Pilot Studies Year Four

Pilot Study Year 4-9

Increasing Activity in Rural Dwelling Adults with Heart Failure

Principal Investigator: Kathy Haugh, Ph.D., RN
Co-Investigator: James D. Bergin, MD
Co-Investigator: Arthur L. Weltman, Ph.D.
Co-Investigator: Diane Whaley, Ph.D.
Co-Investigator: Glenn A. Gaesser, Ph.D.
Co-Investigator: Juanita Reigle, RN, MSN, ACNP-CS

Abstract: While benefits of exercise are well documented for individuals with heart failure (HF), rural dwelling adults (RDA) are often limited in ability or resources to participate in cardiac rehabilitation or home exercise programs. Long-term goal: The broad goal for this program of research is to enhance the quality of life (QOL) of adults with HF. Specific aims: The Health Belief Model guides this study to 1) Explore relationships between perceptions, modifying factors, self-efficacy (SE), and likelihood of PA using a 3 month pedometer intervention among RDA with HF; 2) To determine feasibility of a larger study; and, 3) To determine adequacy and appropriateness of study measures and design. The study will gather preliminary data to test the following hypothesis: After controlling for health status, rural dwelling adults living with heart failure who wear a pedometer for 3 months and receive Health Care Provider (HCP) prescriptive feedback will demonstrate a greater increase in the average number of steps taken/day, report a greater improvement in exercise self-efficacy and QOL, and demonstrate greater improvements in physical function (6MWT, FMD, BP, HR) compared to individuals who wear a pedometer and do not receive HCP feedback or individuals who receive usual care. Design: This prospective, randomized study will determine differences in steps/day, QOL, and physical function between three groups:  PedPlus - receive unit based education and a combination of a pedometer educational/motivational packet, pedometer feedback, and Health Care Provider prescriptive feedback; Ped - PedPlus intervention without Health Care Provider prescriptive feedback; and Usual Care (UC) - unit based education only. Primary outcomes include steps/day (Ped, PedPlus), QOL and six minute walk distance. Secondary outcomes include BP, HR, flow mediated dilation (FMD), and exercise SE. Setting: A tertiary care medical center will be the recruitment and testing site. Physical activity will occur in the patient’s home environment. Sample: Fifty-one RDA, aged ≥ 18, with a confirmed diagnosis of HF (NYHA II-III) will be recruited. Instruments: Short Form 36 (SF-36v2), Kansas City Cardiomyopathy Questionnaire (KCCQ), Cardiac Exercise Self Efficacy Instrument (CESEI) (modified). Procedures: HF patients will receive a recruitment brochure on admission. Potential participants will contact the study nurse who will screen potential participants. At discharge (or within one week), baseline data will be collected: demographics, SF-36v2, KCCQ, CESEI, 6MWT, FMD. Patients will then be randomized using block randomization. The UC group will receive no contact until follow-up. The two pedometer groups will receive pedometer and log recording instructions. Every two weeks the pedometer groups will be reminded by postcard to return logs. The Ped only group will not receive feedback; the PedPlus group will be contacted with an individualized steps/day prescription based on log data. At 12 weeks all data (except SF-36v2) will again be collected along with an activity survey. Primary analysis methods: Data will be analyzed by linear-mixed effects ANCOVA models with the SF-36v2 as covariate.

Performance Sites:

University of Virginia
School of Nursing
Charlottesville, VA

General Clinical Research Center
University of Virginia Health System
Charlottesville, VA

Rural Sites:

Surrounding rural counties of Charlottesville, VA

Pilot Study Year 4-10

Being Tobacco-Free in Rural Virginia: Beliefs and Strategies of Male Adolescents

Co-Principal Investigator: Pamela A. Kulbok, APRN, BC, DNSc
Co-Principal Investigator: Peggy S. Meszaros, Ph.D.
Co-Investigator: Nisha Botchwey, Ph.D.
Co-Investigator: Ivora (Ivy) Hinton, Ph.D.
Co-Investigator: Donna C. Bond, RN, MSN, CNS, AE-C
Co-Investigator: Viktor Bovbjerg, Ph.D.

Abstract: This proposal entitled Being Tobacco-Free in Rural Virginia: Beliefs and Strategies of Male Adolescents builds upon a previous research by the Principal Investigators (PIs) and Co-Investigators (Co-Is). Dr. Kulbok (PI) has foundational experience in health promotion and adolescent health behavior research focused on conceptualization and measurement of health risk behaviors. In secondary analysis of a national sample funded by the National Institute of Nursing Research (NINR), cigarette smoking was found to be a behavioral dimension distinct from substance use behaviors in groups of young, middle, and older adolescents (Kulbok & Cox, 2002). Dr. Meszaros (Co-PI) has research experience in areas of female smoking and parent communication (Meszaros & Matheson, 2006) and adolescent co-occurring disorders.

The proposed study is part of an evolving collaborative, interdisciplinary, and multi-institution research program led by Drs. Kulbok and Meszaros focused on protective factors and adolescent nonsmoking in order to design and test interventions for youth tobacco prevention and ultimately reduce morbidity and mortality from tobacco use. One preliminary study examined attitudes, beliefs and nonsmoking norms of 16 and 17 year old African American and Caucasian, female and male nonsmokers from an urban area (Kulbok et al., in review); another study, currently in the final phase of data-analysis, explored protective factors identified by female adolescent nonsmokers and their parents, who reside in rural counties of Virginia (Kulbok et al., 2006).  

The proposed qualitative study of male adolescent nonsmoking and nonuse of smokeless tobacco (ST) and parental influence, and the use of a modified Photovoice methodology, is a new direction for the research team. Completion of this project will lead to a federal grant submission (for example, NINR- PA-06-298, Understanding Health Risk Behavior Change in Children and Adolescents [R21]) using innovative strategies to design new interventions to prevent youth tobacco use. The results of this research will be disseminated at national meetings such as the American Public Health Association (APHA) (Kulbok is an active member) the Society for Prevention Research (SPR) (Meszaros is an active member) and key tobacco control and prevention meetings at both the state and national levels.  At least two manuscripts will be written about findings related to beliefs and values for nonuse of tobacco and the feasibility of research using Photovoice with male adolescents and their parents applied to youth tobacco prevention.  Manuscripts will be submitted to the Journal of Child and Adolescent Substance Abuse, the Journal of Adolescent and Family Health, and/or Addictive Behaviors.

Performance Sites:

University of Virginia
School of Nursing
Charlottesville, VA

Pilot Study Year 4-11

Blue Ridge Mental Health Initiative Screening Program

Principal Investigator: Emily J. Hauenstein, Ph.D., LCP, RN
Co-Investigator: Irma Mahone, Ph.D., RN
Co-Investigator: Sarah Farrell, PhD, APRN, BC
Co-Investigator: Ishan Williams, PhD
Co-Investigator: Anita Thompson-Heisterman, MSN, RN, CS, FNP

Abstract: Mental health services are in short supply in rural areas which contributes to under treatment of rural residents (Hauenstein, Petterson, Merwin, Rovnyak, Heise & Wagner, in press; Merwin, Hinton, Dembling & Stern, 2003; Wang, Lane, Olfson, Pincus, Wells & Kessler, 2005). There is considerable evidence that primary-care providers are the arbiters of mental heath services in rural areas because of the undersupply of mental health providers and their distance from many rural residents (Acury, Preisser, Gesler & Powers, 2005; Fortney, Rost, Zhang & Warrant, 1999; Merwin, Hinton, Harvey, Kimble, Mackey, 2001: Wang, Lane, Olfson, Pincus, Wells & Kessler, 2005). Further, detection of mental health problems by primary care providers is far below actual prevalence, likely contributing to the demonstrated higher rates of hospitalization for mental health problems, and higher rates of suicidal ideation and suicide completion among rural residents (Anderson & Gittler, 2005; Rost, Fortney, Fischer & Smith 2002; Singh& Siahpush, 2002; Fortney et al., 1999; Wang et al., 2005). The demands on rural primary care providers coupled with their lack of training in psychiatric assessment make detection of psychiatric disorders difficult in these settings.

The BRMC is a federally funded community health center located in Nelson County, Virginia providing primary healthcare services to a largely-impoverished rural population. RHOP, affiliated with BRMC, was established in February 1992 with funding from the United States Public Health Service's Office of Rural Health Policy. Its mission is to increase access to health and human services for people who are hampered by barriers such as lack of transportation, low income, lack of health insurance and cultural differences. A 2002 Healthy Community Access Program grant recipient, RHOP provides a comprehensive array of community-based health services. A program manager leads a community healthcare team including full-time school nurses in each of Nelson County’s four schools,  two nurse practitioners bringing primary and preventive health services to local residents in a wide variety of school and community settings, and care-coordination staff to connect area residents in need to culturally-appropriate service providers who can help.  Community-based services include home visits, regularly-scheduled screening events called “Health Depots,” health education and transportation.  RHOP operates a mobile health unit that houses a fully-equipped exam room and could be used to set up additional eScreen opportunities. RHOP resources are extended significantly through the Nelson Volunteer Coalition, managed by the RHOP volunteer coordinator. Recently BRMC added a psychiatric nurse practitioner (NP), funded through a HRSA Health Disparities Collaborative grant.  This Psych NP manages patients with depression and other mental health issues and has facilitated on-demand mental-health services at the center. Region Ten Community Services Board, BRMC and a handful of private practitioners provide mental-health services in Nelson County.

Performance Sites:

University of Virginia
School of Nursing
Charlottesville, VA