While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
As a pediatrician, Nefertiti Durant, MD, MPH, never envisioned working with overweight African American women in their 20s. But she saw a gap and believed she could fill it.
“I used to work with kids, but I became very interested in this population because nobody was working with African American women who were aged 19 to 30,” Durant said. “That is when they are gaining weight and their physical activity is declining.”
Durant set out to create a culturally appropriate Web-based technology that could help young African American women who were overweight or obese form a virtual community of support to help them lose weight and improve their health. Her hope was that the Web-based platform could eventually be available to African American women across the country struggling with weight issues.
As a young academic herself, Durant herself needed support to carry out these ideas, which she received through her participation in the Robert Wood Johnson Foundation Physician Faculty Scholars program. Read the Program Results Report for more information.
A difficult transition from fellow to assistant professor. Young physicians who have fellowships receive intense support from a mentor, Durant noted. That mentor guides them in their research, helps them find and apply for grants, and assists them in navigating the process of becoming a successful academic researcher. But once physicians leave their fellowships and become assistant professors that support disappears. The transition can be tough.
“You are thrown into this realm of being a faculty member,” Durant notes. “Suddenly people expect you to write papers and run trials all on your own without having the close contact of a mentor.”
RWJF Physician Faculty Scholars, which ran from 2006 through November 2012, sought to strengthen junior medical faculty’s leadership skills and academic productivity. Scholars received funds for a three-year research project, along with mentoring, networking, and other supports. Durant, an associate professor in the department of pediatrics at the University of Alabama at Birmingham School of Medicine, received her award in 2009.
Through the program, Durant had access to mentors around the country, all of whom were renowned researchers, people, she says, ”I would not have been able to reach on a cold call.” Her main mentor was M. Norman Oliver, MD, MA, chair of the department of family medicine at the University of Virginia School of Medicine in Charlottesville. Oliver’s research interests are in the area of racial and ethnic disparities in health.
Oliver helped Durant in a variety of ways as she made the transition from fellow to faculty, including helping her retool crucial parts of her research proposal, set timelines for her investigation, and balance her clinical duties with her research and teaching obligations.
Reaching a neglected population through the power of the internet. For her project, Durant first interviewed young African American women to learn more about the elements of a Web-based exercise program that they would want. Based on that information, Durant created a website she later named commit2fit.org (no longer active) and an iPhone app that included:
Durant later conducted a six-month pilot test in which participants engaged in four intense walking sessions a week using accelerometers (like pedometers) and heart rate monitors to track their workout. The walking sessions were supervised by a research assistant.
Participants also used the commit2fit web-based tool and met in discussion groups where they provided feedback on how using the tool was going for them.
Fifteen of the 27 participants completed the pilot. Each participant who completed the three months of the intervention experienced an increase of an average of 82.5 minutes per week of moderate intensity activity—a statistically significant increase. At six months, participants had not gained any weight, which Durant considered a success.
“We succeeded in preventing weight gain in a population that is at very high risk for weight gain,” Durant notes. “Some four out of five African American women are overweight or obese. At this critical juncture, as young women transition from adolescence to adulthood, if we are impacting their physical activity habits in a manner that prevents weight gain, even if no weight is lost, that might be critical in fighting the obesity epidemic.”
Unexpected findings. In the course of the pilot project, Durant learned some things that surprised her. While the research focused on an Internet-based intervention, the program participants said they most valued the face-to-face contact with each another and with the staff who helped with recruitment and supervised the physical activity sessions.
“They found the staff to be motivating and supportive,” Durant said. “It puts us in a quandary because in terms of Internet interventions we want to get rid of some of the face-to-face time.”
Interestingly, Durant found face-to-face support equally important in her work. Another RWJF Physician Faculty Scholar, Andrea L. Cherrington, MD, MPH, was also an assistant professor based at the University of Alabama at Birmingham. While the two knew one another, it wasn’t until one of the program’s conferences that they made a plan to routinely meet and give each other feedback.
The power of peer support. Cherrington advised Durant to look beyond the traditional sources of funding, such as the National Institutes of Health, and explore organizations such as the American Diabetes Association and the American Cancer Association. Cherrington and Durant also began meeting once a week to write together, an idea they learned from their colleagues in the program.
“People have advocated setting a schedule for your writing time and having someone to sit down and write with you, even if you’re not writing the same thing,” Durant said. “[Andrea and I] sit down for two to four hours and just write. We routinely give each other feedback. We send each other abstracts and discuss our grant proposals.... We do quite a bit of peer-to-peer mentoring.”
Another helpful aspect of RWJF Physician Faculty Scholars was the strong emphasis on a work-life balance, Durant noted. Her husband is also a physician-researcher, and they have two young children. Some of the other scholars were in similar positions.
“They made the simple but very effective argument for just trading off responsibilities totally while you are submitting a grant or in a particularly demanding phase of your project,” Durant said. “We all agreed that there are times when you are not able to do the same level of things within the family structure and that it will go in cycles."
Adapting exercise and motivational technology. Durant has continued her work on creating a Web-based platform that will help overweight women of color become more physically active.
With funding from the American Heart Association, Durant carried out a three-month intervention called “Love Your Heart” to study how increasing physical activity can decrease the risk of cardiovascular disease in young adult African American women. The intervention was a continuation of commit2fit, Durant says, and incorporates some of the lessons learned from that project.
Among the changes were more group exercise programs such as Zumba® and kick boxing and additional nutrition classes that focused specifically on healthy eating for a young adult. Durant also took into account the popularity of face-to-face interaction with the staff during the pilot project, and increased the online presence of staff by having them write blogs.
Social support is important to young African American women, Durant learned from the project, and technology can be used to enhance that support. “The rates of African Americans using social network sites like Facebook continue to grow and grow,” she says. “In previous studies social support has always been cited as a key to physical activity. For young adult African Americans, technology provides them a way to share and get the support they need to change behavior.
“As researchers we can provide the support they need without increasing the burden,” she continued. “African American young adults don’t come to the doctor. Doing something over the Internet or as a text message allows you to give them the support they need without increasing the burden on them to receive it.”
RWJF perspective. Because many scholars are still early in their careers, it may be too soon to judge the real impact of RWJF Physician Faculty Scholars. However, several scholars currently hold leadership positions in academic medical centers and in local, state, and federal government, and conduct innovative research projects with the potential to affect health and health care.
“The RWJF Physician Faculty Scholars program developed a cadre of physicians—65 in total—who will or who have become productive, creative, and influential physician researchers and leaders,” said RWJF Senior Program Officer David M. Krol, MD, MPH. “It also filled a niche for some physicians who wanted to pursue research that would likely not have been funded by other sources.”
Durant said that the RWJF funding allowed her to build a knowledge base on how to harness the power of Internet technology. “Without the program I honestly doubt whether my career trajectory in the field of obesity would be the same,” Durant said. “It really has provided the peer and mentorship support to shape what I do and allow me to do something more innovative.”
Web-based platform helped overweight/obese African-American women in their 20s create supportive community
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