Browsing by Author "Silberberg, Mina"

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    Changing CHANGE: adaptations of an evidence-based telehealth cardiovascular disease risk reduction intervention.
    (Translational behavioral medicine, 2018-03) Zullig, Leah L; McCant, Felicia; Silberberg, Mina; Johnson, Fred; Granger, Bradi B; Bosworth, Hayden B
    Relatively few successful medication adherence interventions are translated into real-world clinical settings. The Prevention of Cardiovascular Outcomes in African Americans with Diabetes (CHANGE) intervention was originally conceived as a randomized controlled trial to improve cardiovascular disease-related medication adherence and health outcomes. The purpose of the study was to describe the translation of the CHANGE trial into two community-based clinical programs. CHANGE 2 was available to Medicaid patients with diabetes and hypertension whose primary care homes were part of a care management network in the Northern Piedmont region of North Carolina. CHANGE 3 was available to low-income patients receiving care in three geographical areas with multiple chronic conditions at low or moderate risk for developing cardiovascular disease. Adaptations were made to ensure fit with available organizational resources and the patient population's health needs. Data available for evaluation are presented. For CHANGE 2, we evaluated improvement in A1c control using paired t test. For both studies, we describe feasibility measured by percentage of patients who completed the curriculum. CHANGE 2 involved 125 participants. CHANGE 3 had 127 participants. In CHANGE 2, 69 participants had A1c measurements at baseline and 12-month follow-up; A1c improved from 8.4 to 7.8 (p = .008). In CHANGE 3, interventionists completed 47% (n = 45) of calls to enroll participants at the 4-month encounter, and among those eligible for a 12-month call (n = 52), 21% of 12-month calls were completed with participants. In CHANGE 2, 40% of participants (n = 50) completed all 12 encounters. Thoughtful adaptation is critical to translate clinical trials into community-based clinic settings. Successful implementation of adapted evidence-based interventions may be feasible and can positively affect patients' disease control.
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    Perceived Benefits of Training Clinicians in Community Engagement for a Leadership Development Program.
    (Family medicine, 2022-02) Simpson, Courtney; Silberberg, Mina; Hibbard, Susan T; Lyn, Michelle J; Sawin, Gregory

    Background and objectives

    Community engagement (CE), including community-engaged research, is a critical tool for improving the health of patients and communities, but is not taught in most medical curricula, and is even rarer in leadership training for practicing clinicians. With the growth of value-based care and increasing concern for health equity, we need to turn our attention to the benefits of working with communities to improve health and health care. The objective of this brief report is to increase understanding of the perceived benefits of CE training for primary care clinicians, specifically those already working.

    Methods

    We assessed perceived benefits of CE training for primary care clinicians participating in health care transformation leadership training through analysis of learner reflection papers.

    Results

    Clinicians (n=12) reported transformational learning and critical shifts of perspective. Not only did they come to value and understand CE, but the training changed their perception of their roles as clinicians and leaders.

    Conclusions

    Educating primary care clinicians in CE as a foundational principle can orient them to the criticality of stakeholder engagement for daily practice, practice transformation, and population health improvement, and provides them with a new understanding of their roles as clinicians and leaders.
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    The Universal Language of Story | Developing Model Narratives for Provider Parent Interactions to Guide Child Vaccination Decisions
    (2023) Gachara, Lisa

    Background: Vaccine hesitancy is driven by various contextual, group, and individual determinants and vaccine-specific factors. Vaccine hesitancy acts as a barrier to childhood vaccination. While literature suggests narrative communication may be influential towards promoting health behavior, there is a gap in understanding how narrative communication approaches can be utilized to support parent-provider conversations around childhood vaccines. The objectives of this study were to: (1) Conduct secondary analysis of in-depth interview data from parents and providers to identify commonalities within the decision-making process for parents making vaccine choices for their children and determine aspects of priority for providers when engaging in vaccine communication. (2) Develop fictional narratives that represent the four distinct parental positions on childhood vaccination (unquestioning acceptors, cautious acceptors, go along to get along, late/selective vaccinators, and refusers) (3) Assess the feasibility and acceptability of the fictional narratives to guide parent-provider communications related to childhood vaccines. Methods: This study conducted a secondary data analysis from the study Development and Testing of ADEPT: A Parent Decision Support for Childhood Vaccinations (ADEPT) by Vasudevan et al. Additionally, we recruited parents and healthcare providers to conduct interviews via zoom. We developed four fictional narratives, by aggregating stories from healthcare providers currently administering childhood vaccines, and parents of young children, that followed a range of mothers making vaccine decisions and their varying concerns. In-depth interviews with vaccine-hesitant and nonvaccine-hesitant parents provided feedback on the acceptability and feasibility of these narratives. Results: 5 healthcare providers and 12 parents with children 3-6 years of age we interviewed. Parents with shared decisions to accept, refuse or delay vaccines describe similar factors influencing their decision such as family experiences and vaccine-specific concerns. Healthcare providers’ steps in vaccine conversation first address parent concerns, create a trusting environment and provide a strong recommendation. Parents chose none, one, or multiple narratives they resonated with, and there was no relationship between vaccine decision-making history and the parental position represented in the narrative. Conclusions: The results suggest that the providers approach vaccine conversation by understanding parents' perspectives and providing a solid recommendation. A multitude of factors influences parents' vaccine decisions. This study suggests the use of narrative in the distribution of healthcare information, and further research can further validate the narratives and refine them for broader use.