Tailoring Chronic Disease Interventions to Meet Specific Needs of Women: A Case Example of a Hypertension Program.
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2025-01
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Women have a unique risk profile for cardiovascular disease (CVD) due to underlying sociocultural and biological determinants. Current CVD prevention and treatment interventions, however, largely remain agnostic to the influences of an individual's sex assigned at birth or gender identity. This study describes a process for tailoring existing evidence-based interventions to the biological and sociocultural determinants of health for women.Methods
This study adapted the Team-supported, Electronic Health Record (EHR)-leveraged, Active Management (TEAM) CVD preventative care intervention designed for telehealth-based remote hypertension (HTN) care in rural Veterans. Tailoring choices were informed by a 12-month process including a focused literature review, qualitative interviews with women's health experts, and feedback from providers and women Veterans on existing intervention materials.Results
Literature review and qualitative interview findings informed the modification of patient- and provider-facing TEAM materials. Patient-facing material modifications included the addition of information relevant to sex-specific CVD risk factors, addressing gender-related barriers to CVD risk reduction, and including diverse visual representation and inclusive language. Provider-facing materials were modified through a new EHR template to comprehensively address sex-specific CVD risk factors. These changes resulted in individualized care plans to better address gaps in HTN management among women.Conclusion
Tailoring existing evidence-based interventions is an achievable and practical strategy to incorporate the sociocultural and biological determinants of CVD health specific to women. This approach could be used to adapt other programs and interventions designed to address health conditions that occur among both men and women but which are sensitive to important biological and sociocultural determinants. These findings highlight the broad discourse on sex- and gender-sensitive health care interventions and advocate for the integration of these interventions into routine clinical practice.Type
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Dancu, Caroline A, Julie Schexnayder, Hayden B Bosworth, Allison Lewinski, Abigail Shapiro, Tiera Lanford, Courtney White Clark, Bevanne Bean-Mayberry, et al. (2025). Tailoring Chronic Disease Interventions to Meet Specific Needs of Women: A Case Example of a Hypertension Program. Women's health reports (New Rochelle, N.Y.), 6(1). pp. 239–248. 10.1089/whr.2024.0139 Retrieved from https://hdl.handle.net/10161/33908.
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Scholars@Duke
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Allison A. Lewinski
I am a health services researcher and implementation scientist with a joint appointment at the Duke University School of Nursing (DUSON) and the Durham Veterans Affairs Health Care System (VHA). My expertise spans diabetes distress, qualitative research methods, and virtual care delivery (including telehealth and digital health).
My research examines how virtual care interventions can reduce distress, improve self-management, expand access to evidence-based care, and enhance patient and population health outcomes. I focus on patient-, provider-, and system-level factors that influence the use and effectiveness of virtual care. This work has been funded by competitive grants, published in high-impact journals, presented at national conferences, and used to inform health system decision-making. I am frequently sought by colleagues locally and nationally for expertise in diabetes distress, qualitative methods, and virtual care strategies for grants, projects, and manuscripts.
I strive to improve outcomes for individuals with chronic illness by developing equitable, sustainable virtual care solutions and evaluating their implementation. To optimize these interventions, I apply qualitative and implementation science approaches to ensure alignment among patient needs, care modalities, disease states, and social contexts. My work addresses critical questions: for whom and for what purposes are these interventions effective, in which contexts, and at what points in the care continuum. Ultimately, my research advances the implementation and adoption of virtual care to reduce psychosocial distress and improve health outcomes through patient-clinician interactions and system-level innovations.
Leah L Zullig
Leah L. Zullig, PhD, MPH is a health services researcher and an implementation scientist. She is a Professor in the Duke Department of Population Health Sciences and an investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham Veterans Affairs Health Care System. Dr. Zullig leads INTERACT, the Implementation Science Research Collaborative, and is co-leader of Duke Cancer Institute's cancer prevention and control program.
Dr. Zullig’s overarching research interests address three domains: improving cancer care delivery and quality; promoting cancer survivorship and chronic disease management; and improving medication adherence. Throughout these three area of foci Dr. Zullig uses an implementation science lens with the goal of providing equitable care for all by implementing evidence-based practices in a variety of health care environments. She has authored over 200 peer-reviewed publications.
Dr. Zullig completed her BS in Health Promotion, her MPH in Public Health Administration, and her PhD in Health Policy.
Areas of expertise: Implementation Science, Health Measurement, Health Policy, Health Behavior, Telehealth, and Health Services Research
Jennifer M. Gierisch
Jennifer Gierisch, PhD, is behavioral scientist and health services researcher. She is an Associate Professor in the Department of Population Heath Sciences and the Department of Medicine at Duke University. She is a core investigator with the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) where she serves as the leader of the Partnered Research Methods Core (PRESTO) and Director of the VA OAA Health Services Research Postdoctoral Fellowship. Dr. Gierisch also is the Co-Director of the Evidence Synthesis Program (VA ESP) at the Durham Veteran Affairs Health Care System. She also served as a faculty director of the Duke Clinical Translational Science Institute's Community Engaged Research Initiative (CeRi) for five years
Dr. Gierisch’s research focuses on three overarching areas: 1) behavioral research on the psychosocial factors that influence appropriate uptake and maintenance of complex health behaviors (eg., weight management, smoking cessation, cancer screening); 2) evidence synthesis on key health and healthcare topics to enhance uptake of evidence-based interventions to improve patient and health system outcomes; and 3) participatory and community engaged research approaches.
Area of expertise: health behavior, community-engaged research, evidence synthesis, intervention development, qualitative research
Karen M. Goldstein
Dr. Goldstein's research interests include women's health, cardiovascular risk reduction, evidence synthesis methodology and peer support.
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