Research Areas

Social and Legal Epidemiology

We apply historical and life-course perspectives to understand how social structures are designed to negatively impact the quality of life among people with disabilities. Pertinent to this work, we primarily assess the impact of law. There are several disability civil rights laws and regulations that impact disabled people's access to healthcare and health-promoting resources: (1) Section 504 of the Rehab Act of 1973; (2) the Americans with Disabilities Act of 1990; and, (3) the Patient Protection and Affordable Care Act of 2010. My work in legal epidemiology and public health law research focuses on how the implementation and enforcement of these regulations, or lack thereof, impact the quality of life of people with disabilities.

Communication Access among Deaf and Hard-of-Hearing Patients

Our projects have focused on assessing patients' experiences with receiving accessible healthcare communication mandated by regulations including the Americans with Disabilities Act and Section 1557 of the Patient Protection and Affordable Care Act. This includes: 

• Communication in emergency rooms for deaf people who use American Sign Language to communicate (James et al., 2022). 

• Mental health and treatment facility non-compliance with Section 1557 by not providing services in sign language to deaf patients (James et al., 2022). 

• Communication access for deaf people in perinatal care (James et al., 2023). 

Impact of Ableism on Health and Quality of Life

Ableism is a form of discrimination targeted against people who are, or who are perceived to be, disabled. Ableism can impact the policies developed by the federal and state governments, by companies, and by individuals. Our research seeks to identify the role of ableism in the health and quality of life outcomes among people with disabilities. Our research includes:

• Understanding the attitudinal environment affecting people living with physical disabilities (Reber et al., 2022).

CHARGE Syndrome

CHARGE syndrome is a rare genetic disorder that impacts multiple body systems. It is also the leading genetic cause of DeafBlindness in the United States. We want to improve the infrastructure for conducting research in CHARGE syndrome.

Clinical Informatics

We are interested in how clinical informatics - like electronic health records (EHRs) - can be used to improve the delivery of care to people with disabilities, and therefore improve health and quality-of-life outcomes. We approach this work from a clinical informatics health equity lens, and question how the systems we develop or use may unintentionally impact the communities we serve. 

Recording Disability Status in the Medical Record

As part of a group at the University of Michigan Center for Disability Health and Wellness, we have developed the Disability and Accommodations Tab. This tool is in the main demographic section of a patient's medical record where providers can record patients' disabilities and disability-related accommodation needs. We have published on the development and use of this work: 

• Halkides et al. (2022), JMIR Formative Research

Bias in Health Informatics Data Structures

Health information services and data are influenced by people who are influenced by social norms and attitudes. This can negatively impact the type of data we collect, and make it more difficult to conduct health equity research. We have critiqued major health information systems (e.g., the Patient Centered Outcomes Research Network [PCORnet]) and hospitals for their historic exclusion of people who use American Sign Language to communicate. Our work has provided guidance on how healthcare systems can improve to foster health disparities work with these populations. 

Research Methodology

How can we explain why a person makes a health decision? How can we identify ways to change behavior? How do we know that a 5-question survey measuring depression symptoms is really measuring depression? These are questions that are of interest to researchers in applied theory and methods. We seek to understand how theory and research methods can be improved to better measure health outcomes and behaviors. 

Psychometrics and Item Response Theory for Health Surveys

Measuring health behavior and health outcomes is not as simple as holding up a measuring tape. Some conditions - like diabetes - have blood tests. As of today, there is no blood test for depression or knowledge. Our research aims to identify better ways to measure health behavior. We use research methods to improve the accuracy and precision of the data health researchers collect. Our research has included:

• Understanding HIV-related stigma among college students (James et al., 2020)

• Measuring health insurance knowledge among college students (James et al., 2021)

• Measuring depression, stress, and anxiety among Malaysians (Thiyagarajan et al., 2022)

Improving Mixed Methods Research Methodology

A central goal of our research is to improve the practice of mixed methods research. Mixed methods research combines quantitative and qualitative data to better understand a problem. Our research has helped develop:

• Ways to integrate philosophical decisions in sampling within explanatory sequential mixed methods studies (James et al., 2022)

• Using software for mixed methods integrative data analysis (Guetterman & James, 2023)

OneHealth and Veterinary Medicine

We love working with veterinarians! We have severed as methodologists for research studies focused on marine mammal conservation, the health of service dogs, and veterinary medical education. Interested in working with us? Dr. James provides free consultation to studies led by veterinarians or studies on marine mammal conservation.

Improving Our Understanding of Human Interaction among Marine Mammals

Human interaction is a major issue impacting the health and safety of marine mammals. James Lab worked with The Pacific Marine Mammal Center in Orange County, CA to study human interaction and how we can use radiographs to improve identification in California sea lions. We found: 

• Without radiographs, the prevalence of human interaction would be 7% (5 of 74 patients). 

• With radiographs, the prevalence of human interaction was 32% (24 of 74 patients). 

• Human interaction would have been missed in 79% of cases (19 of 24). 

Improving Disability Competency among Veterinarians

The University of Florida PAWS Program is a student-led, community-based veterinary clinic that provides free primary care services to low-income clients and those with disabilities. The program is completely run by veterinary students. A process evaluation of the program showed that it improved access to veterinary services, saves clients significant costs, and enhances students' preparedness to serve underserved populations. This demonstrates a strong model of service-learning that integrates social responsibility into veterinary eduation.