Source: WEST VIRGINIA UNIVERSITY submitted to NRP
ASSESSING THE POTENTIAL OF EVIDENCE-BASED DESIGN TO IMPROVE THE DELIVERY OF HEALTH CARE IN RURAL SETTINGS
Sponsoring Institution
National Institute of Food and Agriculture
Project Status
COMPLETE
Funding Source
HATCH
Reporting Frequency
Annual
Accession No.
1015373
Grant No.
(N/A)
Cumulative Award Amt.
(N/A)
Proposal No.
(N/A)
Multistate No.
(N/A)
Project Start Date
Feb 9, 2018
Project End Date
Dec 31, 2022
Grant Year
(N/A)
Program Code
[(N/A)]- (N/A)
Recipient Organization
WEST VIRGINIA UNIVERSITY
886 CHESTNUT RIDGE RD RM 202
MORGANTOWN,WV 26505-2742
Performing Department
Family and Consumer Sciences
Non Technical Summary
The project entitled 'Assessing the potential of evidence-based design to improve the dlivery of health care in rural settings' will employ a variety of activities to determine how and if better design of rural health care faciltiies can lead to improved patient and provider outcomes in the rural setting. There is a growing body of knowledge that points to tangible and measurable facility related benefits in the urban care setting--namely well-funded hospitals and clinics that can avail themselves of cutting edge health care design expertise. As nearly 20% of health care in the United States is delivered in a rural setting, and as rural facilities are often in older and otherwise non-compliant buildings (such as old schools, churches, and modular structures that have exceeded their intended lifespans), and as rural health care budgets generally don't provide for the engagement of high-priced health care design expertise, and as rural health care administrators are often not well-versed in the field of evidence-based design, the door is open to an influx of knowledge that has the potential to move the needle on health care delivery in rural settings. This project builds upon two original pilot studies I conducted to assess the perceived facility related impacts to healthcare participation in six different populations in Appalachia: elderly, patients with disabilities, disability policy makers, caregivers of patients with disabilities, health care providers who treat patients with disabilities, and administrators of a rural health care system.
Animal Health Component
30%
Research Effort Categories
Basic
30%
Applied
30%
Developmental
40%
Classification

Knowledge Area (KA)Subject of Investigation (SOI)Field of Science (FOS)Percent
80460993110100%
Knowledge Area
804 - Human Environmental Issues Concerning Apparel, Textiles, and Residential and Commercial Structures;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3110 - Art and architecture;
Goals / Objectives
The overarching goals of this proposal are to raise awareness of evidence-based design in the rural setting and to bring about a transfer of knowledge--urban setting to rural setting--fromthis burgeoning field. It is important that we find a way to bridge the knowledge gap as nearly 20% of health care is delivered in the rural setting where there are limited dollars for capital improvements. When there is funding for facility upgrades, those capital improvements should be maximized in order to help those facilities deliver the best care possible. My first published manuscript, "Impact of Design on Patient Participation in Healthcare in a Rural Health Clinic in Appalachia," Health Environments Research and Design Journal, 2017, highlighted a connection between the design of the physical facility and the participation of elderly patients in their own healthcare. My follow up study used a similar methodology and found additional connections on facillity and participation in a different population--those who identied as having a disability. My work over the next three years will build on the foundation I've established.
Project Methods
My primary methods will mix both qualitative and quantitative approaches.Qualitative methodology will consist of a continuation of my general inquiry via interviews and focus groups of different populations who access their healthcare in rural areas. I have done this successfully with six different populations on two separate, but related, studies. I conduct the interviews/focus groups, record the conversations, transcribe the recordings, and analyze the recordings, along with my notes, for patterns and themes.Quantitative methodology will consist of surveys I have developed and/or will develop from my qualitative findings. I will also make use of other validated facility assessments such as the previously mentioned Outpatient Health Clinic Usability Profile. I will also analyze regularly collected data from specific partner health care facilties that engage in pre/post-design change types of projects to see how participation is impacted. The participation metrics can be teased out with a variety of data: no show rates (appointment keeping) for starters. Patient's self-reported success with sticking to treatment /prevention regimens, and biometric data (such as blood pressure, weight loss, blood borne markers) collected by the health clinics can provide some longitudinal picture of potential impacts related to change of participation. I will explore the use of other relevant data collection tools as they are developed.

Progress 10/01/19 to 09/30/20

Outputs
Target Audience:I continue to work on my research examining the impact that the physical design of rural health care facilities has on the delivery of health care to certain populations. Currently, my efforts are focused on the population consisting of persons on the autism spectrum. My project is currently in data collection via surveys. While an initial partnership with a national autism advocacy organization did not yield the response rate I was hoping for, I am taking a new approach by going state-by-state and making they survey instrument available to any and all autism support organizations with an interest in completing it. I had to re-do the IRB--a process that took an incredibly long time at my institution (12 weeks)--the delays entirely due to an inefficient review system. Changes/Problems:I had to abandon a survey project focused on design barriers faced by persons with autism. A myriad of challgnes arose, some of which relate to staffing (lost my undergraduate research assistant), lack of success in enrolling participants, and now COVID challenges on an already overtaxed healthcare system. What opportunities for training and professional development has the project provided?I've been approached by a largehealthcare design firm to partner in research on rural healthcare design faciltiies. The contact was based on my webinar for the Center for Heath Design from early in this project. How have the results been disseminated to communities of interest?Yes...published jourals and industry firms who focus in healthcare design What do you plan to do during the next reporting period to accomplish the goals?Continue to work towards a better understanding of design related barriers to healthcare access.

Impacts
What was accomplished under these goals? Published the findings of my study on patient control of their space in a bone marrow transplant unit. Recorded a webinar for an international audience for the Journal of Health Design

Publications

  • Type: Journal Articles Status: Published Year Published: 2020 Citation: Haddox JC, Jiang S. The Virtual Shelf: A pilot study on self-selected imagery displays and the inpatient experience in a cancer treatment setting. 2020;5(1):240249. https://doi.org/10.21853/JHD.2020.95


Progress 10/01/18 to 09/30/19

Outputs
Target Audience:I continue to work on my research examining the impact that the physical design of rural health care facilities has on the delivery of health care to certain populations. Currently, my efforts are focused on the population consisting of persons on the autism spectrum. My project is currently in data collection via surveys. While an initial partnership with a national autism advocacy organization did not yield the response rate I was hoping for, I am taking a new approach by going state-by-state and making they survey instrument available to any and all autism support organizations with an interest in completing it. I had to re-do the IRB--a process that took an incredibly long time at my institution (12 weeks)--the delays entirely due to an inefficient review system. Changes/Problems:I am taking a new approach to data collection--same survey, new method of distribution to target audience--as the first attempts to gain national exposure via a national autism advocacy organization did not play out as expected. I have since taken on an undergraduate research assistant who is creating a new, national list of contacts for each state, and is creating the survey in a new distribution platform, Redcap--a move we feel will address some of the technical difficulties respondents were experiencing with the on-line survey. What opportunities for training and professional development has the project provided?I have taken on an undergraduate research assistant through my university's research apprenticeship program. She works 20 hours per week and is focused on developing our new contact list for survey distribution, handling IRB related concerns, and reformatting the survey for a new distribution platform. How have the results been disseminated to communities of interest?National conference (Environmental Design Research Association 50th conference in Brookly, 2019) Marshall University Journal of Medicine (2019) What do you plan to do during the next reporting period to accomplish the goals?Survey distribution to a national audience Data collection Data analysis

Impacts
What was accomplished under these goals? I have continued my work with a new target audience, persons on the autism spectrum, and have taken on an undergraduate research assistant. I presented my preliminary work at an peer-reviewed, international conference in 2019. I have been invited to submit data gathering questions to a state-wide health care survey that goes out to the West Virginia Practice Based Research Network...a dedicated group of rural health care systems across the state who have committed to sharing of data through this annual survey. Should my questions be among the three sets chosen, it will provide an important opening to further data collection and problem identification with this network.

Publications

  • Type: Conference Papers and Presentations Status: Published Year Published: 2019 Citation: Beth, A., Wener, R., Yoon, B., Rae, R. A., & Morris, J. (Eds.). (2019). Proceedings from EDRA 50: Sustainable urban environments. Brooklyn, NY: Environmental Design Research Association. https://cuny.manifoldapp.org/projects/edra-50-proceedings
  • Type: Journal Articles Status: Published Year Published: 2019 Citation: Miller, Jordan Elliott and Haddox, Chris (2019) "Accessible Design in Rural Health Care: Usability Profile of Outpatient Health Care Facilities in Rural West Virginia," Marshall Journal of Medicine: Vol. 5: Iss. 4, Article 9. DOI: 10.33470/2379-9536.1251 Available at: https://mds.marshall.edu/mjm/vol5/iss4/9


Progress 02/09/18 to 09/30/18

Outputs
Target Audience:I have focused my research on several target audiences: 1. Administrators of rural healthcare facilities (looking at accessibility of healthcare facilities) 2. Persons who identify as being on the autism disorder spectrum 3. Persons who identify as being caregivers for persons on the autism disorder spectrum 4. Patients on a bone marrow transplant unit 5. Healthcare staff of a bone marrow transplant unit 6. Persons who identify as having a disability that impedes their access to healthcare Changes/Problems:The major challenges to my work are the niche nature of the topic (difficult to find interested funders) and the human subject/qualitative nature of the research (long time-lines for project completion and manuscript development) What opportunities for training and professional development has the project provided?1. I have presented my research at a peer-reviewed international qualitative research conference and anticipate doing so again at three venues in summer 2019 (ICQI 2019, EDRA 50 2019, and the Autism Society of America 2. I was asked to prepare and conduct a webinar on evidence-based healthcare design in the rural setting by the Center for Health Design. Attendance was much higher (155) than for their average webinars and the feedback led to the creation of a working group to prepare a deep-dive session for the Health Design Conference in 2019. How have the results been disseminated to communities of interest?I am still in the data gathering of my current projects--data dissemination expected to begin in Spring 2019 What do you plan to do during the next reporting period to accomplish the goals?Continue with my research, developing manuscripts for the literature and reports for the target audiences as needed

Impacts
What was accomplished under these goals? 1. Publication of a second manuscript related to healthcare facility design and healthcare participation--this time the population being persons who identify as having a disability that. 2. Beginning of a study on healthcare facility design and persons who are on the autism disorder spectrum (surveys/focus groups/design interventions). 3. Beginning of a study (with my graduate student) on healthcare facility design and accessibility (physical inspection of 10 facilities) 4. Completion of a study that focused on how self-selected imagery can impact patient experience on a bone marrow transplant unit

Publications

  • Type: Journal Articles Status: Published Year Published: 2018 Citation: Kurowski-Burt, A., & Haddox, J. C. (2018). Barriers to Healthcare Participation in Persons With Disabilities in Appalachia: A Qualitative Pilot Study. HERD: Health Environments Research & Design Journal, 11(4), 95⿿107. https://doi.org/10.1177/1937586718786127