Pilot Studies Year Two
Pilot Study Year 2-4
Preventing Sexually Transmitted Infections and Further Intimate Partner Violence in at-Risk Rural Women
Principal Investigator: Kathryn Laughon, Ph.D., R.N.
Co-Investigator: Barbara Parker, Ph.D. R.N.
Consultant: Claire Kaplan, Ph.D.
Graduate Research Assistant: Melissa Sutherland, Doctoral Student
Abstract: The goal of this proposed research is to test the feasibility and acceptability of a combined brief nursing intervention to prevent HIV and sexually transmitted infections (STIs) and further intimate partner violence (IPV) among rural female family planning clients in Louisa, Virginia. Supportive objectives include: 1) to explore how the rural context affects the ability of rural nurses to intervene to prevent HIV/STIs and IPV female clients and 2) to adapt a combined brief nursing intervention to address HIV/STI and further IPV prevention to the specific needs of rural women. To complete this goal and the corresponding objectives, the following specific aims are proposed: 1) Identify specific needs of rural health providers in addressing HIV/STI prevention and prevention of further IPV; 2) Adapt a combined brief nursing intervention (BNI) to prevent further IPV and reduce risk for HIV/STIs in rural women who are currently experiencing IPV; 3) Obtain initial results of the BNI on improving the outcomes of rural women who are currently experiencing IPV. Primary outcomes of interest are to reduce the frequency and the severity of IPV, to increase the number of safety behaviors implemented by women, and to increase the number of safer sex strategies used by women at 3 months post-intervention and 4) Ascertain the acceptability to research participants of the BNI delivered in a family planning clinic.
The study will employ a two stage design. During stage one, a descriptive study of the specific needs of rural women from the point of view of IPV and/or HIV/STI service providers will be conducted using semi-structured interviews. That data, along with data being collected from women experiencing abuse prior to the start of this proposed research, will be used to adapt the combined BNI as described below. Phase two of the design will consist of the modification of the BNI to the rural context, and pilot testing of the intervention to determine its feasibility and acceptability to rural women experiencing abuse and at-risk for STIs. The pilot testing will take the form of a one group, pre-test/post-test design. The findings from this proposed study will serve as pilot data for a subsequent R01 research grant application to conduct a randomized clinical trial of the intervention developed through this work.
Performance Sites:
University of Virginia School of Nursing
Charlottesville, Virginia
Pilot Study Year 2-5
Testing a Group Intervention for Managing Diabetes with Rural African Americans
Principal Investigator: Sharon Utz, Ph.D., R.N.
Co-Investigator: Richard H. Steeves, Ph.D., R.N.
Co-Investigator: Ivora D. Hinton, Ph.D.
Research Assistant: Jennifer Wenzel, Ph.D., R.N.
Research Assistant: Randy A. Jones, Ph.D., R.N.
Abstract: The problem of diabetes among African Americans is an important example of a health disparity in the U.S. Diabetes is a leading cause of cardiovascular disease, stroke, blindness, end-stage renal disease, and non-traumatic lower limb amputations (NIDDK, 2000; Chin, Zhang, & Merrell, 1998). Type 2 diabetes represents 95% of diabetes and is an increasing health problem affecting mostly older adults and members of racial and ethnic minorities (NDEP, 2000). Current estimates indicate that nearly one in four African American women over age 55 has diabetes--twice the rate of white women (ADA, 2000; Office of Research on Women’s Health, 1998).
The present team of researchers recently completed an NIH-funded (R-15) descriptive study focusing on African American adults with type 2 diabetes in two rural counties of central Virginia with high rates of diabetes. The purpose of the NIH-funded study was to identify facilitators and barriers to self-management, to explore differences between experiences of men and women, and to identify unique cultural factors affecting diabetes self-management (Utz, Wenzel, Hinton, Jones, & Steeves, 2003). Having completed this descriptive study, this team of researchers is now ready to test a culturally-tailored group intervention, consisting of a program to meet the needs described by these rural African Americans living with type 2 diabetes.
This pilot will test the feasibility and the efficacy of the intervention, thus laying the foundation for an R01 proposal to NINR or NIDDK to comprehensively test this unique group approach. Its specific aims are: 1) to develop a “Culturally-Tailored” group intervention to enhance diabetes self-management for African American adults living in a rural county in central Virginia; 2) to test the efficacy of the “Culturally-Tailored” group intervention in two groups of 8 participants each (total 16) against a group of 16 Usual Care subjects who receive standard diabetes care from providers in the community. Comparisons would then be made between the two groups in the following areas: changes in self-management actions, changes in diabetes-related self-efficacy, changes in HgA1c, the degree of success in attaining self-management goals, and satisfaction with diabetes care; and 3) to test the use of a new point-of-care technology for obtaining HgA1c measurement from participants in this rural county.
Participants will be screened by telephone and then randomly assigned using a table of random numbers to either the Usual Care Group or to the Culturally-Tailored Intervention Group. The proportion of men and women in the groups will be adjusted if necessary after randomization to maintain the similarity of proportions to maintain similar characteristics of the groups. Inclusion criteria are: African American, age 18 or above, diagnosed with type 2 diabetes, resident of Louisa County, and able to give informed consent (e.g. no evidence of dementia as determined by routine telephone screening). The program will be advertised via the same methods found effective in our first study -- flyers, church announcements, radio announcements specifically in the community. The overall program will be entitled “Taking Care of ‘Sugar’: African Americans Deal with Diabetes”.
Performance Sites:
University of Virginia School of Nursing
Charlottesville, Virginia
Rural Sites:
Louisa County, Virginia