Pilot Studies Year One
Pilot Study Year 1-1
Mammography Screening in Rural African American Populations
Principal Investigator: Bonnie Jerome-D'Emilia, Ph.D., RN
Co-investigators: Elizabeth Merwin, Ph.D., RN, F.A.A.N.
Steven Stern, Ph.D.
Ivora Hinton, Ph.D.
Abstract: For research to be adopted into practice, the research evidence must be adequately disseminated to providers to inform and guide practice. This is a particularly relevant issue for rural nursing practice in that rural nurses are too often isolated and may have to travel large distances to attend educational programs or to reach the nearest health science library. Further, evidence-based practices may need to be adapted to the unique characteristics of rural health settings, particularly considering the deficiency of specialists and other resources. The large distance between rural clinics makes it difficult to have multiple settings involved in the same study. However, the clinics are often small and conducting studies in only one clinic may result in small sample sizes. Telemedicine and web-based distance learning methodologies provide a technological opportunity to disseminate evidence-based information and also to implement research in rural areas including in multiple rural clinics. This pilot study provides a model for further dissemination of a well-established evidence-based practice--mammography screening. Further, it evaluates the impact of the dissemination through an evaluation of patient outcomes--increases in referral for mammography and increased mammography screening.
Mammography screening is particularly underutilized in rural areas. Its simplicity yet importance makes it an ideal intervention to use as a model to evaluate the feasibility of using telemedicine and web-based technology to disseminate information. The effectiveness of using technological methodologies to disseminate evidence-based information to a population of rural nurses and to improve the rate of mammography screening in African-American and Caucasian women will be determined in this study.
Performance Sites:
University of Virginia School of Nursing
Pilot Study Year 1-2
eScreening: Case Finding in Rural Primary Care
Principal Investigator: Sarah P. Farrell, Ph.D.
Co-investigators: Emily Hauenstein, Ph.D., LCP, APRN, BC
John Schorling and others
Abstract: Despite the attention to screening for depression and alcohol use, Healthy People 2020 objectives continue to include goals addressing the need to increase the detection of depression and decrease the rates of alcohol abuse. Major depression will be the second most burdensome illness in the world by the year 2020 (Murray & Lopez, 2000). Early detection can increase the percentages of people with mental health problems who can receive treatment. However, in isolated rural areas, early detection will require finding innovative ways to screen people who experience barriers to care. The goals of this study are to develop a computer-based electronic screening technology (eScreening) for rural users of primary care. This descriptive pilot study will adapt existing screening measures for depression and alcohol abuse to a portable computer-based format and examine the feasibility of its adoption and use. This will be a three-step design using convenience samples beginning with focus groups with providers to gain a better understanding of the usefulness and acceptability of eScreening. Second, with focus group information, the instruments will be computerized and a touch screen developed to create an easy to use format. Once the computerized platform is complete, the second phase of the study will involve usability testing with selected rural patients from the primary care setting. After modifications in the touch screen platform, in Phase 3 the eScreening will be implemented in primary care with a small sample to determine feasibility. It is expected that findings will lead to an NIH grant application using the R21 funding mechanism to test the completed product with a larger sample of subjects.
Performance Sites:
University of Virginia School of Nursing
Charlottesville, VA
Pilot Study Year 1-3
A Decision-Making Program for Adolescents with Asthma
Principal Investigator: Hyekyun Rhee, Ph.D., RN
Co-Principal Investigator: Patricia Hollen, Ph.D., RN
Co-investigator: Gary P. Rakes, MD
Consultant: Michael Belyea
Abstract: Recent national statistics reveal that approximately 9.2 million children under the age of 18 suffer from asthma, and asthma-related morbidity and mortality is higher in adolescents than in childhood. Having asthma does not seem to deter youngsters from risk behaviors which pose serious threats by impairing overall respiratory function. Thus, we need interventions to improve decision-making skills related to lifestyle behaviors that will reduce the chance that vulnerable adolescents will initiate and engage in risky behaviors.
The specific aims of this study include: (1) determining the feasibility of implementing a short, clinic-based, computerized, decision-making intervention for rural adolescents with asthma; (2) exploring the following hypothesis: rural adolescents receiving the cognitive-behavioral skills program will report improved quality decision-making at 2-, 4-, and 6-months post-intervention compared with the control group; (3) exploring the following hypothesis: rural adolescents receiving the intervention program will report maintained or lowered risk motivation and risk behavior status (smoking, alcohol consumption, or illicit drug use) at 2-, 4-, and 6-moth post intervention compared with the control group; (4) examining the influence of specific factors (personal properties, illness status, social modeling, and cognitive function) on the intervention's impact on decision-making and risk motivation needed for reducing risk behaviors. This is a prospective, randomized study using repeated measures at 2-, 4-, and 6-month follow-ups. The intervention includes a CD-ROM at 2 months, and an interactive substance use CD-ROM at 4 months. Data will be collected from 40 teens with mild to severe persistent asthma, between 14-18 years of age, attending a rural pediatric clinic in Virginia. The teens will be randomly assigned to either the intervention or control group. Baseline data collection of a battery of measures from the teens and their parents will be followed by the intervention at enrollment. For both groups, 2-, 4-, and 6-month follow-up data of the shortened battery of measures will be collected online. To determine the feasibility of the intervention program, descriptive statistics using data from program evaluation instruments will be computed. The effectiveness of the program will be assessed using a repeated measures MANOVA, general linear mixed models, generalized estimating equations (GEE), and multiple regression.
Performance Sites:
University of Virginia
School of Nursing
Charlottesville, VA
Rural Sites:
University of Virginia
Pediatric at Orange, Children's Medical Center
Orange, VA