRs, and how to increase the adoption of new roles in practice settings to improve communication between patients and practices about health care. The specific aims of this two year project are to: 1) Complete a mixed methods secondary analysis to synthesize findings related to improving quality using HIT in primary care across seven nationally funded PPRNet initiatives. 2) Examine current perspectives of PPRNet-TRIP study practice participants related to: developing and sustaining QI efforts; and team development for an increasingly more active health care delivery role through robust EMR implementation.  3) Integrate findings from PPRNet’s previous studies with the current perspectives of practice representatives to refine the overarching theory-based “PPRNet-TRIP QI Model”. The aims and products of the proposed R03 will further the goals of supporting safe, efficient and effective health care for all Americans through use of HIT to improve performance in real world of primary care practices.

For more information contact Dr. Nemeth at nemethl@musc.edu
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A Peer Navigator Intervention for Individuals with Spinal Cord Injury
Sponsor/Type: NIH/NICHD K23
Project Dates: 02/01/2010 - 03/31/2015
Susan Newman, PhD, RN, CRRN

This 5-year K23 Mentored Patient-Oriented Research award proposal is designed to provide the scholarly training, mentorship, and support necessary for the candidate to develop into an independent investigator. The candidate’s goal is to gain expertise in the development and testing of effective and cost-beneficial evidence-based rehabilitative health promotion interventions in partnership with people with spinal cord injury (SCI) in community settings. To achieve this goal, a focused career development plan is proposed to 1) gain expertise in the rigorous conduct of theoretically grounded, community-based health promotion intervention research, 2) develop proficiency in the use and application of research designs that incorporate both qualitative and quantitative methods, 3) enhance skills in community-based participatory research (CBPR), and 4) advance competence in analytical and evidence-based decision making skills related to intervention research with an emphasis on interpretation of health related outcomes and cost effectiveness. The Medical University of South Carolina provides a rich training environment that includes senior experts in community-based participatory research, health disparities research, and applied SCI research. The candidate has identified mentors with complementary expertise in the development and implementation of randomized controlled trials of community-based health promotion interventions with vulnerable populations using a CBPR approach, as well as measurement and interpretation of health and social outcomes after SCI. The mentoring team will be responsible for monitoring and evaluation of the candidate’s progression during the five-year training plan. The research plan, which builds on the training objectives, is designed to respond to a recent NIH initiative to incorporate CBPR approaches to more effectively research health issues in high-risk communities. The proposed work also incorporates the National Health Promotion and Disease Prevention Objectives for 2020 to address the environmental factors that contribute to our health. The research plan includes strategies to address health promotion after SCI beyond the level of the individual and incorporate an ecological approach to identify and address issues in the physical and social environment that affect health after SCI. The objective of the proposed two-phase feasibility study is to investigate a novel ecological approach to health promotion after SCI, using a CBPR approach, in partnership with a local center for independent living. Building on evidence from other fields, we propose an intervention using community-based peer navigators with SCI to proactively mitigate barriers and facilitate access to health care and other community-based services by people with SCI. Our overall goal is to reduce rehospitalizations and secondary conditions and improve community participation and satisfaction with life after SCI. Upon training completion, the candidate will be prepared to design, obtain funding for, and conduct a large-scale randomized controlled trial of a community-based health promotion intervention for and in partnership with people with SCI. This future research will provide empirical data to support development of cost-effective, evidence-based rehabilitative health promotion interventions to improve health and quality of life of this vulnerable population.

For more information contact Dr. Newman at
newmansu@musc.edu
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Communication Intervention for Adolescent Immunizations: Cluster Randomized Trial
Sponsor/Type: Sub to University of Oklahoma HSC/HRSA R40: Maternal and Child Health Research (MCHR)
Project Dates: 02/01/2011 - 01/31/2014
Charlene Pope, PhD, MPH, BSN

Though recommendations for adolescent immunizations have increased, adolescent immunization rates fall well below childhood rates. Missed opportunities for immunization are documented, though the conversations that contribute to vaccine hesitancy and refusal are less documented. The process of health communication between health providers, adolescents, and parents that characterizes information transfer in preventive health visits remains a critical but under-explored site for intervention. Most communication studies between adolescents and health providers use surveys, post-hoc interviews, or code health topics.

This study will record 120 spoken interactions pre- and 120 post-intervention between providers and diverse adolescents and parents in South Carolina and Oklahoma discussing recommendations for tetanus/diphtheria toxoid/acellular pertussis (Tdap), meningococcal conjugate vaccine (MCV 4), and human papillomavirus vaccine (HPV) at preventive health visits. Using methods from discourse analysis, patterns of communication and decision making will be compared to parental willingness to accept vaccines to determine best practices. Applying an integrated health behavior model, findings will be used to develop, test, and implement a provider-patient/parent communication intervention in two pediatric practice-based research networks representing multicultural populations to monitor variations for cultural tailoring.

Focus groups of adolescents, parents, and providers in online and face-to-face environments will refine the intervention and preferences for intervention delivery. Using simulation methods for provider prompting and patient priming, the intervention will be randomly allocated to 6 clinical practices in a cluster randomized trial. Guidance from the USPSTF Counseling and Behavioral Interventions Work Group will be used to evaluate the intervention. Subsequent follow-up will rate visits using the Structured Communication Adolescent Guide (SCAG) recording and repeating discourse analysis to determine changes in communication practices and immunization rates at the practice level.

For more information contact Dr. Pope at  popec@musc.edu
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Ethno-Cultural Barriers to Health Literacy/Disease Management in AAs
Sponsor/Type: NIH/NINR
Project Dates: 04/01/2012 - 01/31/2015

Ida J. Spruill, PhD, RN, LISW, FAAN

More research is needed in this area, as health literacy not only measures a person’s ability to read and comprehend, but also the ability to act on medical instructions and information. This is particularly true for the African American (AA) community which suffers disparate impact from chronic illness. The substantive aim of this descriptive, mixed method study is to explore the effects of beliefs and culture on health literacy and ultimately the management of diabetes in AAs from four regions in South Carolina.  Our methodological aim is to develop a reliable, valid and generalizable survey tool with items that represents cultural beliefs, values, experiences and preferences for health information. This study is innovative in that it acknowledges the heterogeneity of the AA community and will apply theoretically grounded models to guide the substantive and methodologic aims. We will use focus groups and cognitive interviews in year one and instrument pre-testing and population survey implementation in years two and three. Findings from this study will guide the selection of messages and strategies that will be subsequently tested within targeted populations to improve health outcomes. This study can advance the science as it relates to promoting health literacy and disease management among vulnerable populations.

For more information contact Dr. Spruill at spruilli@musc.edu
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Sociodemographic Regulation of CV Function and Structure
Sponsor/Type: NIH/NHLBI
Project Dates: 04/01/2010 - 03/31/2013
Frank A. Treiber, PhD

The fundamental objective of this proposal is to identify whether exposure to chronic stress is associated with development of early risk markers of Cardiovascular disease (CVD) and type 2 diabetes (T2D) and whether this differs between African Americans (AAs) and European Americans (EAs). Collecting data on 2 additional occasions in the Georgia CV Twin study (523 pairs, 302 EA and 221 AA) who will be 19.5±3.5 yrs. old will yield 5 evaluations over a crucial time span capturing the transition from childhood into adulthood. Particularly informative will be addition of new indices of sympathetic nervous system and hypothalamic-pituitary-adrenal axis activation (i.e., blood pressure, high density lipoprotein, triglycerides, waist circumference, fasting glucose and insulin), environmental stress (e.g., childhood trauma, job strain, perceived discrimination and unfairness, community social status) and a measure of vascular function (i.e., arterial stiffness).

For more information contact Dr. Treiber at treiberf@musc.edu
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Smartphone Medication Adherence to Stop Hypertension (SMASH)
Sponsor/Type: The Duke Endowment
Project Dates: 07/01/2012 - 06/30/2014
Frank A. Treiber, PhD

This project proposes an innovative approach of using mobile health technologies to: 1) help enhance patients' abilities to self-manage their health status and enable their providers to: 2) stay informed of their patients' adherence levels and associated BP levels and 3) make timely changes in medical regimens. We recently conducted key informant interviews with 21 racial and ethnic minority residents of Johns, Wadmalaw and Edisto Islands (mean age 34.5 yrs.; 17 males) and several healthcare providers from a FQHC on Johns Island in Charleston County, which provides healthcare to these rural underserved residents. Of the 21 FQHC patients interviewed and evaluated, 29% (n=6) had uncontrolled EH, none had taken any EH medications within the last year, 95% (n=20) owned cell phones, and 19% (n=4) owned smart phones. The number one cause of medication adherence is forgetfulness, accounting for 50-60% of non-adherence among EH patients. This was also the leading factor contributing to their non-adherence followed by lack of refills due to transportation barriers and/or perceived costs issues. None reported side effects as a contributor to non-adherence. Participants were also provided a demonstration of a portable BP monitoring system (AND model UA-767PBT) Bluetoothed to an Android smart phone and/or an electronic medication reminder device (Maya MedMinder).

The MedMinder contains 28 compartments (4 potential dosages per day across seven days) and is programmed to remind patients when to take their medications. Initially, one receives a blinking light from the particular compartment for 30 minutes. If not opened during that time, a loud chime is activated for 30 minutes. After that, an automated personalized call goes out to the patient (and a significant other if desired) to remind the patient to take their missed dose. Patients were also told how the devices are programmed to relay information (e.g., BP, when meds are taken, tray refilled, etc.) to a teleprocessing center where personalized summary reports could be sent back to the patient and/or their doctors at the FQHC. All 21 patients were receptive to using such a system for management of medication usage and monitoring of BP, if it was provided to them. All liked the idea of staying connected to their doctor via such a system. Based upon their comments and suggestions for delivery of reminder, motivational, and reinforcement messages, we have developed SMASH, a prototype model for a mobile health medication and BP monitoring system with interconnected linkages between the patient and healthcare provider.

Importantly, the prototype system will be further refined prior to and following the initial proof of concept clinical trial via input from the patients and providers. Their input will help ensure refinements are made if needed in the mobile health adherence enhancement model to make it fully acceptable and feasible for a larger scale pilot feasibility clinical trial which will follow.

For more information contact Dr. Treiber at treiberf@musc.edu
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Technology Applications Center for Healthful Lifestyles (TACHL)
Sponsor/Type: SmartState SC Centers of Economic Excellence
Frank A. Treiber, PhD

One of the biggest challenges public health researchers face is the development of efficacious, cost-effective lifestyle intervention and healthcare management programs which can be personalized to meet the specific needs and characteristics of individuals. TACHL provides a unique opportunity to address this challenge. The Center provides an outstanding environment to engage in multi-disciplinary based research with scientists from diverse disciplines at MUSC, University of South Carolina (USC) and Clemson University. Through multi-institutional collaborations it develops, evaluates and commercializes technology for individuals, worksites, community groups and health care provider networks to foster efficacious health promotion, disease prevention and health care management and work force capacity-building. Products include software and information systems for mobile smart phones, personal digital assistants, iPad®/tablet technologies, web based computer assisted programs, interactive call centers and others which will implement and monitor various programs including physical activity, diet, stress reduction, smoking prevention/cessation, biomarker monitoring and medication adherence. Product development is guided by the preferences of various users. For example, youth may prefer interactive game based computer technology applications for health behavior change, young adults may prefer smart phone delivered interventions and self-monitoring/adherence programs while seniors and others may prefer direct contact with healthcare call centers via phone and/or video conferencing via computer interface.

TACHL fosters more efficacious health promotion, disease prevention, and healthcare delivery/ adherence related programs applicable to all South Carolinians. These advances will help meet the long term vision of the Center which is to improve the health and well-being of all South Carolinians, provide indirect economic benefits to the state via improved work productivity, decreased absenteeism and decreased health care costs. The Technology Center will also foster economic growth to the state via the commercialization of new technology products, development and recruitment of companies involved in various aspects of software and systems technology development and program delivery. A diversity of new jobs will result including software and hardware developers, technology based educational training, clinical intervention, publishing and advertising positions among other high-tech business related occupations. The 10-year goal is to become a multi institution based national center of excellence. Most importantly, the activities of TACHL will help contribute to a reduction in the chronic disease health disparities ravaging the state and result in improved health and well-being of all South Carolinians.

For more information contact Dr. Treiber at treiberf@musc.edu
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Enhancing Kidney Donation Through Live Organ Video Educated Donors (LOVED)
Sponsor/Type: NIH/NIDDK
Project Dates: 09/30/2012 – 07/31/2017
Frank A. Treiber, PhD and Prabhakar Baliga, MD

Chronic Kidney Disease is diagnosed in four times as many African Americans (AAs) as Whites and nearly twice as many AAs perish from the condition. Kidney transplantation offers the best outcomes for patients with End Stage Renal Disease (ESRD) but rates of procurement far outnumber cadaver organ availability, especially among AAs. A superior option is living donor kidney transplantation (LDKT). Since AAs comprise only 18.5% of LDKT recipients, innovative and culturally preferred strategies are needed to increase LDKT within the AA community. We hypothesize that a patient-centered, two tiered culturally sensitive education/motivation intervention targeting AA ESRD patients and potential donors (PDs) using mobile health (mHealth) technology will result in: 1) increased ESRD patients’ willingness to ask for donation; 2) increased number of PDs who complete medical evaluation; and, 3) increased number of LDKTs. We will leverage mHealth technology as the delivery mechanism to maximize large scale dissemination potential. Guided by behavioral change and technology acceptability theories, the Live Organ Video Educated Donor [LOVED] program will be developed to address two domains. LOVED I will be tailored for AA ESRD patients and navigated by an AA LDKT recipient. LOVED II will be tailored for potential LDKT donors and navigated by an AA LDKT donor. iPad program delivery will include testimonial audio/video clips, home-work assignments, videoconferencing, chat room sessions, and text/emails. The proposed mixed methods research utilizes qualitative and quantitative studies in a 3 phase process of development that will involve:

  1. Development of LOVED I and II technical content and delivery formats guided by behavioral and technological theories using 9 focus groups (8 per group) of AA LDKT recipients/donors, ESRD LDKT eligible patients, PDs who failed to complete screening and transplant healthcare provider team.
  2. Conduct 3 month LOVED I and II proof of concept studies (LOVED I = 24 LDKT eligible patients; LOVED II = 24 PDs who did not complete screening) to assess program acceptability, feasibility, changes in self efficacy and attitudes. Also assessed will be % ESRD patients who identify PDs, % PDs who complete screening, % LDKTs and participants’ perceptions of cultural competence of intervention including levels of trust, discrimination, shared decision making and literacy.
  3. Conduct two 6 month 2-arm randomized control trials (LOVED I vs. standard of care, N=60; LOVED II vs. standard of care, N=80) to generate estimates needed for design of a large scale RCT.

For more information contact Dr. Treiber at treiberf@musc.edu
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Smartphone Management of Hypertension and Diabetes (SMOHAD)
Sponsor/Type: Verizon Foundation
Project Dates: 12/01/2012 – 11/30/2013
Frank A. Treiber, PhD

S.C. has high rates of uncontrolled essential hypertension (EH) & type two diabetes (T2D), leading risk factors for stroke, renal failure & mortality. Highest rates occur among ethnic minorities living in poor, under served, often rural areas. Leading causes of ineffective disease control are med non-adherence & lack of timely changes in regimens by providers (therapeutic inertia). Our mobile health (mHealth) program, Smartphone Management of Hypertension & Diabetes (SMOHAD) will facilitate med adherence & sustained control of EH & T2D among poor, rurally located Hispanics and African Americans. SMOHAD utilizes an electronic medication tray & a combo blood pressure/glucometer Bluetoothed to a smart phone. Patients receive a series of signals from the tray at predesignated times to take meds (blinking light, chime, automated call). They use the BP/glucometer to self monitor their biofunction. Signals from the tray & device are relayed via the phone to our server & processed. Based upon med adherence levels & related biofunction levels, they receive personalized motivational/reinforcement messages. Patients will be recruited by their local federally qualified health center, consented & randomized to either SMOHAD or standard of care (SOC) control. SMOHAD patients will be shown & then demonstrate how to use the devices. Desired results will be medically established levels of control: BP<140/90 mmHg & hemoglobin A1c <7%. Patients will be tested prior to & after the 3 months trial and 3 months later. Results will be measured comparing SOC control vs. SMOHAD groups in % reaching medical standards of control for BP & HA1c, as well as changes in levels of these biofunction indices. The SMOHAD program aligns with Verizon's strategy of capitalizing upon the ubiquity of mobile phone usage across ethnic groups & socioeconomic status to help enhance delivery of cost effective & sustainable healthcare programs, especially for the under served.

For more information contact Dr. Treiber at treiberf@musc.edu
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A Community Partnership Approach For Advancing Burden Measurement in Rare Genetic Conditions
Sponsor/Type: Patient-Centered Outcomes Research Institute (PCORI)
Project Period: 07/01/2012 - 06/30/2014
Pamela H. Williams, JD, PhD, RN

In North America alone, the collective of rare diseases recognized by the National Institutes of Health Office of Rare Disease affects an estimated 30 million persons, or 10 per cent of the population. Rare disease carries with it negative health outcomes (burden) independent of their pathological symptoms. Features of the burden are described as: sparse research resources, treatment options and knowledgeable providers leading to diagnostic delay that affects patient outcomes, lack of access to adequate care, lost faith in the healthcare system,  lack of public awareness/concern, scarce affordable options for medications/drugs/therapeutics,  stigma and insurability concerns. A large portion of the rare diseases have heritable genetic etiology, causing problems with genetic testing access and decisional burden, multiple family members/generations simultaneously affected with risk or burden, reproductive decisional issues related to and psychosocial impact of the heritability factor. Measurement of domains that comprise burden shared across this diverse and historically marginalized collective is a long overdue research direction. It is premature to measure rare disease patients' shared burdens until pilot work tailors needed instrumentation; informed and validated by those who carry the burden.

This pilot study proposes beginning a long-range process of burden measurement development with goals for developing domains generalizable for measurement across a multitude of rare diseases. The strategy for this pilot is to begin a measurement tool's conceptualization, field-testing, and validation in a narrow population for future dissemination to other populations with rare disease. The population living with alpha-1 antitrypsin deficiency (AATD, Alpha-1) was selected as the starting Ònarrow populationÓ because despite its narrowly defined genetic etiology, the sociocultural and psychosocial experiences of its population are diverse due to its variable age of onset, genotype and penetrance so that this single rare disease population collectively shares with many other populations similar burdens independent of symptoms.  Another justification for starting with the Alpha-1 community came from a preliminary assessment of the Alpha-1 patient stakeholder community's collective identity, virtual infrastructure resources and grassroots involvement that reflect that this population has strong indicators of potential for community based participatory research (CBPR) partnership's sustainability.

A CBPR partnership in alpha-1 antitrypsin deficiency (AATD, Alpha-1) is proposed as a novel approach to implementing the measure development process with a rare disease population. Unlike traditional local CBPR partnerships, this rare disease community partnership has a geographically dispersed roster and is linked to its constituency by online media including chat rooms, Facebook, webinars, website and virtual communities. The partnership represents the interests of Alpha-1 research stakeholders across the US and will be supported by the community communication network of its support organizational infrastructure. This CBPR MUSC/Alpha-1 partnership is comprised of diverse stakeholders in the alpha-1 antitrypsin research environment: academic scientists, clinicians, non-profit organizational support leaders, and individual patients living with Alpha-1, listed in the roster of the proposal.

The partnership will apply instrument development methodology to produce a measurement tool that defines the domains of burden independent of underlying rare disease symptoms by engaging local and geographically distributed adults living with Alpha-1 across the United States; with long range goals that it will contribute to measurement of burden across a multitude of rare genetic conditions.

For more information contact Dr. Williams at wilpame@musc.edu
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Measuring and Comparing Social Impact of AATD
Sponsor/Type: Alpha-1 Foundation
Project Period: 07/01/2012 - 06/30/2013
Pamela H. Williams, JD, PhD, RN

The long range objective is to establish an academic-community based participatory research (CBPR) partnership to serve as a platform for sustaining a future program of intervention focused research addressing social implications of living with AATD, using instrumentation adapted in this study to measure and show that the genetic and/or low prevalence components of AATD are independent, quantifiable variables that influence measureable levels of illness impact. An Alpha-1 CBPR partnership is assembled, currently training to conduct this research at the Medical University of South Carolina (MUSC), through the Center of Community Health Partnerships (CCHP). Academic clinicians, scientists, Alpha-1 organizational/support group leaders and patients joined in this proposal to use a CBPR approach and use conventional instrument development methodology to adapt an existing illness burden instrument (the Scale) to measure and test hypotheses regarding social impact of AATD.
Specific Aims:

  1. Empower a collaborative Community Based Participatory Research partnership (the partnership) to understand and measure social impact of living with AATD.
  2. Generate new measurement constructs/items as additions to the Impact of Illness scales in order to separate the impact of genetic heritability and low prevalence of AATD from the impact of symptoms.
  3. Field test the newly generated measurement tool in individuals that include normal, carrier and severely deficient AATD genotypes with and without symptoms of COPD. Field testing will include psychometric and hypothesis testing.

For more information contact Dr. Williams at wilpame@musc.edu
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"Abrazos"
Sponsor/Type: CCSD (Charleston County School District)
Projects Dates: 07/01/2009 - 06/30/2013
Deborah Williamson, DHA, RN, MSN, CNM

Abrazos is a bilingual early childhood development program designated for 3-year old Spanish-speaking children in order to promote school readiness as well as improve their mother's English and literacy skills. Childcare is also provided for siblings under 3 years old.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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PASOs in South Carolina: Promoting Prevention and Bridging the Gaps for the Vulnerable Latino Population
Sponsor/Type: Duke Endowment (Sub to USC)
Project Dates: 07/01/2010 - 06/30/2014

Deborah Williamson, DHA, RN, MSN, CNM

This project will provide coordinated leadership for the development and implementation of this program in the Charleston, Berkeley and Dorchester counties. Like most mothers, immigrant Latina mothers share the desire to have healthy families. However, in their new communities here in SC, they oftentimes lack the information and power to make an informed decisions for themselves and their families. PASOs provides a bridge between the Latino community and the health care system in order to maximize the health of Latino women and children, and provide them with access to needed resources.
The mission of PASOs is to empower Latino families to optimize maternal and child health within their social and cultural context through education, outreach, partnerships, and advocacy. This community based program works to achieve this mission through:

  • Prenatal education with groups of Latinas that focus on participants' strength and work to build trusting relationships
  • Training of community-based peer educators to sustain healthy practices and increase access to care
  • The formation of partnerships between the Latino communities of SC, academia, the non-profit sector, and the public health care system

For more information contact Dr. Williamson at wilmsnd@musc.edu
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Teen Health Advocate Leadership Program Planning Plan
Sponsor/Type: Center for Public Service Communications/NLM
Project Dates: 02/01/2008 - 08/15/2012

Deborah Williamson, DHA, RN, MSN, CNM

Entering its fourth year, the Teen Health Leadership Program (THLP) demonstrates an effective partnership between an academic medical center and local public high school to address community concerns related to adolescent health and development. Johns Island, the site of the THLP, is a rural community plagued by poverty and isolation. Partnerships with community organizations and larger institutions are critical to bring necessary resources to the island. In collaboration with the school district and multiple community organizations, THLP seeks to empower high school students to assist and serve their community. Through innovative computer technologies and the internet, the THLP provides health literacy training, enabling the students to design and implement outreach projects to improve the awareness and use of quality health information in their community. The THLP has produced relevant results related to sustainable partnerships, health literacy and community engagement. First, participatory development of the program among partners and integration of the program into existing structures has produced a sustainable mechanism to support the program for years to come. Second, the internet and use of creative technologies are critical components to achieve health literacy when working with adolescents. Finally, with adequate support, adolescents can serve as messengers of positive health promotion to address the health concerns of their community.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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Early Intervention to Reduce Domestic Violence
Sponsor/Type: MUSC Fdn.
Project Dates: 07/01/2008 - 12/31/2012
Deborah Williamson, DHA, RN, MSN, CNM

Our goal is to reduce interpersonal violence through the work of a network of community partners using primary prevention and early intervention approaches in school and primary care settings. The project will build capacity in communities through GIS mapping of information for participatory decision-making, skill building for parents, students and teachers to improve academic performance including skills for teachers in classroom strategies to reduce peer aggression and disruptive behaviors, and training and quality assurance measures for primary care providers for effective screening and referral for victims of interpersonal violence. Our ecological approach unites health care providers, teachers, and community members to address a significant public health concern in the context of a neighborhood. The project will identify strategies of value to other communities.

For more information contact Dr. Williamson at
wilmsnd@musc.edu
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Education, Outreach and Advocacy to Reduce Health Disparities
Sponsor: The Anonymous - NMF Fund of Coastal Community Foundation of SC
Project Period: 07/01/2012 - 06/30/2013
Deborah Williamson, DHA, RN, MSN, CNM

The purpose of this restricted grant is to support the Medical University of South Carolina, College of Nursing's community outreach, community health partnerships and practice activities related to addressing health disparities and the needs of underserved populations, especially Hispanic/Latino residents of the South Carolina's "Lowcountry". In collaboration with local health, social, and academic professionals, as well as community members and leaders, MUSC CON uses the strategies of professional and community education, outreach and advocacy to remove barriers to accessing necessary health and social services. Barriers include language differences; mistrust and fear; misinformation about where, how, and when to access services; low literacy; lack of health insurance; and cultural differences related to healthcare practices and systems navigation.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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Charleston PASOs - Improving Access to Health Services in the Tricounty Hispanic Community
Sponsor: MUSC Foundation/Trident United Way
Project Period: 07/01/2012 - 06/30/2013
Deborah Williamson, DHA, RN, MSN, CNM

The Hispanic population represents over 235,000 people in South Carolina (SC), of which between 32,000 and 59,500 are estimated to live below the poverty level. Fifteen percent of the SC Hispanic population lives in the Tricounty. This number has more than doubled in the past 10 years. The median income earned by Hispanics ages 16 and older is $17,900 annually (compared to $20,000 by non-Hispanic Blacks, and $30,000 by non-Hispanic Whites). Seventy-four percent of foreign-born Hispanics are uninsured and 76% of Hispanics ages 5 and older speak a language other than English at home. In the Tricounty, the mean household income of PASOs' participants is $14,062, 96% do not have insurance, the average education level is 8th grade, and 64% of participants have a low acculturation level, meaning they still need support as they learn to adjust to and navigate an unfamiliar health care system.

Barriers such as misinformation about where, how, and when to access services; low literacy; poverty; lack of health insurance; language; cultural differences; and discrimination act to limit access to care and resources.

These barriers lead to healthcare disparities in identifying and utilizing medical homes and resources, and create unnecessary costs related to late-stage diagnosis of medical conditions, medical errors, and duplication of services. If this population is ignored, access to care and resources will be reduced even more.

In order to improve access, and prevent unnecessary costs, Tricounty Hispanics need a trusted, reputable source of health information and navigation services. PASOs respects Hispanic cultural values and provides information in a way that can be understood, supported, and adopted by the Hispanic community. The PASOs program also partners with businesses, nonprofits, grass-roots, faith-based, state, county health, and social service agencies to ensure Hispanic residents' needs are being met. As a result, the Hispanic community contacts PASOs when in need because it views PASOs as a trusted source for information on health, referrals to health resources, and for assistance with applying for benefits. PASOs can ensure individuals are referred into medical homes and eligible children are enrolled in Medicaid. Evidence shows that the PASOs model helps to promote healthy behaviors within the Hispanic community which can ultimately reduce preventable health conditions.

For more information contact Dr. Williamson at wilmsnd@musc.edu
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