Microresearch Projects

Current Microresearch Projects

Primary Care Providers' Views on Oral Health at Rural Indian Health Service Sites

Name: Lisa Simon

Research question/hypothesis: Rural dwellers are more likely to be missing teeth and have reduced access to dental care, and most dental health professional shortage areas are in rural counties. American Indian and Alaska Natives face even worse oral health outcomes than other rural Americans. Lack of access to oral healthcare leads many rural dwellers to seek relief in emergency departments as well as in primary care offices; however in both settings, patients may be prescribed opioids and antibiotics but do not have access to definitive dental treatment. In spite of these, recruitment of dentists to rural areas continues to be a challenge, and rural primary care providers may be responsible for more oral healthcare than those in other settings. This study will involve a qualitative analysis of primary care provider’s views on oral health at a rural Indian Health Service site in South Dakota. It will provide insight into how rural patients’ oral health interacts with and complicates their overall health, as well as their utilization of primary care services. Findings may offer insight into novel interventions that can improve integration of oral health and primary care.

Funding Amount: $4,000

Mentor: Dr. Katrina Armstrong

Hydrogen Sulfide and the Rural North Dakota Workforce: A qualitative study on the perceptions, attitudes, and habits regarding exposure at the workplace - A Rural PREP Micro Research Proposal

Name: Michael Walery

Research question/hypothesis: Since 2012, North Dakota has been the second largest crude-oil producing state, second in the nation only to Texas based on reserves of crude oil. Rural health systems have struggled to meet the demands of new types of injuries and illnesses associated with oil drilling and production, while maintaining the health of the rural, agriculture-based population. Hydrogen sulfide is an established neurotransmitter and toxin and remains a significant occupational workforce hazard. Having our residency program associated with a regional level II trauma hospital, with an additional rural training track located in the epicenter of the ‘Oil Boom’ our facilities are often on the receiving end of Bakken oil field related work injuries, including volatile gas exposure. Although case reports have described acute exposures and its dangers among oil field workers, we are unable to find qualitative descriptions of the oil field workers knowledge, experience, caution, and safety practices with regards to Hydrogen Sulfide exposure. The immediate purpose of this study is to ascertain themes of knowledge and experience related to oil-field workers exposure to Hydrogen Sulfide. In this way morbidity and mortality among our rural workforce may be reduced by simply optimizing education and safety measures. The method used to ascertain the above mentioned data will be a qualitative, semi-structured interview format conducted among individual persons identified as working or having worked at an oil field site in a rural area, as defined by the US Census Bureau. Purposeful sampling will be used to recruit and select participants. Criteria for participant selection will include 1) participant was/is gainfully employed at an oil field site in rural North Dakota (rural as defined by US Census Bureau) 2) participant is legally able to provide consent for participation; and 3) participant is willing and able to participate in one 60-90 minute audio-recorded, face to face interview. Narrative data regarding the research query will be transcribed and analyzed, identifying themes across the participant cohort.

Funding Amount: $3,862.50

Mentor: Peter Sandroni

Identifying Barriers and Opportunities to Transform Rural Health Care for Gender Minorities

Name: Nicholas Pochedly

Research question/hypothesis: Transgender and gender non-conforming individuals face barriers to accessing culturally-competent and inclusive healthcare that cisgender (persons who identify as their sex assigned at birth) individuals do not encounter. While the body of literature advancing research into transgender health care is growing, the vast majority of research is executed in urban, coastal communities. A persistent gap in this research effort includes studies conducted with transgender and gender non-conforming populations in rural areas. Objective: We seek to better understand the barriers that transgender and gender non-conforming individuals in rural areas face when accessing health care in a primary care setting. Design: A 40-item survey will be distributed online targeting gender non-conforming individuals. Data will be analyzed using descriptive and inferential analysis. Setting: Southeastern Ohio: a rural, medically underserved community with a mid-sized university. Participants: Persons who self-identify as gender non-conforming and transgender in rural and urban areas. Intervention: Using Likert-scale and open-ended questions, the online survey asks transgender and gender non-conforming individuals to self-report demographic data and comment on their health care experiences. The survey is distributed through community-based organizations, physicians’ offices and ResearchMatch. Main and Secondary Outcome Measures: The data will help to (1) Identify gaps and opportunities in health care access for people identifying as transgender or gender non-conforming, and (2) better understand the past health care experiences of transgender and gender non-conforming individuals who have lived or currently live in a rural community. Results: Anticipate respondents from rural areas will report higher rates of restrictions to access than cisgender or other transgender/gender non-conforming individuals living in urban environments. Conclusions: Identification of barriers that restrict transgender and gender non-conforming individuals’ access to primary care can reveal opportunities for targeted interventions within this community to improve health outcomes.

Funding Amount: $4,000

Mentor: Melissa Thomas

The Impact of a Syringe Exchange Program on Risk-taking Behaviors in Injection Drug Users in Michigan's Upper Peninsula

Name: Cara Crawford-Bartle

Research question/hypothesis: It is a common misconception that substance abuse is an issue of pertinence primarily in urban areas. In fact, substance abuse is just as problematic in rural areas, if not more. Because we frequently see the harms associated with intravenous drug use in our clinic we have decided to start a needle exchange program. In collaboration with our local health department and substance use treatment centers, the program will provide sterile injection equipment, educational resources, and support to local intravenous drug users. As the first program of its kind in Michigan’s Upper Peninsula we will be evaluating our impact on risk-taking behaviors, such as needle sharing, in local injection drug users via surveys administered at each visit to the needle exchange program. Outcomes are expected to guide future harm reduction initiatives in our area. 

Funding Amount: $3,937

Mentor: Patrick Huffer, MD

A Qualitative Study Examining Healthcare Experiences of Transgender Persons in Rural ND

Name: Brittany Bertsch

Research question/hypothesis: Transgender people hold a gender identity that differs from the sex assigned to them at birth. Health care disparities exist among transgender persons residing in the United States. Transgender persons have been shown to have a higher prevalence of overall poorer physical and mental health compared to the cisgender population. Relatively few studies have been published focusing specifically on the transgender population in rural areas, with respect to their experience with healthcare and healthcare services. No studies have been identified which focus specifically on rural areas of North Dakota.  Previous studies have suggested that there is a pressing need for comprehensive health care services for transgender persons living specifically in rural areas. Our motivation is to improve primary care for transgender populations in rural areas. Our first objective will be to gain a better understanding of the structure, context, satisfaction and impression of primary care services available to transgender people in rural North Dakota. A qualitative, phenomenological study using a semi-structured interview format will be utilized to ascertain information from the transgender population of North Dakota regarding their experience with regards to primary health care services. Following this foundational study further research may be done to delineate specific deficiencies or barriers such as lack of provider education, or perceived stigma. Our research team believes this study is an imperative step to ensuring quality healthcare for all people across the state of North Dakota and other rural areas in the USA.  

Funding Amount: $2,944

Mentor: Melissa Naslund

Immunization Health Beliefs and Education in Northern Nevada

Name:James Denisar-Green

Research question/hypothesis:  Accurate knowledge of immunization risks and benefits differs among rural and non-rural Northern Nevadans and as such result in a decreased participation in immunizations in rural Northern Nevada.  

  1. Do rural Northern Nevadans have common social networks or sources of information which influence their health beliefs regarding immunizations?
  2. Do rural Northern Nevadans have particular deficits in their knowledge of recommended immunizations?

Funding Amount: $1210.82

Mentor: Elissa Palmer

Assessing the Feasibility of Rural Primary Care Residency Training for Licensed Naturopathic Medicine Physicians in the Northwest

Name:Thomas Bell

Research question/hypothesis: Naturopathic Doctors (NDs) are licensed as primary care physicians in both Washington and Oregon. They have a broad prescriptive scope, order labs and diagnostic imaging, and can perform minor office procedures. They can also be reimbursed for primary care services through most insurance plans, and are eligible for reimbursement through Medicaid and HRSA wrap-payments. Despite this, only a small percentage of ND graduates currently work as PCPs in rural healthcare facilities.    Naturopathic physicians are an untapped source of clinicians to meet primary care workforce shortages in rural areas of the Northwest.  One likely reason that few NDs are working in these settings is the lack of rural residency training opportunities.  If new residency pathways into rural clinical sites were created, these sites could attract talented ND graduates and help them grow into strong primary care physicians that could serve their community.  

Funding Amount: $2,838

Mentor:

Assessing the Prevalence of CKD in the Yakima Community through Health Outreach Screenings

Name:Amanda Rawson

Research question/hypothesis: Yakima County, is a rural agricultural area located in Central Washington with a large population of Latinos/Hispanics and a significant population of migrant and seasonal farmworkers. Sadly, access to healthcare in Yakima valley remains a persistent problem and 16% of the population remains uninsured. In addition, it is widely recognized that Hispanics/Latinos suffer from chronic diseases at disproportionate rates when compared to non-Hispanic whites and they experience limited access to health care. Since, there is a substantial Hispanic/Latino population and the significant number of individuals that remain uninsured in Yakima county, the purpose of this study is determine the prevalence of CKD within the Yakima County. 

Funding Amount: $2,534

Mentor: Mark Baldwin

Homeless to housed, how does stable housing affect healthcare utilization and perceptions in residents of the Forget-Me-Not Manor, a housing first program in Juneau Alaska

Name: Nathan Ord

Research question/hypothesis: Housing First (HF) is a solution to chronic homelessness that provides access to affordable permanent housing accompanied by increased access to services. This approach has been shown to reduce public service utilization, EMS services, criminal justice services and improve residents’ reports of quality of life within 6 months of housing relative to unhoused controls. However, despite the successes of this model, much is unknown about how the design, programming, and implementation of HF can be optimized to promote success – especially in rural resource limited settings. In 2017, Juneau Alaska a town of 32,000 people opened a HF program for 32 residents with plans to expand. To date, the program has been an immense success – significantly reducing resident’s ER visits, use of sleep off services, and encounters with police. However, residents still have multiple and often debilitating medical conditions that require healthcare services. The goal of this study is to analyze how residents’ healthcare use changes after housing and to investigate which services and support would help residents manage their healthcare needs. The information from this research will inform the planned expansion of HF in Juneau and will hopefully add valuable ingredients to the recipe for designing and implementing HF programs in resource limited settings.

Funding Amount: $1,000

Mentor: Bob Urata

Community Health Worker (CHW) Intervention Targeting Vulnerable Seniors in Dillon, Montana

Name: Angela Bangs, Medical student, University of Washington School of Medicine TRUST Scholar, Dillon, Montana

Research question/hypothesis: Can a CHW program in a rural area result in improved outcomes and quality of life for targeted populations? Can a CHW program result in overall cost savings to the healthcare system? What are the best practices for implementing a CHW program in a rural community?

Abstract: As the county seat of Beaverhead County, Dillon, Montana is a small rural agricultural community consisting of approximately 9,345 residents, as of the 2015 census. The Dillon community has a higher percentage of seniors (adults aged 65 and older), as well as a higher percentage of individuals living under the poverty level when compared to the rest of the state.
A completion of a community/resource analysis, a literature review on the efficacy of CHW interventions in improving overall health outcomes for targeted populations, and an analysis of current CHW projects in Montana indicated both a need and desire to provide additional services for seniors living under the poverty level. The healthcare system in Dillon, Barrett Hospital and Healthcare – BHH, has also identified a need for additional outreach and services for seniors to prevent unnecessary over-utilization of the healthcare system.
This proposed project aims to establish a community partnership with BHH and the Human Service Network, a local community-organized stakeholder group, and to move forward with initiating a pilot CHW project that will target vulnerable seniors living below the poverty level in Beaverhead County, Montana.

Funding Amount: $250

Mentor: Toby Keys, MA, MPH

Effectiveness of Condom Distribution in Rural Oregon

Name: Madeline Boyd, MD, Resident physician, Cascades East Family Medicine Residency Program, Klamath Falls, Oregon

Research question/hypothesis: Does providing condoms free of charge at a rural Oregon clinic result in a decrease in the incidence of sexually transmitted infections diagnosed at the clinic?

Abstract: Condom distribution programs have been proven to be both effective and a cost-effective method of reducing the incidence of sexually transmitted infections (STIs). However, there are no studies showing whether this finding holds true in rural communities in the United States.
This study aims to test whether condom distribution will impact the incidence of STIs in an isolated, rural community in southern Oregon where STI rates have increased significantly over the past decade. Utilizing reports generated by an electronic health record, we will measure STI incidences before and after the implementation of a condom distribution program in a busy residency clinic to study and measure effectiveness of condom distribution in rural communities in the United States.

Funding Amount: $3885

Mentor: Carrie Pierce, MD

Effect of Point-of-Care Lead Level Testing on Compliance and Outcomes

Name: Andrew Gantzer, DO, Resident physician, Firelands Family Medicine Residency Program, Sandusky, Ohio

Research question/hypothesis: Does point of care lead level testing improve screening rates in at risk populations? Does point of care lead level testing improve patient outcomes as they relate to lead poisoning and sequelae?

Abstract: Sandusky, like Flint, contains many homes and apartments which fall into the “at risk” category for lead poisoning. According to the Sandusky Register, “Erie County Health Department officials, carrying out tests for 90 children at the recent Wightman Wieber Kids Festival on July 1st, 2017, were shocked to find that nearly half tested high for lead in their blood.” The American Academy of Family Physicians recommends all “at risk” children, as well as children enrolled in Medicaid, be tested for lead poisoning at both one and two years of age. Our pediatric patient population in Sandusky, and especially those seen by the Firelands family medicine residents through Family Health Services, fall squarely into this category.Unfortunately, this testing is not routinely obtained, often because when a physician orders the test, the child must be taken elsewhere to have it performed. This study aims to determine if having the necessary equipment to test patients in a primary care office setting would improve compliance and help to provide a valuable service to an at-risk community. Not only would this provide better access to services for patients, it would also allow for improved teaching opportunities for medical students and resident physicians. Furthermore, data before and after implementation of point of care testing could be compared to assess the value of having such equipment in a rural primary care office.

Funding Amount: $3000

Mentor: Eric Mast, DO

Exploring Engagement in Preventive Health Services Among Rural Working Adults with Type 2 Diabetes

Name: Lynn Glenn, MSN, APRN-C, Doctor of Nursing Practice student, University of Missouri, Bamberg, South Carolina

Research question/hypothesis: What are the leading individual, interpersonal, health system, and community factors that facilitate or hinder engagement and use of recommended, preventive health services among rural working adults with type 2 DM?

Abstract: Although recent health care reform has increased access to care, many working adults continue to face barriers in being actively engaged in preventive health care services. In particular, rural working adults with type 2 diabetes (DM) experience a tremendous burden in self-management and prevention of secondary complications. Previous studies have demonstrated that low-wage earners are also less engaged in preventive care and are at higher risk for developing diabetes-related complications. In addition to the financial burden of diabetes-related health care, many psychosocial factors influence rural, working adults to seek preventive health care services.
To further examine factors associated with engagement in diabetes preventive care services, a qualitative study targeting a sample of rural working adults with type 2 DM is planned. Findings from this study will be used to develop community-based interventions that can enhance patient activation in preventive health care services and ultimately lead to improved health outcomes among rural working adults with type 2 DM.

Funding Amount: $850

Mentor: Maithe Enriquez, PhD, RN, ANP-BC, FAAN

How are Rural Communities Affected by the Loss of a Physician?

Name: Paulius Mui, Medical student, Virginia Commonwealth University School of Medicine, Richmond, Virginia

Research question/hypothesis: How do rural communities deal with losing a physician? What is it like finding a new physician? How does a rural physician impact the social capital of their community? What is the value of the non-clinical roles that rural physicians hold in their communities?

Abstract: A looming shortage of rural physicians compounds the myriad of existing healthcare challenges already faced by rural patients. Understanding the perspective of rural residents and giving them a voice is an essential element in designing patient-centered solutions to improve health outcomes in rural communities. However, little to no evidence exists in medical literature describing the attitudes of rural residents on the impact of losing their local physician.
This study aims to elucidate how rural residents have dealt with the loss of local physicians and to understand how rural communities might respond to such potential losses. This study will also explore non-clinical roles of physicians from the perspective of rural community members, and the impact of these physicians on community life at large. The findings of this study have the potential to inform policy makers on the value that rural physicians bring to their communities, capture concerns of rural residents about their local physician supply, and highlight the most salient healthcare issues in rural communities as described by local residents.

Funding Amount: $3920.50

Mentor: Rebecca Etz, PhD

Health Beliefs and Cancer Screening among Anabaptists of Central Pennsylvania

Name: Jehoshaphat Reich, MD-PHD student, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania

Research question/hypothesis: What health beliefs are held by Anabaptists who decide to participate in cancer screening compared with those held by Anabaptists who decide not to participate in screening?

Abstract: The Anabaptist population of Pennsylvania comprises 71,000 individuals that engage with the American medical system from an educational disadvantage. They often underutilize cancer screening, which results in adverse health outcomes. The current literature does not examine how their beliefs may influence health decisions to participate in cancer screening. This lack of research hampers physician ability to stage an effective intervention and improve cancer screening utilization to improve health outcomes among the Anabaptist population.
As a people with their own culture and language, the Anabaptists must be approached about healthcare differently than their non-Anabaptist American neighbors. This study aims to serve as an informational foundation for developing educational interventions uniquely geared towards engaging the Anabaptist community. It is in turn hoped that this research will lead to these interventions influencing many Anabaptists to choose cancer screening, reducing their morbidity and mortality due to late diagnoses.

Funding Amount: $3780

Mentor: John Boll, DO

Shared Medical Appointments (SMAs) to address Chronic Pain and Opioid Dependency

Name: Jacob and Jaclyn Thatcher, Medical student and Doctor of Nursing Practice student, Pacific Northwest University College of Osteopathic Medicine & Washington State University, Yakima and Spokane, Washington

Research question/hypothesis: Shared Medical Appointments are a non-inferior treatment modality for chronic pain in a rural primary healthcare setting.

Abstract: Shared Medical Appointments (SMAs) or “group visits”, can reduce direct cost of care, achieve fewer hospital admissions and emergency department visits, as well as lower the severity of acute conditions when utilization occurs. However, SMAs for treatment of chronic pain have not been studied. The current treatment approach for chronic pain is limited to pharmaceutical modalities, behavioral medicine, neuromodulation, and interventional and surgical approaches. The effectiveness of pharmacological treatments has recently drawn particular attention for contributing to an opioid epidemic, with a spike in opioid use disorders, opioid related overdose, death, and digression to heroin and other illicit drugs.
We propose to begin SMAs in a small rural primary care clinic located in Lincoln County, ID. Shoshone Family Medical Center (SFMC) is the only medical facility in the county. Like many full scope rural clinics in the United States, SFMC has seen a significant increase in encounters for chronic pain. Collaboration between the Betty Ford Addiction Recovery Center and The American Chronic Pain Association will ensure the best resources and techniques are utilized. SMAs will be conducted by a multidisciplinary team with a physician assistant, medical student, nurse practitioner student, and clinical pharmacist. Results will be presented at the Paul Ambrose Scholars Program and Association for Prevention Teaching and Research Student Leadership (APTR) as well as the American Academy of Family Practitioners Annual Conference.

Funding Amount: $3998.07

Mentor: Keith E. Davis, MD

Impact of State Healthcare Budget Cuts on Rural Communities

Name: Casey Harrison, CNM; Doctor of Nursing Practice student, Stony Brook University and New York State Association for Rural Health, Rexville, New York

Research Question/Hypothesis: What is the economic impact of state-based rural health funding cuts in rural regions?

Abstract: Rural Americans face unique challenges when it comes to addressing the needs of local and regional public health infrastructure, as these communities face higher rates of poverty, disparities in healthcare equity and access, lower rates of education, and greater on-the-job risks than their urban counterparts.Additionally, rural hospital closures are increasing, with those remaining facing catastrophic losses in grants, public and mental health funding, and research and disease. These closures will dramatically impact entire communities, as a rural hospital is often the sole, or primary employer in the area it serves. The health and social sector also provides a foundation for the health and well-being of rural communities. Rural residents are more likely to derive their income from the healthcare industry both directly and indirectly, and health and wellness of rural communities lies heavily on the Health and Social sector. As such, cuts to the primary source(s) of funding to rural health programs/services increase the negative impact of the social determinants of health and are devastating to the livelihood of rural residents and the communities within which they live and work.
There has been much evidence provided regarding the negative health effects of funding cuts, as well as the economic impact of losing rural hospitals on rural communities. However, there has been little to no rigorous investigation related specifically to the impact of state-based rural health funding cuts in the critical areas of 1) rural hospitals; 2) Area Health Education Centers; 3) Rural Health Networks, and; 4) County Public Health agencies on rural communities.
This project aims to investigate the economic impact of state-based rural health funding in New York State by gathering information to determine the exact amount of state-funding cuts made to each of these entities between the 2016-2017 and 2017-2018 fiscal years. Results will be segregated and analyzed to identify the economic multipliers related to the funding cuts and the resulting economic impact of the funding loss within rural communities. It will also use existing data to interpret and predict further the negative effects relative to 1) health indicators; 2) employment trends; 3) ability to access and leverage other funding sources, and; 4) worsening effects of the social determinants of health.
Studies in this area of focus are non-existent. As such, we expect that the results of this investigation will be ground-breaking, enlightening, and useful.

Funding Amount: $4,000

Mentor: Richard K. Merchant, President, New York State Association for Rural Health