SYDCP Research Team

Nancy Morioka-Douglas, MD, MPH

Nancy Morioka-Douglas, MD, MPH, is a Clinical Professor in the Primary Care and Population Health Division in the Department of Medicine.  She has been a family doctor for almost 40  years.  In 2008, she wrote the original funding proposal for what became the Stanford Youth Diabetes Coaches Program which included:  "This one year pilot will explore an innovative intervention that combines these strategies in a way that has neither been reported in the literature nor attempted according to queries to national leaders in this area. A sample of high school students at East Palo Academy will be taught how to “coach” patients with diabetes using well recognized “self management” techniques. Each student will be deployed into the community to partner with one or two older family members with diabetes."

Since that time, the team has used quality improvement processes to iteratively improve the program.  They continue to evaluate effectiveness and have found that high school youth who participate in SYDCP significantly improve daily consumption of fruits and vegetables and physical activity for 60 minutes per day.  High school students also significantly improved health knowledge, family communication, self-esteem, self-efficacy, problem solving, and ability for stress reduction.  

Dr. Morioka-Douglas' goal is to make SYDCP sustainable and reproducible in low-income communities around the country.  To do this, she has developed relationships with family medicine residency training programs, Area Health Education Centers, and now looks forward to partnering with SNAP-Ed programs.  

For her work, in 2017, she received the Dr. Augustus A. White and Family Faculty Professionalism Award at Stanford School of Medicine.  The honor recognizes outstanding work in reducing health disparities or in enhancing the effectiveness of underrepresented minorities in the university community through research, education, mentoring or service.



Eunice Rodriguez, Dr.PH, MPH

Eunice Rodriguez, Dr.PH, MPH is an Associate Professor (Teaching)at Stanford in the Department of Pediatrics. Dr. Rodriguez has also served as an evaluator at the Stanford Geriatric Education Center. Dr. Rodriguez’ research integrates two fields: social epidemiology, within the broader area of public health, and program evaluation, as a synthesis of theory and methods applied to the evaluation of health and social programs.

In Evaluation research her interest lies in the use and exploration of mixed methods, and in Social Epidemiology her interest lies in the study of the social programs and policies that may have an impact on health, well-being, and social reintegration.


Liana Gefter, MD, MPH

Liana Gefter, MD, MPH is a Research Associate in Division of Primary Care and Population Health, Department of Medicine and is the research coordinator for the Stanford Youth Diabetes Coaches Program. Dr. Gefter served as a Teach for America corps member teaching elementary and middle school in East Palo Alto, CA for three years prior to attending medical school. While a medical student at Stanford, she created and coordinated a pipeline program, bringing medical students to teach in East Palo Alto and bringing students from East Palo Alto to the medical school.

After graduating from Stanford Medical School in 2008, Dr. Gefter worked as a consultant in the field of child advocacy and began her work as a Research Associate at Stanford. Dr. Gefter created the curriculum for the Stanford Youth Diabetes Coaching Program combining evidence-based strategies for meeting the needs of underserved students and the principles of proven models of chronic disease self-management for adults.


Angela Jiang, MD

Can "Angela" Jiang, MD is a Clinical Assistant Professor at the Stanford University School of Medicine and sees patients at the Stanford Family Medicine clinic. Prior to medical school, Dr. Jiang was a Teach for America corp member and spent three years teaching high school biology in Chicago. While in medical school, she was the high school outreach chair and brought medical students to teach in classrooms in Chicago.

During residency at the Stanford Health Care-O’Connor Family Medicine program, Dr. Jiang was able to participate as an instructor for the SYDCP. She now is on the research team helping develop the curriculum for the Stanford Youth Health Coaching Program and also writing a new curriculum for an MA pipeline course.


Ashini Srivastava MBBS, MPH

Ashini Srivastava MBBS, MPH is involved with data analysis and evaluation of Stanford Youth Diabetes Coaches Program. Her research interests include creating health education materials for underserved and ethnically-diverse communities to help them attain better health status.

She has more than fifteen years’ experience in developing online educational content for medical students and community-based health workers. She completed medical school in India and later earned a Master’s degree in Public Health. She was inspired to work in the area of school health after working as a community physician in a K-12 school-based health center in India for five years.


Publications

Clinical Professor, Medicine - Primary Care and Population Health

Publications

  • Remote Implementation of a School-Based Health Promotion and Health Coaching Program in Low-Income Urban and Rural Sites: Program Impact during the COVID-19 Pandemic. International journal of environmental research and public health Gefter, L., Morioka-Douglas, N., Srivastava, A., Jiang, C. A., Patil, S. J., Rodriguez, E. 2023; 20 (2)

    Abstract

    Adapting existing health programs for synchronous remote implementation has the potential to support vulnerable youth during the COVID 19 pandemic and beyond.The Stanford Youth Diabetes Coaches Program (SYDCP), a school-based health promotion and coaching skills program, was adapted for remote implementation and offered to adolescents from low-income communities in the US: an urban site in San Jose, CA and rural sites in Lawrence County, MO, and Central Valley, CA. Participants completed online pre- and post- surveys. Analysis included paired T-tests, linear regression, and qualitative coding.Of 156 enrolled students, 100 completed pre- and post-surveys. Of those: 84% female; 40% Hispanic; 37% White; 28% Asian; 3% African American; 30% other race. With T-tests and regression models, the following measures showed statistically significant improvements after program participation: health knowledge, patient activation, health understanding and communication, consumption of fruits and vegetables, psychosocial assets of self-esteem, self-efficacy, problem-solving, and ability to reduce stress. Technology barriers were frequently reported at Lawrence County site. 96% participants reported making a lifestyle change after program participation.Remote implementation of health promotion programs for vulnerable youth in diverse settings has potential to support adoption of healthy behaviors, enhance patient activation levels, and improve psychosocial assets.

    View details for DOI 10.3390/ijerph20021044

    View details for PubMedID 36673800

  • PILOT STUDY OF A NEW TELEHEALTH PROGRAM FOR DEPRESSED OLDER ADULTS: THE POSITIVE EXPERIENCE PROJECT (PEP) Gallagher-Thompson, D., Morioka-Douglas, N., Fogg, B. J., Keck, M. OXFORD UNIV PRESS. 2021: 631
  • Remote Implementation of a Health Promotion Program in an Underserved High School during COVID-19: Lessons Learned J Pediatr & Child Health Care Gefter, L., Morioka-Douglas, N., Srivastava, A., Jiang, C., Rodriguez, E. 2021; 6 (2)
  • Increasing patient activation scores of vulnerable youth by partnering medical residency programs with public high schools. Patient education and counseling Gefter, L. R., Morioka-Douglas, N. n., Srivastava, A. n., Rodriguez, E. n. 2020

    Abstract

    To assess whether participation in Stanford Youth Coaches Programs (SYCP) increases patient activation scores and patient activation levels for vulnerable youth from low income communities.From 2016 to 18, seven high schools and four residency programs in California, Alabama, Kansas and Missouri participated in SYCPs. Enrolled youth participants completed online pre and post-participation surveys including the Patient Activation Measure (PAM®10). We used paired T-tests, chi square tests, and linear multivariate models to compare pre-and post-scores and levels.143 participants completed pre- and post-participation surveys. The PAM®10 mean pre-test score was 64.5 and post-test was 69.37, with mean difference 4.89 (p=.002). Participants showed significant improvement in patient activation levels after participation. 60 % participants in lowest activation Level 1; 63 % in Level 2; and 32 % in Level 3 moved to a higher level of activation after participation; 46 % who started in Level 4 moved down to Level 3 after participation.Participation in SYCPs has potential to significantly increase patient activation for vulnerable youth which could lead to lifelong improvements in health outcomes and decrease in healthcare costs.

    View details for DOI 10.1016/j.pec.2020.08.035

    View details for PubMedID 32948399

  • Addressing Health Disparities and Increasing Cultural Competency of Medical Trainees with Community Engagement J Community Med Health Educ Gefter, L. R., Morioka-Douglas, N., Srivastava, A., Rodriguez, E. R. 2019; 9 (1): 647
  • Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout. JAMA network open Kroth, P. J., Morioka-Douglas, N. n., Veres, S. n., Babbott, S. n., Poplau, S. n., Qeadan, F. n., Parshall, C. n., Corrigan, K. n., Linzer, M. n. 2019; 2 (8): e199609

    Abstract

    Many believe a major cause of the epidemic of clinician burnout is poorly designed electronic health records (EHRs).To determine which EHR design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem.This survey study of 282 ambulatory primary care and subspecialty clinicians from 3 institutions measured stress and burnout, opinions on EHR design and use factors, and helpful coping strategies. Linear and logistic regressions were used to estimate associations of work conditions with stress on a continuous scale and burnout as a binary outcome from an ordered categorical scale. The survey was conducted between August 2016 and July 2017, with data analyzed from January 2019 to May 2019.Clinician stress and burnout as measured with validated questions, the EHR design and use factors identified by clinicians as most associated with stress and burnout, and measures of clinician working conditions.Of 640 clinicians, 282 (44.1%) responded. Of these, 241 (85.5%) were physicians, 160 (56.7%) were women, and 193 (68.4%) worked in primary care. The most prevalent concerns about EHR design and use were excessive data entry requirements (245 [86.9%]), long cut-and-pasted notes (212 [75.2%]), inaccessibility of information from multiple institutions (206 [73.1%]), notes geared toward billing (206 [73.1%]), interference with work-life balance (178 [63.1%]), and problems with posture (144 [51.1%]) and pain (134 [47.5%]) attributed to the use of EHRs. Overall, EHR design and use factors accounted for 12.5% of variance in measures of stress and 6.8% of variance in measures of burnout. Work conditions, including EHR use and design factors, accounted for 58.1% of variance in stress; key work conditions were office atmospheres (β̂ = 1.26; P < .001), control of workload (for optimal control: β̂ = -7.86; P < .001), and physical symptoms attributed to EHR use (β̂ = 1.29; P < .001). Work conditions accounted for 36.2% of variance in burnout, where challenges included chaos (adjusted odds ratio, 1.39; 95% CI, 1.10-1.75; P = .006) and physical symptoms perceived to be from EHR use (adjusted odds ratio, 2.01; 95% CI, 1.48-2.74; P < .001). Coping strategies were associated with only 2.4% of the variability in stress and 1.7% of the variability in burnout.Although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.

    View details for DOI 10.1001/jamanetworkopen.2019.9609

    View details for PubMedID 31418810

  • The electronic elephant in the room: Physicians and the electronic health record JAMIA Open Kroth, P. J., Morioka-Douglas, N., Veres, S., Pollock, K., Babbott, S., Poplau, S., Corrigan, K., Linzer, M. 2018; 1 (1): 49-56

    View details for DOI 10.1093/jamiaopen/ooy016

  • Supporting At-Risk Youth and Their Families to Manage and Prevent Diabetes: Developing a National Partnership of Medical Residency Programs and High Schools PLOS ONE Gefter, L., Morioka-Douglas, N., Srivastava, A., Rodriguez, E. 2016; 11 (7)

    Abstract

    The Stanford Youth Diabetes Coaches Program (SYDCP) is a school based health program in which Family Medicine residents train healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes. This study evaluates the impact of the SYDCP when disseminated to remote sites. Additionally, this study aims to assess perceived benefit of enhanced curriculum.From 2012-2015, 10 high schools and one summer camp in the US and Canada and five residency programs were selected to participate. Physicians and other health providers implemented the SYDCP with racial/ethnic-minority students from low-income communities. Student coaches completed pre- and posttest surveys which included knowledge, health behavior, and psychosocial asset questions (i.e., worth and resilience), as well as open-ended feedback questions. T-test pre-post comparisons were used to determine differences in knowledge and psychosocial assets, and open and axial coding methods were used to analyze qualitative data.A total of 216 participating high school students completed both pre-and posttests, and 96 nonparticipating students also completed pre- and posttests. Student coaches improved from pre- to posttest significantly on knowledge (p<0.005 in 2012-13, 2014 camp, and 2014-15); worth (p<0.1 in 2014-15); problem solving (p<0.005 in 2014 camp and p<0.1 in 2014-15); and self-efficacy (p<0.05 in 2014 camp). Eighty-two percent of student coaches reported that they considered making a behavior change to improve their own health as a result of program participation. Qualitative feedback themes included acknowledgment of usefulness and relevance of the program, appreciation for physician instructors, knowledge gain, pride in helping family members, improved relationships and connectedness with family members, and lifestyle improvements.Overall, when disseminated, this program can increase health knowledge and some psychosocial assets of at-risk youth and holds promise to empower these youth with health literacy and encourage them to adopt healthy behaviors.

    View details for DOI 10.1371/journal.pone.0158477

    View details for Web of Science ID 000379809400051

    View details for PubMedID 27383902

    View details for PubMedCentralID PMC4934855

  • Service-Based Learning for Residents: A Success for Communities and Medical Education. Family medicine Gefter, L., Merrell, S. B., Rosas, L. G., Morioka-Douglas, N., Rodriguez, E. 2015; 47 (10): 803-806

    Abstract

    Community-based service-learning opportunities could support residents' acquisition of Accreditation Council for Graduate Medical Education (ACGME) competencies, but this concept has not been tested, and such programs are difficult to find. The objective of this work was to assess the value and the ACGME competency relevance of a service-learning program for residents that could be easily replicated nationally.Forty-one family medicine residents from three training programs participated in the Stanford Youth Diabetes Coaches Program at six high schools in California and Georgia serving minority students of low socioeconomic status. Residents completed online surveys to provide qualitative feedback and assess the program's impact on their acquisition of residency program competencies and self-management support proficiencies, including prior use and planned use of action plans-a key self-management support strategy.Ninety-five percent of residents indicated that the program was a valuable experience that contributed to acquisition of residency program competencies, including interpersonal and communication skills and communication with teens. Compared with baseline, significantly more residents reported intention to use action plans with patients following participation. Themes from qualitative feedback included: valuing the overall experience, increasing opportunities to practice teaching, enhancing their ability to communicate with adolescents, contributing to the health of the community, recognizing the potential of action plans, and increasing intent to use action plans.This pilot demonstrated that a brief service-learning program can enhance standard residency curriculum by encouraging acquisition of ACGME competencies and promoting utilization of self-management support in clinical practice.

    View details for PubMedID 26545059

  • Training at-risk youth to become diabetes self-management coaches for family members: partnering family medicine residents with underserved schools. Diabetes educator Gefter, L., Rosas, L. G., Rodriguez, E., Morioka-Douglas, N. 2014; 40 (6): 786-796

    Abstract

    The purpose of this study is to evaluate the impact of a school-based health program in which family medicine residents trained healthy at-risk adolescents to become diabetes self-management coaches for family members with diabetes.A mixed methods study included 97 adolescents from 3 San Francisco Bay Area high schools serving primarily ethnic minority youth of low socioeconomic status. Physicians came to schools once a week for 8 weeks and trained 49 adolescents to become coaches. Student coaches and 48 nonparticipant students completed pre- and posttest intervention questionnaires, and 15 student coaches and 9 family members with diabetes gave in-depth interviews after participation. Linear regression was used to determine differences in knowledge and psychosocial assets on pre- and posttests between student coaches and nonparticipant students, and NVIVO was used to analyze interview transcripts.After controlling for initial score, sex, grade, and ethnicity, student coaches improved from pre- to posttest significantly compared to nonparticipants on knowledge, belonging, and worth scales. Student coaches reported high satisfaction with the program. Articulated program benefits included improvement in diet, increased physical activity, and improved relationship between student coach and family member.Overall, this program can increase diabetes knowledge and psychosocial assets of at-risk youth, and it holds promise to promote positive health behaviors among at-risk youth and their families.

    View details for DOI 10.1177/0145721714549676

    View details for PubMedID 25208725

  • No Papanicolaou tests in women younger than 21 years or after hysterectomy for benign disease. JAMA internal medicine Morioka-Douglas, N., Hillard, P. J. 2013; 173 (10): 855-856

    View details for DOI 10.1001/jamainternmed.2013.316

    View details for PubMedID 23568165

  • The "Top 5" Lists in Primary Care Meeting the Responsibility of Professionalism ARCHIVES OF INTERNAL MEDICINE Aguilar, I., Berger, Z. D., Casher, D., Choi, R. Y., Green, J. B., Harding, E. G., Jaeger, J. R., Lavin, A., Martin, R., Montgomery, L. G., Morioka-Douglas, N., Murphy, J. A., Oshman, L., Picker, B., Smith, S. R., Venkatesh, S., Williams, M., Wright, G. M. 2011; 171 (15): 1385-1390

    Abstract

    Physicians can adhere to the principles of professionalism by practicing high-quality, evidence-based care and advocating for just and cost-effective distribution of finite clinical resources. To promote these principles, the National Physicians Alliance (NPA) initiated a project titled "Promoting Good Stewardship in Clinical Practice" that aimed to develop a list of the top 5 activities in family medicine, internal medicine, and pediatrics where the quality of care could be improved.Working groups of NPA members in each of the 3 primary care specialties agreed that an ideal activity would be one that was common in primary care practice, that was strongly supported by the evidence, and that would lead to significant health benefits and reduce risks, harms, and costs. A modification of nominal group process was used to generate a preliminary list of activities. A first round of field testing was conducted with 83 primary care physicians, and a second round of field testing with an additional 172 physicians.The first round of field testing resulted in 1 activity being deleted from the family medicine list. Support for the remaining activities was strong. The second round of field testing showed strong support for all activities. The family medicine and internal medicine groups independently selected 3 activities that were the same, so the final lists reflect 12 unique activities that could improve clinical care.Physician panels in the primary care specialties of family medicine, internal medicine, and pediatrics identified common clinical activities that could lead to higher quality care and better use of finite clinical resources. Field testing showed support among physicians for the evidence supporting the activities, the potential positive impact on medical care quality and cost, and the ease with which the activities could be performed. We recommend that these "Top 5" lists of activities be implemented in primary care practice across the United States.

    View details for DOI 10.1001/archinternmed.2011.231

    View details for Web of Science ID 000293642800016