Summaries of UW ICTR Collaborative Health Equity Research (CHER) Pilot Grants, 2017

Two new UW ICTR CHER Pilot Grants were awarded in response to the 2017 RFA:

  • Feasibility and Acceptability of a Pilot Culturally Specific Educational-Behavioral Intervention for African Americans with Type 2 Diabetes

PI:OlayinkaShiyanbola, PhD, UW School of Pharmacy

Collaborator: North East Side Senior Coalition

Summary:The goal of this ICTR Collaborative Health Equity Research Pilot award is to utilize patient and community stakeholders to design and determine the feasibility and acceptability of an educational-behavioral intervention focused on addressing culturally informed illness and medication beliefs, self-efficacy, and medication adherence among African Americans with type 2 diabetes.

In the United States, diabetes affects 3.7 million African Americans (AAs) who are more likely to be diagnosed with the disease and are at a greater risk for diabetes-related death and disability compared to non-Hispanic whites. The magnitude of the diabetes disparity within Wisconsin is enormous. Approximately 356,000 adults in Wisconsin are diagnosed with diabetes. Diabetes is the seventh leading cause of death in Wisconsin, incurring an estimated $3.9 billion annually in health care and lost productivity costs. Each year, more than 1,300 Wisconsinites die from diabetes and many more suffer diabetes-related complications such as heart disease, kidney disease, blindness, and amputations. This burden is higher among minority populations, especially among AAs. In 2005, AAs in Wisconsin had higher rates of hospitalization and death from diabetes complications like heart disease and stroke compared to the total Wisconsin population.

The most important self-management behavior for improving diabetes outcomes is medication adherence, which is the extent to which taking medications corresponds to provider recommendations. Poor medication adherence leads to 125,000 deaths and 300,000 hospitalizations annually. Poor adherence to diabetes medicines is common among AAs and contributes to disproportionally worse outcomes. AAs have a 25% lower adherence to diabetes medications than whites. Existing adherence interventions are sometimes ineffective for AAs because of their unique beliefs regarding disease and medicines, as well as low self-efficacy, which are not adequately addressed in interventions. Our long-term goal is to decrease diabetes-related morbidity among AAs by implementing culturally appropriate interventions to increase medication adherence. This project advances the development of culturally appropriate adherence interventions for AAs with diabetes and focuses on specific behavioral constructs identified from our prior work to influence adherence.

  • Development of Tailored Approaches for Optimizing Research Engagement among Disadvantaged Patients with Alzheimer’s Disease and their Caregivers in Acute Care Settings

PI:Andrea Gilmore-Bykovskyi, PhD, RN, UW School of Nursing
Collaborators:BerBeeWalsh Department of Emergency Medicine, UW Hospital; St. Joseph Hospital, Ascension Healthcare Wisconsin

Summary:Despite well-documented disparities in Alzheimer’s disease (AD) prevalence, incidence, treatment, and mortality, individuals from disadvantaged backgrounds (racial/ethnic minorities, low socioeconomic status) are disproportionately under-represented in clinical AD research. This poses a major barrier for efforts to better understand how disease risk factors and protective factors influence AD progression, and exacerbates existing disparities in health and care. Current recruitment methods for AD research predominantly identify patients from outpatient and memory screening clinics, or with pre-existing dementia diagnoses. Research suggests that these methods create systematic barriers to including individuals from disadvantaged backgrounds as they are more likely to: 1) have higher levels of comorbidities (thus more likely to be ineligible), 2) be undiagnosed, 3) have limited access to outpatient care and rely on acute care settings to meet health needs, and 4) may not speak English. Unfortunately, effective strategies for addressing these multi-faceted barriers to research participation are not yet available, and the overwhelming contribution of lack of access to routine outpatient care in these groups remains unaddressed. In recognition of this critical gap, the National Institute on Aging and the National Plan to Address Alzheimer’s Disease specifically call for research to “identify and implement steps for engaging and enhancing research participation” among disadvantaged patient groups (e.g. racial and ethnic minorities).

In response to this need, we propose to develop tailored recruitment strategies that are responsive to these barriers and can be initiated in acute care settings to facilitate improved research participation among disadvantaged individuals with AD and their caregivers in research. This represents a critical first step towards addressing disparities in research participation among disadvantaged AD patients who are not sufficiently targeted by outpatient and community screening methods, by virtue of being unconnected to care or lacking social connection to their community. Findings from this study will introduce a significant innovation in the field of AD research recruitment by informing strategies for engaging these patients in research during acute care stays and acute illness, which is a major challenge in clinical AD research.