About

The Behavioral Medicine Research Group at the University of Utah provides a unique opportunity for interdisciplinary engagement among researchers, including core Health Psychology faculty in the Psychology Department, affiliated faculty in the U of U Medical Center, and health-focused graduate students across all areas of the department. The group meets twice each month throughout the semester, offering activities such as research presentations from faculty and graduate students, outside speakers, grant development brainstorming sessions, professional development topics, and journal club discussions on current articles in behavioral medicine. The group's work has contributed to numerous successful grant applications and has played an important role in the training of students and early career faculty, fostering highly successful careers.

Research topics

• Medicine
• Nursing
• Computer Science
• Gerontology
• Virology
• Psychology
• Psychiatry
• Data Mining
• Biology
• Internal medicine
• Environmental health
• Family medicine
• Knowledge management
• Economic growth
• Medical education
• Medical emergency

Selected publications

• A Systems‐Approach to Addressing the US Rural Veterinarian Shortage Through Collaborative Problem‐Solving Training and Education

  New Directions for Student Leadership · 2025-12-01

  articleOpen access

  The shortage of rural veterinarians in the United States poses significant challenges to food security, public health, and the agricultural economy. This article explores two systems-based training strategies to address this issue through two case studies: the Integrated Beef Cattle Program (IBCP) in the College of Veterinary Medicine (CVM) at Oklahoma State University (OSU) and the development of adaptive leadership and collaborative problem-solving capacity among rural veterinarians at Pat Dye Clinics. Grounded in Heifetz et al.'s (2009) adaptive leadership framework and Kirton's (2011) Adaption-Innovation Theory (A-I theory), these initiatives demonstrate how leadership development and cognitive diversity can enhance recruitment, retention, and resilience in rural veterinary practice. Findings suggest that integrating leadership learning in veterinary education and professional development can serve as a critical leverage point for systemic change.

  PublisherOA PDFDOI

• “Be Really Careful about That”: Clinicians' Perceptions of an Intelligence Augmentation Tool for In-Hospital Deterioration Detection

  Applied Clinical Informatics · 2025-03-01 · 3 citations

  articleOpen access1st authorCorresponding

  OBJECTIVE: This study aimed to explore clinicians' perceptions and preferences of prototype intelligence augmentation (IA)-based visualization displays of in-hospital deterioration risk scores to inform future user interface design and implementation in clinical care. METHODS: Prototype visualization displays incorporating an IA-based early warning score (EWS) for in-hospital deterioration were developed using cognitive theory and user-centered design principles. The displays featured variations of EWS and clinical data arranged in multipatient and single-patient views. Physician and nurse participants with at least 5 years of clinical experience were recruited to participate in semistructured qualitative interviews focused on understanding their experiences with IA and thoughts and preferences about the prototype displays. A thematic analysis was performed on these data. RESULTS: Six themes were identified: (1) clinicians perceive IA as valuable with some caveats related to function and context; (2) individual differences among users influence preferences for customizability; (3) EWS are particularly useful for patient triage; (4) need for patient-centered contextual information to complement EWS; (5) perspectives related to understanding the EWS composition; and (6) design preferences that focus on clarity for interpretation of information. CONCLUSION: This study demonstrates clinicians' interest in and reservations about IA tools for clinical deterioration. The findings underscore the importance of understanding clinicians' cognitive needs and framing IA-generated tools as complementary to support them. A clinician focuses on high-level pattern matching information, and clinician's comments related to the power of consistency with typical views (e.g., this is "how I usually see things"), and questions regarding support of score interpretation (e.g., age of the data, questions about what the model "knows") suggest some of the challenges of IA implementation. The findings also identify design implications including the need for contextualizing the EWS for the patient's specific situation, incorporating trend information, and explaining the display purpose for clinical use.

  PublisherOA PDFDOI

• Addressing food insecurity among U.S. refugees, considering the temporal patterns of food insecurity after resettlement: Qualitative insights from Utah.

  PubMed · 2025-01-01 · 1 citations

  articleOpen access

  BACKGROUND: Refugees experience high rates of food insecurity (FI) and its associated health outcomes, such as depression and hypertension. Prior research has identified barriers in accessing food among U.S. refugees. What remains unknown is when accessing food becomes a problem for U.S. refugees and what their preferred strategies are to address FI. Therefore, the objectives were to explore FI experiences among refugees to identify time points at which accessing food becomes a problem and to identify refugees' preferred strategies to address FI. METHODS: In collaboration with one of the U.S. resettlement agencies in Utah, refugees were recruited for semi-structured interviews using convenience and snowball sampling. Thirty-six interviews were conducted between July and September 2024, in four different languages: English (4 interviews), Dari (6), Arabic (12), and Kinyarwanda (14). Interview transcripts were analyzed using thematic analysis. RESULTS: FI was at its peak among refugees at four time points. First, when they found their first job in the U.S. Second, after six months in the U.S., when they had to renew their Supplemental Nutrition Assistance Program (SNAP) application. Third, when they were no longer receiving caseworkers' support from resettlement agencies. Fourth, when they faced fluctuations in employment or household expenditures. Refugees' preferred strategies to address FI were addressing language barriers, providing a champion to check on them frequently and help when needed, providing information on addressing unmet needs, extending and expanding SNAP benefits, and providing gardens to grow food. CONCLUSION: Four time points when refugees are at higher risk of FI were identified. Community organizations, policymakers, and resettlement agencies should therefore develop interventions to address FI among refugees, specifically around these four time points and informed by refugees' preferred strategies.

  PublisherOA PDFDOI

• Changing Approaches to Antibiotics in Community-acquired Pneumonia: A Mixed-methods Analysis of Veteran Affairs Medical Centers

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  article

  Abstract Rationale: Clinical experience during the COVID-19 pandemic may change provider attitudes and behavior, particularly surrounding initial antibiotic choices. This study integrated quantitative analysis of practice data and qualitative analysis of clinician interview to understand changes in antibiotic use for pneumonia that have emerged from the pandemic. Methods: We identified antibiotics received within 24 hours of all emergency department (ED) encounters at 134 VA Medical Centers (1/1/2015-4/30/2023) with an initial pneumonia diagnosis based upon ED-assigned diagnosis code or natural language processing and a confirmatory chest imaging report within 24 hours. We developed two mixed effects logistic regression models to predict treatments trained on two periods – early (2015-2016) and late (2022-2023) – that incorporated 60 patient factors, including presenting demographics, comorbidities, vital signs, and laboratory results. We visualized trends in observed versus predicted treatment based upon both models. We then compared patient factors that were most predictive of treatment in the early versus the late model. Qualitative interviews with 29 clinicians from eight VA facilities (2023-2024) explored experiences and influences on pneumonia management and were coded by two trained qualitative analysts utilizing the approach by Crabtree and Miller. Results: Of 337,414 identified ED encounters, 299,335 (87%) received antibiotics within 24 hours, while 46,509 (13%) did not. In the early period, the strongest predictors of withholding an antibiotic for the first 24 hours were elevated brain natriuretic peptide (aOR 1.69[95%CI 1.4-2.0]) and history of congestive heart failure (1.35[1.23-1.49]). In the late period, a positive COVID-19 test became the strongest predictor (OR 2.13 [1.88-2.41]). A positive influenza test had no association with withholding antibiotics in the early period and (aOR 0.95 [0.71-1.27] but became a positive predictor in the late period 1.36 [1.13,1.63]). Interviewed clinicians reported improved viral detection, peer practices, protocols, and stewardship programs as influences on practice. Varying mental models of disease ranging from models of microbial invasion to ecosystem and active hosts. Conclusion: The practice of withholding antibiotics for community-acquired pneumonia increased following the COVID-19 pandemic, which may be influenced by changing approaches to viruses. Further research is needed to evaluate the clinical impact of this practice change.

  PublisherDOI

• Extent and Drivers of Physician Practice Variation in Early Sepsis Management: A Mixed Methods Study

  American Journal of Respiratory and Critical Care Medicine · 2025-05-01

  article

  Abstract RATIONALE: Timely antimicrobial treatment improves sepsis outcomes. We conducted a mixed methods study to understand the extent and drivers of physician variation in door-to-antimicrobial time for sepsis. METHODS: In this mixed methods study, quantitative analyses employed a retrospective cohort including adult patients presenting to one of four Utah emergency departments (EDs) from 2013-2017 who met Sepsis-3 consensus criteria prior to ED departure. ED attending physicians were included if they managed ≥20 eligible patients. The primary analysis employed a generalized linear mixed model to quantify physician-level variation in door-to-antimicrobial timing after adjusting for patient and site level characteristics. ED physicians with mean adjusted door-to-antimicrobial time in the top or bottom quartile were eligible to participate in cognitive task analysis interviews eliciting knowledge, opinions, and practice patterns regarding sepsis diagnosis, management, and metrics, with particular attention to the management of uncertainty and task prioritization. An interdisciplinary coding team, blinded to physician antimicrobial behavior, analyzed interview transcripts iteratively developing codes based on the words of the participants in a thematic analysis approach. A codebook was developed from these initial codes and refined by consensus and discussion. Codes relevant to physician practice variation were identified and responses were evaluated in the context of observed antimicrobial initiation behavior. RESULTS: Among 9,810 patients cared for by 88 ED attending physicians, adjusted mean door-to antimicrobial time varied significantly by physician (p<0.001), ranging from 94 to 177 minutes (Figure). After pilot testing with 3 physicians, 18 physicians (9 from each quartile of fastest and slowest mean door-to-antimicrobial time) participated in the interviews. Most physicians described reliance on heuristics and pattern recognition (type 1 clinical decision making) for identifying patients with sepsis. Physicians with faster antimicrobial times emphasized proactive, parallel task execution and care coordination when evaluating and treating patients with possible sepsis, whereas physicians with slower times described a more reactive and stepwise process. Recognition of the physicians’ role preventing delays in team-based patient evaluation and treatment was also more common among physicians who administered antimicrobials faster. Physicians in both time-to-antimicrobial quartiles generally felt protocols and care bundles aided sepsis care, particularly by reducing cognitive load, but some physicians expressed concern for protocols’ “one size fits all” approach. CONCLUSIONS: ED physicians exhibited nearly two-fold variation in adjusted mean time to antimicrobial initiation for sepsis patients. Physicians with shorter mean door-to-antimicrobials times described a proactive, parallel processing approach to coordinating sepsis care by the multidisciplinary ED team.

  PublisherDOI

• Patient- and Family-Centered Outcomes After Intensive Care Unit Admission

  American Journal of Critical Care · 2025-01-01 · 6 citations

  article

  BACKGROUND: Family satisfaction with intensive care is a measure of patient experience and patient-centered care. Among the factors that might influence family satisfaction are the timing of patient admittance to the intensive care unit (ICU), the ICU environment, and individual health care providers. OBJECTIVE: To evaluate family satisfaction with the ICU and to explore associations between satisfaction and specific characteristics of the ICU stay. METHODS: Participants were adult family members of ICU patients. One family member per patient was enrolled. Regression was used to test the association between time or day of admittance and scores on the Family Satisfaction With Care in the Intensive Care Unit survey. Additionally, we explored exposure to admitting physicians and registered nurses. Free-text survey comments were grouped by using qualitative content analysis. RESULTS: Surveys were completed by 401 family members. There was no association between survey scores and providers, nor between scores and the time or day of the ICU admission. Three major themes emerged as important to patient and family satisfaction: (1) communication and information, (2) personalization or the patient as expert, and (3) staff and environment. CONCLUSIONS: Family satisfaction with an ICU admission was not influenced by the timing of the admission. Overall satisfaction with the ICU was high. The qualitative analysis points to the importance of collecting qualitative data in addition to using standard survey tools to capture the richness of patient experience. Ongoing efforts to engage with families remain critical to the practice of family- and patient-centered care in the ICU.

  PublisherDOI

• Veterans Affairs FreshConnectProduceRx: a study protocol for a pragmatic quasi-experimental study assessing health, healthcare costs, and implementation processes of a produce prescription program in VA medical centers

  BMC Public Health · 2025-07-03 · 2 citations

  articleOpen access1st authorCorresponding

  BACKGROUND: Food insecurity, poor nutrition, and diet-related diseases create major intersecting health challenges. The Veterans Health Administration (VHA) has identified food insecurity as a high-priority problem and established regular clinical screening. Veterans with identified food insecurity and diet-sensitive cardiometabolic health conditions will benefit from the successful implementation of effective Food is Medicine interventions. METHODS: This pragmatic, quasi-experimental intervention study of effectiveness and implementation of a produce-prescription program is conducted in 2 VA hospital health systems in Salt Lake City, Utah, and Houston, Texas. Eligible Veterans have (a) a diet-sensitive cardiometabolic health condition (obesity, hypertension, and/or diabetes) identified in the electronic health record (EHR) by diagnostic codes (ICD-10) and/or lab values and (b) low-income identified by priority status in administrative data. Program enrollment is pragmatically integrated within the VA clinical care process of food security screening and service referrals. Eligible Veterans who screen positive for food insecurity during clinical care processes are referred to the intervention. The Veterans Affairs FreshConnect Produce Prescription (VA FCPRx) intervention program includes 12 months of a produce prescription allowance for purchasing fresh fruits or vegetables, provided as $100 monthly on a pre-paid card for use at local grocery stores. The program also includes culinary education through cooking courses provided by VA nutritionists or nutritional consults provided one-on-one by a VA dietitian. Process and outcome measures will be evaluated using the PRISM RE-AIM framework. Health outcomes related to diet-sensitive chronic conditions (e.g., HbA1c levels for patients with diabetes) and healthcare costs (e.g., outpatient costs) are assessed using EHR data. VA FCPRx participant outcomes are assessed in comparison to a group of similar Veterans using intention-to-treat analyses. Patient-reported outcomes, implementation strategies and outcomes, and staff and Veteran experience are assessed with a combination of surveys, focus groups, and program administrative data. DISCUSSION: This pragmatic quasi-experimental intervention study will provide important new evidence about the impact of a produce prescription program for U.S. Veterans on health outcomes, healthcare costs, and patient-reported outcomes. The assessment of effectiveness and implementation processes and outcomes will inform the design and scaling of impactful, pragmatic, cost-effective programs for food insecure Veterans with diet-sensitive cardiometabolic conditions.

  PublisherOA PDFDOI

• Incorporating a Produce Prescription Intervention Into Clinical Practice: Lessons Learned From a Food Is Medicine Intervention

  Health Promotion Practice · 2025-09-16 · 1 citations

  articleSenior author

  Food is Medicine (FIM) interventions are growing in popularity. Designed to provide nutritious food to patients experiencing food insecurity and/or diet-related health conditions, these programs have the potential to improve dietary quality and health outcomes. As more programs are being implemented, however, there is little information available on the practicalities and logistics of implementation, particularly when embedding FIM interventions within health care organizations. In this report, we outline providers' experiences implementing a produce prescription pilot for 545 military veterans in two major metropolitan areas in a single health care organization. We outline the lessons learned in the process and provide key insights and factors that should be considered when planning an FIM intervention.

  PublisherDOI

• Enhancement of Patient-Centered Lung Cancer Screening

  JAMA Oncology · 2025-12-26 · 3 citations

  articleOpen access

  Importance: Lung cancer screening (LCS) with low-dose computed tomography (CT) remains underused in the US, partly because of incomplete smoking history documentation in electronic health records (EHRs) and limited time for shared decision-making in primary care. Objective: To determine whether a patient-facing, EHR-integrated tool combined with clinician-facing clinical decision support improves the identification of LCS-eligible patients and the ordering of low-dose CT compared with clinician-facing tools alone. Design, Setting, and Participants: This pragmatic, unstratified, randomized clinical trial with parallel groups was conducted from March 29, 2024, to March 28, 2025, at primary care clinics at University of Utah Health and New York University Langone Health. Adults aged 50 to 79 years with a documented smoking history, an active patient portal account, and a primary care visit in the preceding year were included. Study 1 enrolled patients with uncertain LCS eligibility (10 to 19 pack-years, unknown pack-years, or missing quit date); study 2 enrolled patients with documented eligibility (20 or more pack-years and currently smoking or quit smoking within 15 years). Interventions: The control included the clinician-facing Decision Precision+ tool (preventive care reminders and a shared decision-making tool). The intervention included the Decision Precision+ tool as well as the MyLungHealth tool, which collected detailed smoking history (study 1) and delivered personalized education and risk/benefit information (studies 1 and 2) via the patient portal in English and Spanish. Main Outcomes and Measures: The primary outcomes were the proportion of patients newly identified as eligible for LCS (study 1) and low-dose CT ordering rates (study 2) over 12 months. Analyses used intention-to-treat mixed-effects logistic regression. Results: There were 31 303 randomized participants, including 26 729 in study 1 (13 144 [49.2%] female; 13 580 [50.8%] male; median [IQR] age, 62 [55-69] years) and 4574 in study 2 (2230 [48.8%] female; 2344 [51.2%] male; median [IQR] age, 63 [56-69] years). In study 1, the MyLungHealth tool increased new LCS eligibility identification (635 of 13 412 [4.7%] vs 308 of 13 317 [2.3%]; adjusted odds ratio, 2.19; 95% CI, 1.99-2.42; P < .001). In study 2, low-dose CT ordering was higher in the intervention arm (474 of 2312 [20.5%] vs 434 of 2262 [19.2%]; adjusted odds ratio, 1.16; 95% CI, 1.04-1.30; P = .008). Conclusions and Relevance: In this randomized clinical trial, integrating a patient-centered tool into primary care EHR workflows increased the identification of patients eligible for LCS and the ordering of low-dose CTs. The relative increases in these primary outcomes were substantial, but absolute increases were more modest. Research on more intensive interventions is warranted to evaluate their ability to further improve LCS screening. Trial Registration: ClinicalTrials.gov Identifier: NCT06338592.

  PublisherOA PDFDOI

• Shared Decision-Making Tools Implemented in the Electronic Health Record: Scoping Review

  Journal of Medical Internet Research · 2025-01-11 · 9 citations

  reviewOpen accessSenior author

  BACKGROUND: Patient-centered care promotes the involvement of patients in decision-making related to their health care. The adoption and implementation of shared decision-making (SDM) into routine care are constrained by several obstacles, including technical and time constraints, clinician and patient attitudes and perceptions, and processes that exist outside the standardized clinical workflow. OBJECTIVE: We aimed to understand the integration and implementation characteristics of reported SDM interventions integrated into an electronic health record (EHR) system. METHODS: We conducted a scoping review using the methodological framework by Arksey and O'Malley with guidance from the Joanna Briggs Institute. Eligibility criteria included original research and reviews focusing on SDM situations in a real-world clinical setting and EHR integration of SDM tools and processes. We excluded retrospective studies, conference abstracts, simulation studies, user design studies, opinion pieces, and editorials. To identify eligible studies, we searched the following databases on January 11, 2021: MEDLINE, Embase, CINAHL Complete, Cochrane Library including CENTRAL, PsycINFO, Scopus, and Web of Science Core Collection. We systematically categorized descriptive data and key findings in a tabular format using predetermined data charting forms. Results were summarized using tables and associated narratives related to the review questions. RESULTS: Of the 2153 studies, 18 (0.84%) were included in the final review. There was a high degree of variation across studies, including SDM definitions, standardized measures, technical integration, and implementation strategies. SDM tools that targeted established health care processes promoted their use. Integrating SDM templates and tools into an EHR appeared to improve the targeted outcomes of most (17/18, 94%) studies. Most SDM interventions were designed for clinicians. Patient-specific goals and values were included in 56% (10/18) of studies. The 2 most common study outcome measures were SDM-related measures and SDM tool use. CONCLUSIONS: Understanding how to integrate SDM tools directly into a clinician's workflow within the EHR is a logical approach to promoting SDM into routine clinical practice. This review contributes to the literature by illuminating features of SDM tools that have been integrated into an EHR system. Standardization of SDM tools and processes, including the use of patient decision aids, is needed for consistency across SDM studies. The implementation approaches for SDM applications showed varying levels of planning and effort to promote SDM intervention awareness. Targeting accepted and established clinical processes may enhance the adoption and use of SDM tools. Future studies designed as randomized controlled trials are needed to expand the quality of the evidence base. This includes the study of integration methods into EHR systems as well as implementation methods and strategies deployed to operationalize the uptake of the SDM-integrated tools. Emphasizing patients' goals and values is another key area for future studies.

  PublisherDOI

Frequent coauthors

• J. Rick Turner

  IQVIA (United States)

  655 shared

• Yori Gidron

  University of Haifa

  532 shared

• Linda C. Baumann

  University of Cologne

  274 shared

• Michelle Skinner

  Oregon Health & Science University

  272 shared

• Pamela S. King

  Wayne State University

  268 shared

• Yoshiyuki Takimoto

  The University of Tokyo

  266 shared

• Alyssa Karel

  260 shared

• Jordan Carlson

  University of Missouri–Kansas City

  138 shared

Labs

• Behavioral Medicine Research GroupPI

  Engage with a dynamic interdisciplinary group of researchers, including core Health Psychology faculty in the Psychology Department, affiliated faculty in the U of U Medical Center, and health-focused graduate students across all areas of the department.

Education

• Postdoctoral Fellow, Developmental Health Psychology

  University of Utah

  2010

• PhD, Psychology and Behavioral Sciences

  University of California Irvine

  2005

• B.A., Psychology and History

  University of California, Riverside

  1998