I am a health education scientist, social epidemiologist, and health services researcher, working as a Postdoctoral Research Fellow at the University of Michigan in the Department of Family Medicine. At the University of Michigan, I am working with the Center for Disability Health and Wellness and the Michigan Mixed Methods Program.
My research largely focuses on healthcare access, utilization, and delivery among people with disabilities. I apply frameworks from social and legal epidemiology, health services research, and health promotion to understand how ableism impacts health and quality of life outcomes. In my work, I apply quantitative methods (e.g., Latent Class/Profile Analysis, time-varying effects modeling, psychometrics), qualitative methods, and mixed methods to understand health inequities facing priority patient populations. Methodologically, I am interested in the development of conceptual frameworks in research and practice, and the integration of samples in mixed methods studies.
My research has received generous support from:
Ph.D. in Health and Human Performance conc. Health Behavior, 2021
University of Florida
M.S. in Health Education & Behavior, 2017
University of Florida
B.S. in Psychology, 2016
University of Florida
Background. Deaf and hard-of-hearing (DHH) patients are an underserved priority population. Existing, although contextually limited, findings indicate that DHH patients are more likely to use the emergency department (ED) than non-DHH patients. However, little attention has been given to the differences in ED utilization by patients’ language modality. Objective/Hypothesis: We hypothesized that DHH ASL-users and DHH English-speakers would have higher rates of ED utilization in the past 36 months, than non-DHH English-speakers. Methods. We used a retrospective chart review design using data from a large academic medical center in the southeastern United States. In total, 277 DHH ASL-users, 1,000 DHH English-speakers, and 1,000 non-DHH English-speakers were included. We used logistic regression and zero-inflated modeling to assess relations between patient segment and ED utilization in the past 12- and 36-months. We describe primary ED visit diagnosis codes using AHRQ Clinical Classifications Software. Results. DHH ASL-users and DHH English-speakers had higher adjusted odds ratios of using the ED in the past 36-months than non-DHH English-speakers (aORs = 1.790 and 1.644, respectively). Both DHH ASL-users and DHH English-speakers had higher frequency of ED visits, among patients who used the ED in the past 36-months (61.0% and 70.1%, respectively). The most common principal diagnosis code was for abdominal pain, with DHH English-speakers making up over half of all abdominal pain encounters. Conclusions. DHH ASL-users and DHH English-speakers are at higher risk of using the ED compared to non-DHH English-speakers. We call for additional attention on DHH patients in health services and ED utilization research.
Deaf and hard-of-hearing (DHH) populations are understudied in health services research and underserved in healthcare systems. Existing data indicate that adult DHH patients are more likely to use the emergency department (ED) for less emergent conditions than non-DHH patients. However, the lack of research focused on this population’s ED utilization impedes the development of health promotion and quality improvement interventions to improve patient health and quality outcomes. The purpose of this study was to develop a conceptual model describing patient and non-patient (e.g., community, health system, provider) factors influencing ED utilization and ED care processes among DHH people. We conducted a critical review and used Andersen’s Behavioral Model of Health Services Use and the PRECEDE-PROCEED Model to classify factors based on their theoretical and/or empirically described role. The resulting Conceptual Model of Emergency Department Utilization Among Deaf and Hard-of-Hearing Patients provides predisposing, enabling, and reinforcing factors influencing DHH patient ED care seeking and ED care processes. The model highlights the abundance of DHH patient and non-DHH patient enabling factors. This model may be used in quality improvement interventions, health services research, or in organizational planning and policymaking to improve health outcomes for DHH patients.
Deaf people who use American Sign Language (ASL) are more likely to use the emergency department (ED) than their hearing English-speaking counterparts and are also at higher risk of receiving inaccessible communication. The purpose of this study is to explore the ED communication experience of Deaf patients. A descriptive qualitative study was performed by interviewing 11 Deaf people who had used the ED in the past 2 years. Applying a descriptive thematic analysis, we developed five themes: (1) requesting communication access can be stressful, frustrating, and time-consuming; (2) perspectives and experiences with Video Remote Interpreting (VRI); (3) expectations, benefits, and drawbacks of using on-site ASL interpreters; (4) written and oral communication provides insufficient information to Deaf patients; and (5) ED staff and providers lack cultural sensitivity and awareness towards Deaf patients. Findings are discussed with respect to medical and interpreting ethics to improve ED communication for Deaf patients.
Language status can be conceptualized as an equity-relevant variable, particularly for non-English-speaking populations. Deaf and hard-of-hearing (DHH) individuals who use American Sign Language (ASL) to communicate comprise one such group and are understudied in health services research. DHH individuals are at high-risk of receiving lower-quality care due to ineffective patient–provider communication. This perspective outlines barriers to health equity research serving DHH ASL-users due to systems developed by large-scale informatics networks (eg, the Patient-Centered Clinical Outcomes Research Network), and institutional policies on self-serve cohort discovery tools. We list potential to help adequate capture of language status of DHH ASL-users to promote health equity for this population.
Objectives: Deaf American Sign Language (ASL) users comprise a linguistic and cultural minority group that is understudied and underserved in health education and health care research. We examined differences in health behaviors, concerns, and access to health care among Deaf ASL-users and hearing English-speakers living in Florida. Methods: We applied community-engaged research methods to develop and administer the first linguistically accessible and contextually tailored community health needs assessment to Deaf ASL-users living in Florida. Deaf ASL-users (n = 92) were recruited during a 3-month period in summer 2018 and compared with a subset of data on hearing English-speakers from the 2018 Florida Behavioral Risk Factor Surveillance System (n = 12 589). We explored prevalence and adjusted odds of health behavior, including substance use and health care use. Results: Mental health was the top health concern among Deaf participants; 15.5% of participants screened as likely having a depressive disorder. Deaf people were 1.8 times more likely than hearing people to engage in binge drinking during the past month. In addition, 37.2% of participants reported being denied an interpreter in a medical facility in the past 12 months. Conclusion: This study highlights the need to work with Deaf ASL-users to develop context-specific health education and health promotion activities tailored to their linguistic and cultural needs and ensure that they receive accessible health care and health education.