Community-Based Research Projects

The Community Health section of the Department of Family and Community Medicine engages students and residents in community service training, in addition to conducting research projects of our own within community partnerships we have developed across the Dallas-Fort Worth Metroplex. Examples are below.

Resident: Hina Rizvi, M.D.
Research Mentors: Amer Shakil, M.D.; Nora Gimpel, M.D.
Title: Awareness of Osteoporosis among South Asian Women
Status: Completed (2008)

The purpose of this study was to assess the awareness of osteoporosis prevention among peri- and post-menopausal women of Southeast Asian (Pakistan, India, Bangladesh) descent attending the community centers in the Dallas/Fort Worth metroplex and to assess the difference between their beliefs, knowledge, and attitudes before and after educational intervention.

Participants showed a significant increase in osteoporosis knowledge post intervention. Participants who completed the intervention were better prepared to prevent and manage osteoporosis. Results indicate the efficacy of educational intervention in improving osteoporosis awareness and point to the potential for knowledge acquisition aimed at developing community-based prevention strategies at the community level.

Resident: Natalia Gutierrez, M.D.
Research Mentor: Nora Gimpel, M.D.
Title: Clinical Effectiveness of Shared Medical Appointment for Hispanic Diabetic Patients in the Parkland Family Medicine Clinic in Dallas, Texas
Status: Completed (2009)

The overall objectives of the study were: to improve glycemic control; to improve nonglycemic goals such as LDL, HDL, triglycerides, blood pressure, and BMI; to prevent or slow the development of long-term complications; to improve adherence to preventive care measures such as annual retinal exam, monofilament foot examinations, aspirin use, pneumococcal and influenza vaccinations; to improve diabetes knowledge, quality of life, and satisfaction; and to evaluate acculturation level and its association with the outcomes.

Baseline characteristics were not significantly different between the intervention and control groups. When comparing pre- and post- measures, there was approximately a one unit decrease in HbA1c for the intervention group and a 0.5 unit decrease in the control group (p = .02). In the intervention group, the diabetes quality of life and knowledge scores increased by 5 and 1.5 points, respectively (p < .01). There was a significant decrease (p < 0.05) in systolic blood pressure and an increase in adherence to the American Diabetic Association (ADA) guidelines. Patient satisfaction was high among all SMAs (mean = 3.5, 1-4 Likert scale, 4 being the highest).

It was concluded that SMAs were effective in improving HbA1c in a clinic that is a part of a larger medical school and hospital infrastructure. The SMA model promotes discussion among patients and health providers and develops peer support with increased patient and provider productivity and satisfaction. We suggest that health care teams consider this model as an alternative approach or in addition to conventional one-on-one patient interactions.

Resident: Hena Zaki, D.O.
Research Mentors: Nora Gimpel, M.D.; Amer Shakil, M.D.
Title: Barriers to Health Care Facing the South Asian Population in Dallas, Texas
Status: Completed (2009)

The objectives were to describe the degree of access to health care South Asians in Dallas receive and determine barriers that affect health care access and experience among this population.

A survey assessing demographic information, socioeconomics, health insurance type and coverage, care utilization, and potential barriers to care was collected from South Asian adults attending seven community centers in the Dallas area.

The study population was mostly female (58 percent). Almost 30 percent had lived in the U.S. for 11-20 years, 85 percent reported good or excellent English proficiency, and 86 percent had a college degree or higher education. This population reported high income levels; most were employed and had private health insurance. Furthermore, about 50 percent reported one or two doctor visits a year, regardless of health insurance status. Our findings indicate that few barriers exist among this population. It is obvious that further research is needed in order to address types of health care utilized by this population.

Resident: Donald Graneto, M.D.
Research Mentor: Nora Gimpel, M.D. and Barbara Foster, Ph.D.
Title: Physician Decision-Making in the Prescription of Non-Professional Post Exposure Prophylaxis to Patients after a Possible High Risk Exposure to HIV
Status: Completed (2010)

This study was conducted among physicians (residents and attending) at the UT Southwestern Medical Center and affiliated hospitals in order to assess the prescribing of post-exposure prophylaxis (PEP) when exposure is in a nonoccupational setting. The objectives are to identify the determining factors and assess the need for educational intervention to improve compliance by physicians.

We identified the trends in physician decision-making for prescribing or not prescribing nonoccupational PEP. It is hoped that these results will serve as a basis for programs to improve physician awareness of the issues associated with nonoccupational PEP, including available options and existing regulations. This will set us on a right course of decreasing the spread of HIV among at-risk members of society.

Resident: Alex Vilaythong, D.O.
Research Mentors: Nora Gimpel, M.D.; Lance Rasbridge, Ph.D.; Barbara Foster, Ph.D.
Title: Health Care Challenges among the Karen-Burmese Refugee Population in Dallas, Texas
Status: Completed 2011

This is a cross-sectional study being conducted among the Karen-Burmese refugee population in Dallas in order to assess the effect of cultural factors on refugees’ health status; to determine the health care needs of the refugee population; and to ascertain their access to health care. Surveys and in-depth interviews will be used to gather the data.

The study is still in progress, and data gathered from the questionnaires and in-depth interviews have the potential of providing insight into refugee health care needs and the impact of cultural factors on their health. They will also point researchers and agencies in the community toward designing sustainable programs tailored to the health care challenges of the refugee population. The report on the completed study will add to the body of literature in this study area and serve as a reference point for future researchers.

Resident: Guadalupe Reyna, D.O.
Research Mentors: Nora Gimpel, M.D.; Ellen Elliston, Ph.D.; Barbara Foster, Ph.D.
Title: Knowledge toward Domestic Violence against Women in the Primary Care Setting of a Large Texas Urban City
Status: Completed 2011

This is a nonexperimental cross-sectional study being conducted in order to assess the awareness, attitudes, and beliefs of physicians working in a county teaching hospital and community clinics toward domestic violence.

We expect to find a significant proportion of providers who have not identified an abused person in the past year and do not routinely screen for domestic violence and abuse. Expected results will demonstrate physicians’ perception and confidence level with domestic violence. This project will provide future direction in developing community-based strategies for domestic violence education for physicians. Results may help primary care physicians to develop and apply better screening tools to recognize and prevent domestic violence in the community. Improving awareness may also lead to lowered health care costs, better well-being, and increased safety of patients.

Resident: Lisa Jolly, M.D.
Research Mentors: Nora Gimpel, M.D.; Dorothy Sendelbach, M.D.; Barbara Foster, Ph.D.
Title: Knowledge and Attitude of African American Males toward Breastfeeding
Status: Ongoing (2011)

This is a nonexperimental cross-sectional study being conducted in order to assess the attitudes of African American men toward breastfeeding, and the influence of their perception on the practice of breastfeeding in their community.

Resident: Elilta Hagos, M.D.
Research Mentors: Nora Gimpel, M.D.; Laura Armas, M.D.; Barbara Foster, Ph.D.
Title: What are the Predictors of Dysplastic Progression of Initially Negative Colposcopy in HIV Positive Women?
 Ongoing (2011)

This is a retrospective cohort study of HIV positive women, and the purpose is to determine if colposcopies should be performed on them following every abnormal pap smear. This study will involve chart reviews and focus group interviews.