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

Risk Communication

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

Role: Co-Investigator
Principal Investigator: Delesha Miller, PhD
Novartis
2010

Communication About Glaucoma and Patients Outcomes

Role: Co-Investigator
Principal Investigator: Betsy Sleath, PhD
National Eye Institute
2009-2013

The Effect of Medicaid Prescription Restrictions on Mental Health Utilization

Role: Co-Investigator (Principal Investigator: Joel Farley, Ph.D.)
Pfizer, Inc.
2007

Consumer Assessment of Pharmacist/Pharmacy Services

Role: Principal Investigator on subcontract
Pharmacy Quality Alliance (through subcontract with the American Institutes for Research)
2007

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
2006-2008

Wisewoman Medication Empowerment Module

Role: Co-Investigator
Principal Investigator: Thomas Keyserling, MD
Centers for Disease Control and Prevention
2006

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