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PhD Nursing Research Programs

"MUSC Nurses Change Lives"

Currently Funded Research Projects


Principal Investigator Title (click each link for more info) Sponsor / Type
Bissinger, Robin L. Advanced Nursing Education Expansion (ANEE) HRSA
  Nurse Faculty Loan Program HRSA
  Advanced Education Nursing Traineeship (AENT) HRSA
Gilden, Gail A. Advanced Nursing Education Grants: Growing the Next... HRSA
Gregoski, Mat Camera Adherence Monitoring: Proof of concept increasing... PhRMA Foundation
Jenkins, Carolyn H. Southeastern Virtual Institute ... - Project 10 US Army/USAMRAA
  National Chronic Disease Screening Program... Sanofi US Services, Inc.
Kelechi, Teresa J. Preventing Venous Leg Ulcers with Cryotherapy... NIN/NINR R01
Novel Wound Powder RGN107 to Reduce Wound Odor... NIH/NINR R21
Magwood, Gayenell S. Personalized Bio-behavioral Weight Loss Intervention for... NIH/NINR K01
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
Smith, Shannon B. The Promise of Nursing for South Carolina FNSNA
Spruill, Ida J. Ethno-Cultural Barriers to Health Literacy/Disease... NIH/NINR R01
Stuart, Gail W. Virtual Interprofessional (VIP) Education Josiah Macy Jr. Foundation
Treiber, Frank A. Smartphone Medication Adherence to Stop Hypertension... The Duke Endowment
  Smartphone Medication Adherence to Stop Hypertension Among Hispanics... NIH/NHLBI R21
Technology Applications Center for Healthful Lifestyles SmartState SC Centers
Enhancing Kidney Donation Through Live Organ Video... (LOVED) NIH/NIDDK
Smartphone Delivered Meditation for BP Control NIH/NHLBI R01
Wagner, Janelle Pediatric Epilepsy Depression Screen (PEDS) Study William A. Henkin Foundation
Williams, Tiffany RWJF New Careers in Nursing: Mentoring Future Nurse... RWJF
Williamson, Deborah C. PASOs in South Carolina: Promoting Prevention and Bridging the... The Duke Endowment
Charleston PASOs: Improving Access to Health Services... Trident United Way
Teen Health Advocate Leadership Program CPSC/NLM
Building Capacity in the Hispanic Community: A Health Promotion... Yaschik Foundation

 


Advanced Education Nursing Traineeship (AENT)
Sponsor/Type: HRSA
Project Period: 07/01/2013 – 06/30/2014
Robin L. Bissinger, PhD, APRN, NNP-BC

The overall goal of this project include: to increase the supply of primary care nurse practitioners and to increase the employment of funded graduates in rural, underserved or public health practice settings. This will result in improvement of quality and safety of health care for patients and increase access to care for citizens in rural and underserved areas. This application requests support for students enrolled in two advanced education nursing degree programs of the College of Nursing: the Master of Science in Nursing (MSN) and the Doctor of Nursing Practice (DNP).

For more information contact Dr. Bissinger at bissinrl@musc.edu
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Advanced Nursing Education Expansion (ANEE)
Sponsor/Type: HRSA (Health Resources and Services Administration)
Project Period: 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 Period: 07/01/2013 - 06/30/2014
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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Advanced Nursing Education Grants: Growing the Next Generation of Nursing Leaders (NGNL)
Sponsor/Type: HRSA
Project Period: 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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Camera Adherence Monitoring (CAM): Proof of concept increasing medication adherence and reducing clinician inertia using a low-cost CareCam platform
Sponsor/Type: PhRMA Foundation
Project Period: 03/01/2013 – 07/31/2014
Mat Gregoski, PhD, MS

In the United States cardiovascular diseases (CVD) including heart disease and stroke are the leading cause of mortality accounting for more than one third (33.6%) of all deaths1. Prehypertension is a precursor of clinical hypertension and is closely related with the increased incidence of CVD with prehypertensive patients having increased risk of CV mortality and morbidity compared to normotensives 2. Further, epidemiologic studies have shown that blood pressure (BP) levels are monotonically associated with future CVD development and that essential hypertensive (EH) patients accrue the highest rates of CVD3. Among EH patients, BP control (i.e. <140/90 mmHg) has shown some improvement in recent years, yet large ethnic/racial disparities continue to exist. Hispanics and African Americans have the lower BP control rates compared to whites4. Two major

factors responsible for uncontrolled EH are medication non-adherence and failure to intensify or modify therapy in a timely efficient manner (i.e. therapeutic inertia). Recent reviews of randomized controlled trials (RCTs) using EH patients have demonstrated BP self-monitoring, medication reminding strategies, and utilization of case managers as effective means of improving BP control; but only ~45% of patients reached BP control and beneficial effects diminished at intervention cessation. Establishing control of ambulatory 24-hour BP(<130/85 mmHg during waking hours) has been shown to enhance reduction of CVD events over clinic BP control 10 but few medication adherence programs have implemented its use. This study’s purpose is to test a low-cost novel proof of concept medication adherence and therapeutic inertia program for Hispanics and African Americans at risk for EH using a modified mobile health (mHealth) platform. The proposed platform is comprised of four main components: 1) low-cost wireless medication bottles capable of determining exact dosage of medication adherence in real-time, 2) interactive database capable of sending and receiving data with iterative processing from voice, text, and internet sources to patients and providers 3) automated ecological momentary assessment reminders using personalized messages developed using Self-Determination Theory delivered through patient’s choice of voice, text, or email communication 4) decision based algorithms created from clinician-based rules to immediately alert providers (and researchers) of physiological (e.g. BP levels, weight fluctuations) and adherence (missed or double dosages) responses in near real-time.

For more information contact Dr. Gregoski at gregoski@musc.edu
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Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) - Project 10
Sponsor/Type: US Army/USAMRAA
Project Period: 07/01/2010 - 06/30/2014
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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National Chronic Disease Screening Program: Screening for Diabetes in Underserved Rural Communities in South Carolina
Sponsor/Type: Sanofi US Services, Inc.
Project Period: 09/09/2013 – 09/08/2014
Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, RNC, FAAN

An estimated 25.8 million persons in the United States (US) have diabetes and about 27% or 7.0 million of those are undiagnosed; and a 2012 report estimated that 22.3 million in the US are diagnosed with diabetes and their health care account for 1 out of 5 dollars spent on health care. An additional 79 million have prediabetes and only 7.3% have been told they have prediabetes and even fewer have an action plan to reduce the risks of developing or managing diabetes. Of particular note, 14.1% (n = 2,256 estimated) of the residents of Bamberg County, South Carolina (SC) report a diagnosis of diabetes, a rate nearly twice the national average and 78% are classified as overweight or obese (41% obese); however, in a similar county in SC, following an awareness and action program focused on diabetes, about 20% of African Americans reported a diagnosis of diabetes. Bamberg County has a population of about 16,000 and about 61% of the population are African Americans.

Low median household incomes in Bamberg County ($16,236) and the rural nature of the county, restrict access to comprehensive medical care, and opportunities for physical activity and access to affordable healthy food choices are also limited. We therefore propose a Screening and Innovative New Guidelines for diagnosing diabetes and prediabetes (SING for Diabetes). The program will be a community-academic partnership with Medical University of South Carolina (MUSC) Diabetes Initiative (DSC) and College of Nursing’s REACH SEA-CEED, Voorhees College Center of Excellence in Rural and Minority Health, The Regional Medical Center of Orangeburg, and Bamberg County (and surrounding areas).

Innovation: The unique aspects of this pilot include: 1) multi-level community partnerships focused on action oriented research; 2) a comprehensive community-owned plan for screening and follow-up, including mobile health linkages to primary care for those with abnormal results; 3) a community action plan for multiple levels of interventions to reduce risks for all screened as well as additional actions for those with abnormal results; 4) linkages of multiple grants including the Diabetes Initiative of South Carolina (MUSC, SC DHEC, and other Partner Organizations), the National REACH Coalition’s REACH SEA-CEED, the Center of Excellence in Rural and Minority Health, University of North Carolina Chapel Hill-MUSC Clinical and Translational Science Award (CTSA) Diabetes Project, and MUSC’s SmartState Technology Applications Center for Healthful Lifestyles (TACHL) to improve innovations, actions and outcomes; 5) development of technology and a “best practices toolkit” that can assist other communities to replicate successful community efforts.

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 Period: 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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Novel Wound Powder RGN107 to Reduce Wound Odor, Pain and Exudate at End-of-Life
Sponsor/Type: NIH/NINR R21
Project Period: 04/01/2013 – 03/31/2015
Teresa J. Kelechi, PhD, RN, GCNS-BC, CWCN

Palliative care can provide comfort and support for individuals at the end of life who have a wound. Such people frequently face distressing symptoms that profoundly affect quality of life. Wound care research on feasible comfort measures is minimal to address physical symptoms such as pain, odor, and wound drainage (exudate) that often accompany wounds that develop at the end of life. We propose to study a wound comfort intervention comprised of a low-cost wound powder, RGN107 that can be sprinkled on wounds using a squirt bottle. After several applications, the powder forms a “crust” seal border over the wound, protecting it from dressings that can stick to the fragile wound bed and preventing manipulation from wiping, both of which can cause pain. The goal is to augment usual wound care, adding to the comfort and quality of life of dying individuals as well as their caregivers. No previous studies have determined the feasibility of using a specially developed wound powder to examine adherence to a wound comfort protocol for individuals receiving hospice care. Our pilot data indicate that RGN107 is nontoxic, and efficacious, providing substantial relief from pain and exudate from venous leg ulcers. We propose to extend these findings to a highly challenging population of hospice enrollees with wounds such as pressure ulcers. Approximately 50% of the individuals who develop wounds have tried various methods to manage symptoms, but continue to suffer from uncontrolled wound pain, odor, and exudate. The purpose of our study is to examine the feasibility of an enhanced wound care approach and examine monitoring of adherence, measures of signals of efficacy in the control of symptoms, and impact on quality of life after use of RGN107. This R21 will employ a comparative group design to determine feasibility in two models of a hospice organization, home based care and inpatient hospice that will target 50 individuals with life expectancies more than 1 month, but less than 6 months. We will tailor the training for each model recognizing the variability of caregivers. In the inpatient setting, training will be delivered over the three shifts and over several days. In the home, the registered nurses that plan wound care, along with associated agency and family caregivers will be instructed in the home setting over several training sessions. A DVD of wound procedures will be used to reinforce learning. Our team will monitor adherence by fidelity processes such as making regular visits to assess caregiver performance, evaluating the wound itself, and reviewing documentation. Data collection sources include project records, patient/provider logs, surveys and interviews conducted at three time points, baseline, and then weeks 2 and 4. We hypothesize our intervention will enhance comfort care and quality of life at the end of life for both the patient and the caregiver.

For more information contact Dr. Kelechi at kelechtj@musc.edu
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Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) - Phase 1: Project 2
Sponsor/Type: DOD Dept. of Defense
Project Period: 07/01/2010 – 06/30/2014
Marilyn A. Laken, PhD, RN

This 4-year project aims to work with faith communities, businesses, primary care providers and schools in Williamsburg County to increase awareness of causes of CVD, with an emphasis on obesity, to improve the health of citizens of the County. An Asset Map was developed identifying programs and activities of each entity to identify local resources. Practices were encouraged to join the OQUIN network to improve evidence-based care. Work-site health screening activities were encouraged and we evaluated the access to care and medications of workers with hypertension from one large company. The school district and several faith communities received funding to implement projects that provided education and screening to their constituents. A local Community Health Advisory Board directs activities of this project.

For more information contact Dr. Laken at lakenm@musc.edu
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Southeastern Virtual Institute for Health Equity and Wellness (SE VIEW) Phase 2: HPHC (Healthy People in Health Communities)
Sponsor/Type: DOD Dept. of Defense
Project Period: 09/01/2011 – 08/31/2015
Marilyn A. Laken, PhD, RN

This initiative was funded in the Phase 1 SE VIEW award as a project to promote lifelong health through healthy lifestyles and access to primary preventive health care and necessary medications. This 3-year project aims to establish Health Information Exchange (HIE) between Williamsburg Regional Hospital and one or more local primary care practices in Williamsburg County. MUSC OCIO is actively involved in not only establishing HIE in the County, but potentially linking the County with regional health care. The principal approaches are: a) developing community dialogue about ongoing needs and resources, b) providing health education and grants for local programs, c) supporting health screen/referral for care, d) assessing and overcoming barriers to health care and medications, e) strengthening the local health care delivery network, f) building local capacity to sustain these efforts, and g) promoting and assisting the adoption of electronic medical record (EMR) systems and other HIT tools by local caregivers.

For more information contact Dr. Laken at lakenm@musc.edu
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Controlling Blood Pressure in Treatment Resistant Hypertension: A Pilot Study
Sponsor/Type: NIH/NHLBI R34
Project Period: 03/03/2011 – 01/31/2015
Marilyn A. Laken, PhD, RN

Background: Treatment resistant hypertension (TRH), i.e., blood pressure (BP) above goal on >3 BP medications affects millions of people and contributes to health disparities. In clinical trials, where patient compliance is confirmed and BP meds are systematically titrated to attain control, ~20% of patients have TRH, which suggests limited effectiveness of current treatment strategies contributes to TRH. This pilot study examines the feasibility, safety, and preliminary effectiveness of four evidence-based approaches to improving BP control in TRH. The four strategies include adding an aldosterone antagonist in eligible patients (AAEP), renin treatment-guided therapeutics (RTGT), clinical hypertension specialist care (CHSC), and RTGT+CHSC.

Hypothesis: Defining pathophysiological mechanisms (RTGT) and/or expert consultation (CHSC) will improve BP control more than ‘blindly’ adding an aldosterone antagonist in eligible patients (AAEP).

Specific aim: Assess the feasibility, safety, and preliminary comparative effectiveness in a diverse group of patients and clinical settings of four evidence-based treatment strategies for treatment resistant hypertension (TRH) to test the hypothesis that RTGT and/or CHSC are more effective than AAEP for controlling BP in TRH.

Hypothesis: Eliciting patient, provider and staff experiences and insights post intervention will identify barriers and facilitators to implementing AAEP, RTGY, and CHSC that will inform design of the demonstration study.

Specific Aim: Conduct post-intervention patient questionnaires and interviews and staff and provider focus groups and an online SWOT to identify barriers and facilitators to AAEP, RTGY and CHSC that will inform the demonstration study in real world practice settings.

Methods: 8 diverse clinics (>1 community health centers, single & multi-site primary care clinics, community residency training programs) that provide care for a diverse patient population will be randomized to 1 of 4 study arms. Each cilnic will enroll 18 TRH patients (36/arm). All clinics receive BpTRU monitors and training to standardize BP measurements and ‘eliminate’ white coat hypertension. Key study data include patient demographics, visits, BP values, meds, and lab data. Post study focus groups and strengths, weaknesses, opportunities, threats (SWOT) analysis with providers and staff and patient questionnaire and interviews will be used to evaluate several dimensions of the study and guide the demonstration study design.

Significance: TRH is common medical condition, and relatively ineffective treatment regimens are a significant contributing factor. The long-term goal is to establish practical, effective, and widely replicable approaches for controlling BP in TRH and reducing clinical complications and related health disparities.

For more information contact Dr. Laken at lakenm@musc.edu
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USC Community Transformation Grant
Sponsor/Type: Sub USC/DHEC/CDC
Project Period: 12/03/2013 – 08/31/2014
Marilyn A. Laken, PhD, RN

This CDC-funded 5 year project aims to reduce CVD risk in SC by: 1) enrolling more PC practices in a Practice network and 2) increasing the implementation of evidence-based care related to CVD. A variety of interventions are employed including audit & feedback to providers related to evidence-based care and HTN/lipid control, an annual meeting, quarterly newsletter, training in Lean Six Sigma, and support for 8 people identified by 7 practices to be trained as QI Professionals producing QI projects related to reducing CVD.

For more information contact Dr. Laken at lakenm@musc.edu
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Personalized Bio-behavioral Weight Loss Intervention for African American Women
Sponsor/Type: NIH/NINR K01
Project Period: 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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A Peer Navigator Intervention for Individuals with Spinal Cord Injury
Sponsor/Type: NIH/NICHD K23
Project Period: 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 Period: 02/01/2011 - 01/31/2015
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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The Promise of Nursing for South Carolina Grant Application
Sponsor/Type: Foundation of the National Student Nurses’ Association (FNSNA)
Project Period: 06/01/2013 – 05/31/2014
Shannon B. Smith, DNP, RN, ACNS-BC, CGRN

This grant application is for development of an educational innovation: a virtual pre-entry program, the Promise of Nursing Toolbox (PONT) that will address our known student challenges and identify tools for success at entry. Students will be required to review and complete the electronic toolbox modules prior to the first day of class. Once admitted, we will bolster the skills sets of students to navigate ABSN coursework using PONT. We will offer ongoing access, additional supportive retention efforts through educational intervention, referral and integration of the faculty advisor role in the individualized academic success plan.

We will develop content modules via a learning management system (LMS). These will be self-directed sessions that involve an activity (self assessment, Tegrity recording, quizzes) are learner centered with progression based upon content mastery. Students at risk for academic success will be identified prior to the start of the program, referred to campus resources and their faculty advisor. This will ensure that students do not get behind before they can be identified and supported.

Program Grant funds for this toolbox will support start up funding for: design and implementation of the PONT, workload for a Program Administrator to track compliance, facilitate referral for support, purchase of instruments to assess learning and study strategies and greater educational efficiencies by allowing more faculty time for small group remediation sessions. It is our belief that learner initiated acquisition of success skills for an accelerated curriculum will decrease the demand on faculty with curricular progression. This decreased demand will allow the CON to expand program capacity by 15% (fall 2013 and spring 2014) without additional faculty or compromising student success.

For more information contact Dr. Smith at smithsh@musc.edu
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Ethno-Cultural Barriers to Health Literacy/Disease Management in AAs
Sponsor/Type: NIH/NINR
Project Period: 04/01/2012 - 01/31/2016

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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Virtual Interprofessional (VIP) Education
Sponsor/Type: Josiah Macy Jr. Foundation
Project Period: 01/01/2014 – 12/31/2015
Gail W. Stuart, PhD, RN, FAAN

MUSC – College of Nursing seeks funding to create a highly innovative, interactive, advanced computer simulation technology to develop a new level of interprofessional healthcare learning experiences.

  • The goal of the project is to develop a platform or framework for virtual interprofessional learning that fully engages the learner, and that can be utilized as a prototype to provide a wide variety of clinical learning opportunities across disciplines, universities and geographies.
  • The topical focus of our prototype will be on improving student competencies in addressing patient care quality and safety. However the platform will allow for the use of other clinical scenarios in the future.
  • The innovation lies in the use of avatars - or virtual 3-D representations - of our learners, patients, and patient environments - for case presentation, analysis, clinical decision-making, team communication and resolution of significant healthcare events and environments that could not be enacted or be readily available in more static e-Learning platforms.


This innovative proposal takes the beneficial aspects of emerging technologies to an exciting new level of learning opportunity, moving beyond a narrow focus on real-time constraints, didactic teaching/learning strategies, online discussion boards, and task simulations to a more dynamic focus on the health care student’s case analysis, critical decision-making, and team interactions.

For more information contact Dr. Stuart at stuartg@musc.edu
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Smartphone Medication Adherence to Stop Hypertension (SMASH)
Sponsor/Type: The Duke Endowment
Project Period: 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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Smartphone Medication Adherence Stops Hypertension (SMASH) Among Hispanics
Sponsor/Type: NIH/NHLBI R21
Project Period: 03/15/2014 – 02/28/2016
Frank A. Treiber, PhD

Uncontrolled essential hypertension (EH) is a major risk factor for stroke, renal failure and cardiovascular events. Hispanics have the highest rate of uncontrolled EH (BP ≥ 140/90 mmHg) in the U.S. Two primary responsible factors are patient medication non-adherence and clinician failure to intensify therapy in timely manners (i.e., therapeutic inertia). BP control programs are needed which can be sustained by EHs and readily disseminated by healthcare providers. There have been no randomized controlled trials (RCTs) evaluating theory driven culturally tailored mobile health technology applications among Hispanics with uncontrolled EH. In response to PA-12-023, the proposed R21 research proposal will test and refine the Smart phone Medication Adherence Stops Hypertension (SMASH) program. SMASH includes multi-level components: 1) automated reminders from an electronic medication tray; 2) tailored text message/voice mail motivational feedback and reinforcement based upon adherence to daily medication and BP monitoring; 3) automated summary reports and direct alerts to providers and 4) booster program for SMASHers who show deterioration in BP control and/or medication adherence after the 3 month trial. The aims are as follows:

Aim 1a: Conduct 3 month 2 arm (SMASH vs. enhanced Standard Care [SC]) feasibility RCT with 6 month follow up in 60 uncontrolled EH 21-55 year old Hispanics. Primary feasibility outcomes are measures of recruitment and retention rates, intervention use and patient and provider satisfaction, and Aim 1b: Obtain estimates of variability of changes in primary outcomes of BP changes (i.e. % reaching JN7 designated BP control: resting BP <140/90 mmHg). Other BP measures include: % reaching 24-hour BP control: < 130/80 mmHg) and absolute reductions in resting and 24-hour BP at 3, 6, 9 months. Secondary outcomes: patient adherence (med intake, BP self-monitoring), self-determination theory constructs of self-efficacy and intrinsic motivation (i.e., autonomous regulation) and provider adherence to JNC7 guidelines (timing of med changes).

Aim 2. Conduct focus groups after 6 month final follow-up with providers and staff (n=6-10) and random sample of SMASHers (n=16) to assess key user reactions including perceived cultural sensitivity, acceptability, usability, salience & sustainability facilitators/barriers.

Aim 3. Triangulate data from Aims 1 and 2 to further refine and optimize SMASH and prepare for a full-scale efficacy/effectiveness RCT (PA-12-022, R01).

Long-term objective is to develop practical, effective and sustainable mHealth primary and secondary prevention programs for EH and CVD. Dissemination of SMASH across ethnic/racial groups will help ameliorate the burden of CVD and associated health disparities.

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 Period: 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 Delivered Meditation for BP Control Among Prehypertensives
Sponsor/Type: NIH/NHLBI R01
Project Period: 06/01/2013 – 05/31/2018
Frank A. Treiber, PhD

Stage 2 pre essential hypertension (preEH; 130-139/<90 mmHg) entails a 3-fold risk of developing EH and 2-fold risk of cardiovascular disease (CVD) events compared to those with optimal blood pressure (<120/80 mmHg). Prevention programs are needed which can be sustained by preEHs and readily disseminated by healthcare providers. Psychological stress is a risk factor for future EH and CVD. Stress reduction via meditation has shown promise in reducing blood pressure (BP) but adult studies have not determined optimal dosage level nor  evaluated dosage adherence objectively. Multiple underlying biobehavioral mechanisms linking meditation with BP reduction also require additional scrutiny. The proposed research will address these issues by further developing and optimizing a smart phone breathing awareness meditation  program (Tension Tamer:TT). Stage 2 preEH 21-50 year old African Americans and Whites balanced by geographical locale (urban vs. rural) and healthcare providers from 12 practice sites (6 urban/6 rural with 12,843 stage 2 preEHs) within the OQUIN practice based research network  will be enrolled.
The 3 stage process of intervention development specified in PA-11-063 will involve:

  1. Optimization of TT content and delivery formats guided by behavioral and technological theories using 6 focus groups of OQUIN healthcare providers and 6 focus groups with preEHs (8 preEHs per group);
  2. 6 month TT proof of concept study (n=60 stage 2 preEHs) to establish dosage tolerability and impact upon resting and 24 hour SBP and biobehavioral mechanisms: worry, rumination, anxiety, hostility, mindfulness, sleep, physical activity, sympathetic nervous system (SNS) and hypothalamic pituitary adrenal axis (HPA) activity;
  3. 12 month 2-arm randomized control trial (RCT; TT vs enhanced standard of care smart phone health education program; total n=80) to generate estimates needed for design of a large scale RCT. This series of iterative studies, implemented and guided by healthcare providers and their preEH patients, will result in an intervention acceptable to multiple racial/ethnic groups in both urban and rural settings, feasible to conduct in clinical practice settings, effective in reducing SBP in a pilot RCT and ready for a large scale RCT.

For more information contact Dr. Treiber at treiberf@musc.edu
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Pediatric Epilepsy Depression Screen (PEDS) Study
Sponsor/Type: William A. Henkin Foundation
Project Period: 09/01/2013 – 08/31/2014
Janelle Wagner, Ph.D

Epilepsy has been proposed as a spectrum of disorders subsequent to evidence for the direct contribution of seizures as well as underlying epilepsy brain pathology to psychiatric symptoms. Epilepsy also poses significant psychosocial challenges, which may increase the risk for development of psychiatric comorbidities. With both biological and psychosocial factors contributing to psychiatric comorbidities, prevalence rates in youth with epilepsy are 10-30% for depression and > 25% for suicidal ideation. Recent research has demonstrated that this increased risk of depressive symptoms is present at or before the first recognized seizure, over the chronic course of epilepsy, and relates to health-related quality of life (HRQoL) years later. Studies have also stated that, due to the influence of underlying brain pathology, aspects of depression may be less evident or emphasized in persons with epilepsy. In addition, atypical features may also be expressed due to underlying neurologic condition, peri-ictal symptoms, or the psychotropic effect of AEDs. Therefore, particular attention to the methods and measures used to assess depression in youth with epilepsy is necessary.

To address these salient findings, comprehensive epilepsy care should integrate screening for psychiatric comorbidities at seizure onset and continued throughout the course of the youth’s epilepsy. Epilepsy experts have developed consensus and clinical practice statements for the screening and assessment of psychiatric comorbidities in youth with epilepsy. However, at present there are no evidence-based assessment measures specific to depressive symptoms in youth with epilepsy. There is a gap between published consensus statements and clinical practice due to lack of available resources and epilepsy provider hesitancy. Unfortunately, at best, only ~one-third of YWE who could benefit from mental health services receive it.

The annual economic burden of epilepsy is estimated at $9.6B, and co-morbid mental health difficulties increase medical visits 2–4-fold, placing these youth at considerable risk for negative outcomes (e.g., low health-related quality of life (HRQoL) and epilepsy self-management). Even subthreshold symptoms not warranting a clinical diagnosis of depression can still significantly impair HRQoL. Despite documented comorbidities and economic and personal burden of epilepsy, monies allocated for epilepsy research are an abysmal 0.97% of funding at the National Institutes of Health.

To address these critical gaps in health care and national priorities of key epilepsy stakeholders, this proposal will evaluate the psychometric properties and utility of the Neurological Disorders Depression Inventory for Epilepsy-Youth version (NDDI-E-Y), an evidence-based depression screening tool revised for youth with epilepsy. In initial testing on 93 youth, the 11-item NDDIE-Y demonstrated strong test re-test reliability and internal consistency and preliminary support for validity. Notably, a modest sample size did not allow for complete confidence in some of the results (e.g., ROC and factor analysis). Based on initial results, the NDDI-E-Y has been revised. Finally, we did not investigate potential relationships of the NDDI-E-Y with HRQoL or other self-report depression measures.

Thus, the proposed, innovative study will address previous limitations by: 1) inclusion of a larger sample size to allow for extensive reliability and validity testing of an epilepsy specific depression screening measure, the revised NDDI-E-Y, via complex statistical methods and 2) evaluating patient utility and satisfaction with the NDDI-E-Y administered during a routine epilepsy visit.

Study Aim. Validate an evidence-based depression screening tool for youth with epilepsy

Subaim 1: Evaluate the psychometric properties of the revised NDDI-E-Y to inform potential future use of the NDDI-E-Y as a depression screening tool and epilepsy health outcome.
Hypothesis 1.1: The revised NDDI-E-Y will have strong internal consistency and test re-test reliability.
Hypothesis 1.2: The revised NDDI-E-Y will demonstrate construct validity by associations with other self-report measures of depression and HRQoL, stable factor structure, and high sensitivity and specificity for predicting depression on the Children’s Depression Inventory.

Subaim 2: Determine patient utility of and satisfaction with the NDDI-E-Y administered during a routine epilepsy visit as an integrated physical and behavioral health experience.
Hypothesis 2.1: Patients will report satisfaction with the NDDI-E-Y administered during a routine epilepsy visit.

For more information contact Dr. Wagner at wagnerjl@musc.edu
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RWJF New Careers in Nursing: Mentoring Future Nurse Leaders
Sponsor/Type: Robert Wood Johnson Foundation (RWJF)
Project Period: 09/01/2010 - 08/31/2014
Tiffany Williams, DNP, APRN, CPP-PC

The University and College have developed and implemented targeted recruitment activities for underrepresented and disadvantaged students/faculty. These activities utilize partnerships with South Carolina Area Health Education Consortium and efforts by faculty. These include; The Ernest Just Symposium, SC AHEC Summer Careers Academy, AHEC Bench to Bedside, outreach to HBCU, advertisements in Minority Nurse, revised admission criteria and student referral. With RWJ funding, our diversity has increased from 18% in Spring 2008 to an average of 37.3%. This is a 100% increase.

In SC, the 2nd degree student does not have access to state loans, incentives or scholarships, thus the RWJ monies allow the opportunity and the ability to focus on nursing. NCIN students are selected using academic performance, demographic data, Expected Family Contribution and FAFSA. The NCIN Team evaluates the data and offer to the selected students.

Leadership is our strength and is integrated within the curriculum. The scholars must participate in a leader activity and have sponsored the MS Community Walk, joined professional organization(s) and become a student Tutor(s). Mentoring is a key factor to success. We have asked our NCIN Scholars to buddy with a subsequent RWJ cohort student and to identify a person from their community who is interested in health care to visit the campus (face to face and virtual). Each scholar has a faculty mentor and both participate in NCIN meetings and activities. This connection to people is seen as integral to student success.

Our Diversity Committee focuses on recruitment, retention and support of underrepresented students, faculty and staff. The College goal is an organizational culture that promotes openness to diverse perspectives, inclusion and full participation of students, staff and faculty. We actively apply for and receive grants that support diversity and see this as sustainable. We continually search for measures to further advance this initiative.

For more information contact Dr. Williams at williamt@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 Period: 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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Charleston PASOs: Improving Access to Health Services in the Tricounty Hispanic Community
Sponsor/Type: Trident United Way
Project Period: 07/01/2012 – 06/30/2014
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 promotes healthy behaviors within the Hispanic community which can ultimately reduce preventable health conditions.

Charleston PASOs plans to implement strategy two under the target issue “increasing access to health care.” Through collaboration with local health, social, and academic professionals, as well as Hispanic community members and leaders, Charleston PASOs will provide a coordinated support service that improves access to healthcare by diminishing or removing multiple barriers that prevent Tricounty Hispanic families from being able to access necessary health and social services. Barriers addressed by PASOs 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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Teen Health Advocate Leadership Program Planning Plan
Sponsor/Type: Center for Public Service Communications/NLM
Project Period: 02/01/2008 - 09/30/2014

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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Building Capacity in the Hispanic Community: A Health Promotion Program With A Focus on Health Literacy and Community Navigation
Sponsor/Type: Henry and Sylvia Yaschik Foundation
Project Period: 06/01/2013 – 05/31/2014
Deborah Williamson, DHA, RN, MSN, CNM

Purpose

This application requests funding for one year to complete a thorough evaluation, manualization, and dissemination of a health promotion program that is an integral part of Abrazos, a family literacy program that targets young Hispanic families. Requests for program materials from across the state and the region has prompted the need to complete this evaluation process in order to be able to disseminate the program as a “Promising Best Practice”.

Background

Abrazos is an established family literacy program in North Charleston supported by a partnership between the Medical University of South Carolina (MUSC) College of Nursing (CON), and the Charleston County School District (CCSD) to address the educational and health needs of the local Hispanic population. Hispanic mothers participate in “English For Speakers of Other Languages (ESOL)” classes while their children participate in an early childhood development program. An integral part of Abrazos is the MUSC CON health promotion program promoting health literacy through a relevant curriculum and building capacity by developing the skills of the participants to navigate community and medical resources.

The Abrazos program is funded by Title I, through the Charleston County School District. This very popular program has grown from serving 12 women and children and operating 2 mornings per week to now serving 50 women and children 4 days per week. Over the past 4 years, 172 families have participated in this program and anecdotal data suggests that improvements in accessing health services and community resources occur as a result of program participation. There are many family literacy programs – some are run by for profit or non-profit organizations, others are administered by state agencies. The Abrazos program is unique in combining family literacy with a health promotion component that is culturally and linguistically appropriate for

Hispanic families. There are no similar local programs, and we are unaware of any similar programs that exist within the state.

Recently the health promotion program was featured on SCETV in a program titled “Social Determinants of Healthcare” narrated by Dr. Ray Greenberg, MUSC President. (To view: Go to http://scetv.org/index.php/the_big_picture/ and search for the title “Social Determinants of Healthcare”. There are several clips, but you want the one that is not identified as an interview and is titled: “Recently, the Medical University of South Carolina hosted a conference to discuss the role social determinants . . . ”. Go to minute 16 to see live footage of the health promotion program). After this program was aired, multiple requests from around the region were received for copies of program materials. Prior to distribution of program materials, a rigorous evaluation of materials needs to be completed. Although Title I provides the funding for the program, there are no funds to support a thorough evaluation and manualization of the health promotion component.

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