Pilot Studies Year Five

 

Pilot Study Year 5-12

Online Screening for Postpartum Depression

Principal Investigator: Emily E. Drake, RN, PhD, Assistant Professor

Abstract: Postpartum Depression (PPD) is one of the most common complications of childbearing. It is estimated that 3-25% of all women in the first months following delivery will experience PPD (Gaynes, et al., 2005; O’Hara & Swain, 1996). However, it is difficult to determine the exact incidence of PPD and estimates of the prevalence of PPD vary. This is a disease that often goes undiagnosed and unreported. The fear and stigma associated with PPD is a major challenge in the treatment of this disease. Women often lack a confidential, secure and dependable method of screening and a way to receive information about referral and treatment.

The long-term goal of this program of research is to develop a private, online screening and referral intervention for PPD that could be used with large populations. The first step will be to pilot test the online version of this instrument with a known population. The purpose of this pilot proposal is to develop and test an innovative, on-line screening tool designed to improve the identification of postpartum depression in women. The research questions for this study are: 1) Can an online, web-based screening tool be developed based on existing PPD screening instruments? 2) How will postpartum women respond to this kind of screening (accessibility, satisfaction, response rates) particularly in rural, underserved areas?

A descriptive design will be used to explore the feasibility of online screening for PPD in a convenience sample of primarily rural, underserved women in the first 2-3 months after delivery. Women will initially be recruited for the study from a local hospital in the first days after delivery. A 10-item instrument will be used to measure postpartum depression (EPDS: Cox, Holden & Sagovsky, 1987). Demographic variables will also be measured to assess factors that may influence response rates, as well as open-ended questions regarding the experience of online screening.

Performance Sites:
University of Virginia
School of Nursing & Medical Center (100 deliveries/month)
Charlottesville, Virginia

Pilot Study Year 5-13

The Impact of Cell Phones and SMS on Clinical Outcomes in Patients with HIV/AIDS

Principal Investigators: Sarah Delgado, RN, MSN, ACNP and Rebecca Dillingham, MD, MPH

Research Team:
Jason Freeman, PhD, Associate Professor, University of Virginia School of Medicine
Mary Rafaly, BSW, clinical social worker, Infectious Disease Clinic
Jenny White, RN, BSN, School of Medicine
Julia Brant, BA, student in the UVA post baccalaureate pre-medicine program
Erin Yeagley, RN, MSN, FNP student in the Doctor of Nursing Practice program
Tushar Sinha, MD, University of Virginia School of Medicine, Residency Program

Abstract:  HIV infection is no longer a death sentence in the United States. Thousands of patients manage HIV as a chronic illness and live happy, productive lives. However, successful management of HIV infection requires strict adherence to highly-active antiretroviral therapy (HAART) for life. HIV-infected patients in rural Virginia struggle with formidable barriers to adherence including poverty, geographic isolation, lack of transportation and fear of stigma. Programs employing cell phone technology to improve chronic disease management have been successful in a variety of settings. The proposed pilot study will evaluate a cell phone-based strategy to promote adherence to HAART in rural HIV-positive Virginians who are at high-risk for non-adherence. The primary outcome measure will be the percentage of patients remaining in care at 6 months. Secondary outcomes will include: reduction in HIV viral load, medication adherence as measured by participant self-report and measurement of the interval between obtaining medication refills, clinic visit attendance, and patient perception of quality of life and self-efficacy. The study will also assess participants’ knowledge of HIV disease and access to support at two intervals. Data about the acceptability of the cell phone intervention will be collected via an exit interview.

Study visits will coincide with established medical visits, and patients will be randomly assigned to a control group receiving usual care or an intervention group, receiving usual care and a cell phone at no cost. The phone will be programmed with phone numbers related to the management of their HIV. In addition, a web based program will send text messages to each cell phone reminding intervention group participants to take their medications, call for refills and come to clinic appointments. All study participants will be followed for 6 months. Development of the text messaging system and an evaluation of the feasibility, acceptability, and cost-analysis of its implementation are additional outcomes of this study.

Performance Sites:
University of Virginia Health System, Infectious Disease Clinic
Charlottesville, Virginia

Pilot Study Year 5-14

Motivations for Seeking Emergency Department Care Among Rural and Urban Patients

Principal Investigator: Sarah L. Anderson, Ph.D., RN
Co-Investigator: Audrey Snyder, Ph.D., RN
Co-Investigator: Sandra Annan, Ph.D., RN

Abstract:  People living in rural areas constitute about one fourth of the United States population, and this population may be at greater health risk than non-rural residents. Health needs and health problems in the rural setting are often different from others in non-rural areas. A higher proportion of people living in rural communities have complex illnesses (Gamm, Hutchinson, Dabney & Dorsey, 2003). Furthermore, people living in rural communities also face many barriers to care and access issues. Some barriers to care and health care access issues occurring in the rural setting are well documented in the literature. Rural populations are less likely to have access to hospice services, prenatal care, screening services, cardiac rehabilitation services, and specialists (Gamm et al., 2003; Virnig, Ma, Hartman, Moscovice & Carlin, 2006). Barriers to care for rural elders included: economic and transportation difficulties, social isolation, lack of quality health care, and limited local health care (Goins, Williams, Carter, Spencer, & Solovieva, 2005). Economic constraints can impede health care, and economic difficulties resulting from job loss are common in rural areas. Historically, rural household incomes are low. From 40 - 45% of rural people live in poverty (Stommes & Brown, 2002). Such individuals may not want to incur medical bills that they cannot pay, thus do not seek preventative care, or medications and medical supplies.

Gaining information directly from rural patients is critical to understanding rural health care issues. People living in rural communities experience many barriers to health care access such as financial and transportation difficulties.  The health of many rural residents is such that local medical specialists are needed, yet few practice in the rural setting. Research suggests that many people living in rural areas bypass local hospitals and present instead to a non-rural emergency department (ED) for their health care. The health care team at the emergency department in the University of Virginia Health System cares for many of these rural patients. However, overcrowding and long waits make this seemingly convenient setting less than ideal for non-emergent care.  The purpose of this study is to determine, from the patient’s perspective, issues related to accessing health care and rationale for presenting to a non-rural emergency department for health care. Both rural and non-rural participants will be recruited in order to compare the two groups. Ultimately, this study, and a comprehensive one to follow, seeks to investigate rural access to care issues so as to facilitate access (at rural and non-rural locations) to provide the best overall health care for rural patients.

Performance Sites:
University of Virginia Health System
Emergency Department
Charlottesville, Virginia

Pilot Study Year 5-15

Shared Decision Making and Medication Use in Public Mental Health

Principal Investigator:  Irma Mahone, RN, PhD, Research Assistant Professor
Co-Investigator: Sarah Farrell, PhD, APRN, BC, CNL, Associate Dean
Co-Investigator: Ivora Hinton, PhD, Coordinator of Data Analysis and Interpretation

Abstract:  Psychiatric rehabilitation for persons with serious mental illness (SMI), with key features of choice, self-determination and active participation, has been a focus in mental health (MH) for the past 30 years, providing an excellent foundation for expansion and development of shared decision making (SDM) between client and healthcare provider. The concept of SDM has taken a firm hold in non-psychiatric chronic illnesses, where it has proven successful in improving effectiveness of treatments. In the Recovery Model of MH treatment consideration is given to the values and preferences of the consumer when medication is prescribed. SDM may prove to be a means of engaging SMI patients more in their medication regimen and of better undestanding real-world effectiveness of antipsychotics in MH treatment. The primary purpose of this study is to lay the foundation for implementing an acceptable, feasible SDM intervention in medication use for a SMI population through the public MH services sector. The research method used is Participatory Action Research (PAR) as this method focuses on participant strengths and recognizes valuable knowledge of participants. Utilizing a small core group of interested MH providers and a larger advisory collaborative of lay and professional stakeholders, a specific SDM intervention will be agreed on for future testing in rural and non-rural SMI individuals.

The UVA-SON research team, in partnership with the community core group, is forming an advisory collaborative of potential stakeholders in the local MH community interested in advancing SDM in the SMI population. This group will decide on a SDM intervention to be tested based on 1) current SDM in SMI academic literature review, 2) a critique of available SDM programs and initiatives, 3) the unique needs and strengths of the rural communities served by Region Ten, and 4) the preferences and values expressed by members of the core and advisory groups.

This pilot lays the foundation for implementing a suitable SDM intervention in the SMI population and establishing a sustainable, acceptable and accessible SDM alternative in the public mental health sector. This study contributes to a greater understanding of the important variables and dynamics in fulfilling the complex nursing role of combining routine nursing tasks with patient self-management and SDM in MH.

Performance Sites:
Region Ten Community Services Board, Old Lynchburg Rd., Charlottesville, VA
University of Virginia School of Nursing, Charlottesville, VA