Susan Blalock, Ph.D., M.P.H., is a professor in the Division of Pharmaceutical Outcomes and Policy. She is a behavioral scientist with expertise in the area of patient and public health education and is particularly interested in risk communication and the impact of pharmaceutical care, including patient education and counseling, on patient health outcomes.
Susan Blalock Lab
Dr. Blalock is a behavioral scientist with expertise in the area of patient and public health education. She holds undergraduate and graduate degrees in pharmacy and public health from the University of Michigan. Her doctoral degree is from the Department of Health Behavior and Health Education in the Gillings School of Global Public Health at UNC-Chapel Hill. She is particularly interested in risk communication and the impact of pharmaceutical care, including patient education and counseling, on patient health outcomes. Her past research has focused primarily on the prevention and treatment of rheumatoid arthritis, osteoarthritis, and osteoporosis.
Her current work focuses on patient-provider communication concerning medication risks and the evaluation of community-pharmacy-based programs focused on illness prevention and disease management. Current projects includes, content analysis of patient-provider communication concerning the risks associated with medications used to treat rheumatoid arthritis, evaluation of a falls prevention program delivered via community pharmacy residents; an osteoporosis prevention program targeting patients taking oral glucocorticoids, a class of medications known to increase the risk of developing osteoporosis; and a proactive pneumococcal vaccination program delivered through community pharmacies.
Dr. Blalock also has expertise in the development of patient-reported outcomes measures. Her work includes development of a scale to assess patient concerns regarding their pharmacotherapy. Community pharmacists can use this instrument to tailor their counseling efforts toward each patient’s unique needs. Examples of other areas of interest include how best to train pharmacists and pharmacy students to provide high quality patient education; the impact of medication counseling on patient outcomes such as satisfaction with care, medication adherence, drug-therapy problems, and adverse drug events; how to improve the quality of written patient education materials; and structural factors that may facilitate, or impede, the provision of high quality educational services by pharmacists.
Determinants of Behavior Change and Evaluation of Behavior Change Interventions
Health care providers often find themselves in the position of trying to change human behavior and they know, from experience, that this is not an easy task. Dr. Blalock’s work in this area addresses a very basic research question: “Why do people often not practice those behaviors that are recommended to promote health and well-being?” Most of her work has focused on behaviors recommended to reduce the risk of developing osteoporosis. Her work reflects a gradual transition from research focused on behavioral recommendations targeted toward the general public to those involving medication-related issues in patient populations. For example, a current study examines patient behavior within the context of glucocorticoid-induced osteoporosis. Glucocorticoids are a class of medications known to increase the risk of developing osteoporosis. However, one finding from this study is that only about one-third of individuals taking glucocorticoids report having been counseled about osteoporosis prevention. More work is needed to determine how best to improve patient counseling efforts. Much of Dr. Blalock’s current work focuses on how to enhance the patient counseling provided by community pharmacists
Principles of informed consent, informed and shared decision-making, and professional ethics highlight the importance of patients’ understanding both the risks and benefits of available treatment options. Although patients differ in their desire to participate fully in shared decision-making, almost all patients express an interest in information about available treatment options and most want information about treatment risks. However, research suggests that this type of information is not routinely provided during patient office visits. Perhaps not surprisingly, research also suggests that many patients have a poor understanding of the risks associated with the medications prescribed for them. These observations highlight the need to better understand how health care providers currently communicate information about medication risks to patients, how patients process the information provided, and how this information influences patient judgments and decisions regarding medication use. Dr. Blalock’s current research is designed to increase understanding of these important issues. Her work is guided by fuzzy-trace theory, a dual-process model of memory, reasoning, and development, that has been used to study how both children and adults make decisions that involve risk. Fuzzy-trace theory was developed by Dr. Valerie Reyna at Cornell University and grew out of findings from cognitive research conducted over the past 20 years suggesting that judgment and memory operate independently. Briefly, fuzzy-trace theory posits that, when an individual is exposed to any meaningful stimulus (e.g., a statement made by one’s physician), two representations of the stimulus are encoded in memory, a verbatim representation and a gist representation. Gist representations reflect the essential meaning of the stimulus to the person. Different people exposed to the same stimulus may form different gist representations, depending on their preexisting knowledge, previous experiences, emotional state, developmental stage, and worldview. A central tenet of fuzzy-trace theory is that, when making judgments and decisions, people tend to rely on gist representations that are stored in memory and only retrieve verbatim representations when it is required by the task at hand. Currently, Dr. Blalock is using audiotapes of rheumatoid arthritis patient office visits to develop a detailed, 2-level coding scheme that will capture information exchanged during these visits concerning medication risks. The Verbatim-Level Coding Scheme will capture the specific types of information concerning medication risks that were discussed during each visit. The Gist-Level Coding Scheme will capture gist themes that were expressed during the visits (e.g., medication is safer than alternatives) and the clarity with which gist was communicated. This study has the potential to contribute to a paradigm shift in the field of risk communication and will lead to improved methods to train rheumatologists how best to counsel patients about medication risks to achieve optimal health outcomes.
Measurement of Patient-Reported Outcomes
Measurement is a critical component of all scientific endeavors. Unless something can be measured, it cannot be studied. The development of valid and reliable measures is particularly important in the behavioral sciences because often the phenomena of interest cannot be directly observed. Dr. Blalock’s work in this area has included: evaluating the psychometric properties of instruments developed in the general public when used in patient populations, evaluating the sensitivity of functional status measures, developing abbreviated versions of existing instruments to increase their utility in clinical practice, and developing instruments to assess constructs of theoretical interest. Most recently, Dr. Blalock and colleagues developed a measure designed to assess patient concerns regarding prescribed medication regimens. This measure is intended to be used to assess outcomes associated with pharmaceutical care programs. Current outcome measures used to assess such programs often lack the sensitivity to detect change. It is hoped that this new measure will help to overcome this problem.
Psychosocial Aspects of Chronic Illness and Disability
The development of a chronic illness, particularly one associated with physical impairment, presents many adaptational difficulties. Often, chronic illnesses are accompanied by psychological distress, as individuals experience difficulty doing activities that they once performed with ease. However, past research has observed that there is only a modest association between objective level of physical impairment and psychological distress. That is, individuals with the most functional impairment do not necessarily experience the most distress. Much of Dr. Blalock’s research has focused on the identification of factors that influence the development of psychological distress in response to chronic illness. The goal of this work has been to better understand the variation in distress that may accompany chronic illness and, ultimately, develop interventions that prevent or ameliorate this distress.
Communicating Risks Associated with Prescription Medications.
Role: Principal Investigator
American College of Rheumatology Research & Education Foundation
2010 – 2012
Determining the Effects of Conflicting Medication Information and Spouse Support on the Medication Adherence of Osteoarthritis Patients
Principal Investigator: Delesha Miller, PhD
Communication About Glaucoma and Patients Outcomes
Principal Investigator: Betsy Sleath, PhD
National Eye Institute
The Effect of Medicaid Prescription Restrictions on Mental Health Utilization
Role: Co-Investigator (Principal Investigator: Joel Farley, Ph.D.)
Consumer Assessment of Pharmacist/Pharmacy Services
Role: Principal Investigator on subcontract
Pharmacy Quality Alliance (through subcontract with the American Institutes for Research)
Anti-osteoporosis Medication Trends and Determination in the US Ambulatory Population from 1996-2004: Results from the Medical Expenditure Panel Survey (MEPS)
Role: Senior Investigator (Mentor)
Principal Investigator: Joel Farley, PhD
American Society of Health-System Pharmacists
Wisewoman Medication Empowerment Module
Principal Investigator: Thomas Keyserling, MD
Centers for Disease Control and Prevention
Enhancing Pneumococcal Vaccination Rates Through Community Pharmacist Involvement
Role: Co-Investigator (Principal Investigator: Stefanie Ferreri, PharmD)
Centers for Disease Control and Prevention
October 2005-September 2007
Blalock SJ, Keller S. Consumer Assessment of Pharmacy Quality. In, Warholak TL, Nau DP, eds. Pharmacy Quality: Improving the Safety and Effectiveness of Pharmacy Services. London: McGraw-Hill; 2010.
Blalock SJ, Beard AJ, Dusetzina SB. Individual/Interpersonal Models of Health and Illness Behavior. In Rickles NM, Wertheimer AI, Smith M, eds. Social and Behavioral Aspects of Pharmaceutical Care, 2nd. Edition. Sudbury, MA: Jones and Bartlett, 2010.
DeVellis RF, Blalock SJ. Outcomes of Self-Management Interventions. In Newman S, Steed E, Mulligan K eds. Chronic Physical Illness: Self-Management and Behavioural Interventions. London: McGraw-Hill; 2008.
Weinstein ND, Sandman PM, Blalock SJ. The Precaution Adoption Process Model. In Glanz K, Rimer BK, Lewis FM, eds. Health Behavior and Health Education: Theory, research and practice. San Francisco: Jossey-Bass; 2008:123-147
Aljadhey H, Tu W, Hansen RA, Blalock SJ, Brater DC, Murray MD. Risk of hyperkalemia associated with selective cox-2 inhibitors: a propensity score matching study. Pharmacoepidemiol Drug Saf, in press
Farley JB, Wang C, Blalock SJ. Status of Ph.D. education in economic, social, and administrative sciences between 2005 and 2008. Am J Pharm Educ, in press
Blalock SJ, Demby KB, McCulloch KD, Stevens JA. Factors influencing hip protector use among community-dwelling older adults. Injury Prevention, in press
Beard AJ, Sleath B, Blalock SJ, Roth M, Weinberger M, Tudor G, Chewning B. Predictors of Rheumatoid Arthritis Patient-Physician Communication about Medication Costs during Visits to Rheumatologists. Arthritis Care Res, 2010;62(5):632-9.
Hansen RA, Chin H, Blalock SJ, Joy MS. Pre-dialysis chronic kidney disease: evaluation of quality of life in clinic patients receiving comprehensive anemia care. Res Soc Adm Pharm, 2009;5(2):143-53.
Sleath B, Blalock SJ, Bender DE, Murray M, Cerna A, Cohen MG. Latino patients’ preferences for medication information and pharmacy services. J Am Pharm Assoc 2009;49(5):632-6.
Sleath B, Blalock SJ, Robin A, Hartnett ME, Covert D, DeVellis B, Giangiacomo A. Development of an instrument to measure glaucoma medication self-efficacy and outcome expectations. Eye, 2009; July 17, PMID:19648896.
Blalock SJ, Gregory, PJ, Patel, RA, Norton LL, Callahan LF, Jordan JM. Factors Associated with Potential Medication-Herb/Natural Product Interactions in a Rural Community. Altern Ther Health Medicine, 2009;15(5):26-34.
Farley JF, Blalock SJ. Trends and determinants of prescription anti-osteoporosis medication Use. Am J Health Syst Pharm, 2009; 66(13):1191-201.
Joyner PU, Thomason TE, Blalock SJ. Practice settings, job responsibilities, and job satisfaction of nontraditional PharmD and BS pharmacy graduates. Am J Pharm Educ. 2009; 73(2):33.
Sleath B, Blalock SJ, Bender D, Murray M, Cerna A, Cohen MG. Latino’ sources of medication and medication information in the United States and their home countries. Patient Educ Couns. 2009; 75(2):279-82.
Blalock SJ, Demby KB, McCulloch KL, Stevens JA. Seniors’ perceptions of using hip protectors to reduce fracture risk. J Am Geriatr Soc. 2008:56:1773-1774.
Ferreri S, Roth MT, Casteel C, Demby KB, Blalock SJ. Methodology of an ongoing, randomized controlled trial to prevent falls through enhanced pharmaceutical care. Am J Geriatr Pharmacother. 2008;6: 61-81.
Farley JF, Blalock SJ, Kline RR. Effect of the women’s health initiative on prescription anti-osteoporosis medication utilization. Osteoporos Int. 2008,19:1603-1612.
Thorpe CT, DeVellis RF, Blalock SJ, Hogan SL, Lewis MA, DeVellis BM. Patients’ perceptions about illness self-management in anca-associated small vessel vasculitis. Rheumatology 2008; 47(6):881-6
Joyner PU, Cox WC, White-Harris C, Blalock SJ. The structured interview and interviewer training in the admissions process. Am J Pharm Educ. 2007;71:83
Thorpe CT, DeVellis RF, Lewis MA, Blalock SJ, Hogan S, DeVellis BM. Development and initial evaluation of a measure of self-management for adults living with anca-associated small vessel vasculitis. Arthritis Rheum. 2007;5:1296-1302.
Blalock SJ. Predictors of calcium intake patterns: a longitudinal analysis. Health Psychol. 2007;26(3):251-258.
Thorpe JM, Sleath BL, Kalinowski CT, VanHoutven CH, Blalock SJ, Landerman LR, Campbell WH, Clipp EC. Caregiver psychological distress as a barrier to vaccination for influenza among community-dwelling elderly with dementia. Med Care. 2006;44(8):713-21.
Hansen RA, Greene SB, Williams CE, Blalock SJ, Crook KD, Akers R, Carey TS. Types of medications errors in North Carolina nursing homes: a target for quality improvement. Am J Geriatr Pharmacother. 2006;4(1):52-61.
Blalock SJ. Toward a better understanding of calcium intake: behavioral change perspectives. J Reprod Med. 2005;50:901-6.
Blalock SJ, Byrd JE, Hansen RA, Yamanis TJ, McMullin K, DeVellis BM, DeVellis RF, Panter AT, Kawata AK, Watson, LC, Jordan JM. Factors associated with potentially inappropriate drug utilization in a sample of community-dwelling older adults. Am J Geriatr Pharmacother. 2005;3:168-179.
Blalock SJ, Norton LL, Patel RA, Dooley MA. Patient knowledge, beliefs, and behavior concerning the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Care Res. 2005;53:732-739.
Welch AC, Ferreri SP, Blalock SJ, Caiola SM. North Carolina family practice physicians’ perceptions of pharmacists as vaccinators. J Am Pharm Assoc. 2005;45:486-491.
Blalock SJ, Patel RA. The Drug Therapy Concerns Scale: Initial development and refinement. J Am Pharm Assoc. 2005;45:160-169.
McIntosh J, Blalock SJ. Effects of media coverage of the Women’s Health Initiative on the attitudes and behavior of women regarding hormone replacement therapy. Am J Health Syst Pharm. 2005;62:69-74.
Patel R, Carr-Lopez SM, Blalock SJ. Assessment of clinical endpoints and medication utilization in patients with type 2 Diabetes. J Air Force Pharm. 2004;11(2): 93-98.
Blalock SJ, Norton LL, Patel RA, Cabral K, Thomas CL. Development and assessment of a short instrument for assessing dietary intakes of calcium and vitamin D. J Am Pharm Assoc. 2003;43:685-693.
Blalock SJ, DeVellis BM, Patterson CC, Campbell MK, Orenstein DR, Dooley MA. Effects of an osteoporosis prevention program incorporating tailored educational materials. Am J Health Promot. 2002;16:146-156.
Currently, I have teaching responsibilities in both the professional program in the School of Pharmacy and the graduate program in the Division of Pharmaceutical Outcomes and Policy. Teaching within these two curricula present unique challenges and opportunities. However, my approach to each is guided by one primary goal – to prepare students for life-long learning by enhancing their ability to think critically, analytically, and creatively. To accomplish this goal, I strive to make learning fun.
Within this context, I view teaching as similar to story-telling. At the beginning of the story (i.e., course), it is necessary to capture the audience’s attention. Gradually, the characters are introduced, the story unfolds, and the plot thickens. Details are added to provide richness, but not in a way that distracts from the primary storyline. And, when the story ends, all the pieces fit neatly together. There are no puzzled faces (I dream of that day) and people remember the main elements of the story long after other memories have faded.
In teaching, students help professors tell the story. They are able to communicate, either verbally or non-verbally, to tell the professor if they have gotten lost in the details or if they have simply lost interest in the story. Thus, each time a professor teaches a class, it is a little different, tailored to the unique combination of abilities and interests of students participating in the class.
Teaching provides professors with the opportunity to change the future. Most of the students I teach today will outlive me by two or three decades. However, through my work with them, I have the opportunity to influence the work they do – long after I have stopped working myself. This recognition comes with enormous responsibility. I believe that teaching involves much more than simply conveying knowledge. It also involves conveying values. Most of my students in the PharmD curriculum will become health care providers. In that capacity, they will be responsible for caring for patients. It is important that they have the technical expertise necessary to provide the best possible care. However, it is equally important that they have compassion and respect for others. I try to model these values in my interactions with students, whether in the classroom or in one-on-one interactions. I always try to treat students respectfully and make time for them whenever they need my assistance, or when they simply need an ear to listen to a problem they are experiencing. While maintaining high classroom standards, I also try to model compassion. After exams, I always ask students who did poorly to meet with me. My goal in these meetings is to express concern for the student, convey both the gravity of the situation as well as my faith in the student’s ability to succeed, help the student problem-solve, and coordinate assistance if needed. My hope is that students will internalize my concern for their well-being and that this, in turn, will influence how they interact with patients in the future.
Title: Drug Literature Analysis and Interpretation
Provides students with a working knowledge of the concepts and methods of clinical drug trials. In addition the course reviews the principles of drug study design and biostatistics. The course blends concepts and principles with discussion of clinically-important articles from the biomedical literature. This course will add to students’ competencies in identifying, analyzing and interpreting literature and assist students in their application of that literature into clinical practice.
Title: Social and Behavioral Aspects of Pharmaceutical Care
This course draws from medical socialogy and health psychology to familiarize students with core theories, research, measures, and design issues relevant to conducting social/behaviorial research surrounding pharmaceutical use.
Chris Gillette: The effect of risk and side effect communication on asthma medication adherence. 
Deidre Washington: The Effect of Patient’s Race on Patient-Provider Communication with Pediatric Asthma Patients. 
Hisham Aljadhey: The effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on blood pressure, renal function, and serum potassium concentrations. 
Ashley Beard: Cost as a feature of medication management communication in medical visits. 
John Byrd: Impact of medication stressors on emotional health of informal caregivers of demented patients. 
Suzanne Cadarette: Barriers to and facilitators of osteoporosis investigation and treatment among older community-dwelling women in Ontario: Application of a health services utilization conceptual framework. 
Mark Patterson: Effect of prescription copayments on medication persistence and hospitalizations in commercially insured patients with heart failure. 
Carolyn Thorpe: Treatment adherence among adults living with ANCA small vessel vasculitis. 
Joshua Thorpe: Health care utilization in community-dwelling persons with dementia: The role of informal caregiver emotional health. 
Injury Prevention Research Center, Member of Core Faculty Group
Health Promotion and Disease Prevention Center, Member of Scientific Advisory Committee
- American Association of Colleges of Pharmacy
- American Pharmaceutical Association
- American Public Health Association
- Association of Rheumatology Health Professionals
School of Pharmacy Standing Committees
ACPE Self-Study Steering Committee, Chair of Mission, Planning and Evaluation Subcommittee
Service Outside School of Pharmacy
North Carolina Falls Prevention Coalition, Chair of Community Awareness and Education Working Group
Injury Prevention Research Center, Member of Core Faculty Group
Health Promotion and Disease Prevention Center, Member of Scientific Advisory Committee