This year, St. John’s University (STJ) and Jamaica Hospital Medical Center, Department of Family Medicine (JHMC), launched a collaborative research training program – The Collaborative Health Integration Research Program (CHIRP). The overall goal of CHIRP is to reduce health disparities by generating new knowledge and providing research training in health disparities. CHIRP trainees conduct mechanistic research investigating the role of psychosocial factors in the development and management of chronic disease in high risk populations. The projects are designed to provide information that can guide the formulation of provider, patient, and system-based interventions to improve health outcomes.
CHIRP trainees include JHMC Family Medicine Residents and STJ undergraduate students in psychology and biology, and masters and doctoral-level graduate students in psychology. This year the program also includes a high school student from the Bronx High School of Science. All trainees work together on behavioral medicine research projects; and in the process, learn to become competent researchers.
Project ideas emerge from clinical observations and existing data sources. The JHMC Family Medicine Residents propose research ideas based on their observations of the clinical needs presented by patients at JHMC. JHMC serves a low-income culturally diverse group of patients, many of whom have chronic conditions, including diabetes and hypertension. Every day residents confront the challenges of preventing and managing chronic diseases in patients facing many psychosocial stressors with few resources. The residents generate ideas about the factors that increase risk for chronic conditions and create barriers to effective health care. We use CHIRP projects to test some of the residents’ hypotheses. Other projects emerge from Dr. Brondolo’s previously funded projects on stress and health.
This year trainees are working on projects in three main areas of research:
Studies of psychosocial predictors of treatment adherence: Treatment for Type II diabetes is complex and demands high levels of motivation and conscientiousness on the part of the patient. In this project we are examining the relationship of patients’ knowledge, beliefs, and attitudes towards diabetes and assessing the relationship of these factors to treatment adherence and outcome.
Studies of racism and health: This research is an outgrowth of our NHLBI-funded program on the relationship of racism to cardiovascular health. Our current studies focus on the well-documented relationships of racism to two risk factors for cardiovascular disease: depression and smoking. We examine the conscious and non-conscious psychological processes and interpersonal behaviors that may explain the link between racism and depression and other health behaviors, including smoking and sleep.
Work stress and health: The work stress and health projects investigate the relationship of occupational stress to depression and PTSD in understudied high risk populations. These projects emerged from our NIOSH-funded study of web-based interventions to reduce the mental health risks associated with medical examiner work. Studies of work-related stress provide trainees with an opportunity to examine situational and contextual factors that can affect health.
CHIRP uses a collaborative experiential approach to training. Knowledge acquisition and skill development occur as trainees engage in the research process. Trainees work on projects that are conceptualized and implemented at a level suitable for publication. They serve as apprentices in the research process, accepting responsibility for different parts of the projects based on their skills level and experience. As trainees acquire new skills, they assume more responsibility and train others.
For each project, JHMC family medicine residents work with STJ students to gather literature and generate specific testable hypotheses. Doctoral-level graduate students supervise the work of masters-level students and undergraduates in small group recitations. They share the results of their work with the JHMC residents who read and review the material. All trainees practice research protocols in group meetings. Together, they build portable laboratories and collect data at JHMC ambulatory care sites. JHMC residents “try-out” the protocols, and discuss modifications. Once the protocols are finalized, the St. John’s team collects data. Dr. Brondolo and Wan Ng, the program coordinator, supervise each step of the process.
The collaborative process extends to the data analyses needed for the studies. The psychology team conceptualizes and conducts the analyses. Students learn skills in data management and analysis, using multiple programs including Excel, SAS, and SPSS. Initially, all data are analyzed in group meetings using SAS. The data are projected onto a white board, and students take turns running the analyses. Once students have basic data manipulation skills, they can analyze portions of the data on their own and present their findings to the group.
CHIRP trainees have the opportunity to consult with internationally recognized biostatisticians to provide guidance on analysis. As the data are analyzed, Dr. Brondolo and the STJ students present the analyses to the JHMC residents. These experiences provide an opportunity for STJ students to serve as research consultants to physicians, and offers the JHMC resident physicians an opportunity to develop a greater understanding of the fundamentals of data analysis and interpretation.
CHIRP collaborators share ideas both in person and remotely using Drop-Box, an online file-sharing system; and on Skype, on online communication program that enables screen-sharing. These technologies enable CHIRP collaborators to meet despite working in different locations and facing busy schedules. These technologies permit team editing of literature reviews and protocols, and allow collaborative data analysis.
As part of the class, all trainees learn to work effectively with research participants. All CHIRP trainees complete NIH certification in the responsible execution of research with human participants. They follow dedicated protocols and testing procedures to insure that participant care is the most important priority. The values driving the research and the study process are discussed repeatedly and serve as the topic for written reflections that are required of all STJ trainees.
CHIRP trainees have been presenting data from these projects at conferences and submitting abstracts to new conferences. We write papers and grants collectively, projecting the material on the screen and editing collaboratively. This term we have submitted two papers and residents have presented at 3 conferences. We are preparing new abstracts for conferences this Spring. We have submitted two grants, one to NSF and one to NIHMD based on the racism and health projects.
The program as a whole is supervised by Dr. Brondolo of STJ, Dr. Alan Roth, Chair of the JHMC Department of Family Medicine, Dr. Gina Basello the JHMC Family Medicine Residency Director, and Dr. Kate Walton of STJ. Dr. Walton directs the Masters Program in Experimental Psychology, and many students from the Masters program are CHIRP fellows. The technical coordinator for the program is Wan Ng, a graduate of the St. John’s undergraduate and masters program who has worked in the Social Stress and Health laboratory for four years. Our doctoral level supervisors this year are Robert Lane and Emily Wolodiger from the Clinical Psychology Doctoral Program. The undergraduate and graduate student trainees from St. John’s University receive course credit each semester for their participation. JHMC residents meet their training in research requirements through participation as well, and our student from the Bronx High School of Science is completing requirements for the Intel Science Competition.
CHIRP contributes to the pipeline of researchers, including those from underrepresented groups, who are committed to health disparities research. The CHIRP trainees report that they are excited to be learning “real-world” research skills they will use in the future. They enjoy the contact with patients at JHMC. As CHIRP trainees collect data, they can see their ideas in action. Their hypotheses come to life in the clinic and the lab. Family medicine residents become better clinicians as they turn clinical observations into research questions and evaluate the existing literature. Most important, CHIRP trainees are proud that they are conducting studies that can affect the health of others. They know their research is consistent with the Vincentian mission and can help patients to help themselves to improve health and the ability to benefit from health care.
CHIRP builds the pipeline of researchers working to reduce health disparities.