Andrea Cherrington

University of Alabama at Birmingham, Birmingham, Alabama, United States

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Publications (43)64.62 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: African Americans are disproportionately affected by the diabetes epidemic; they suffer greater diabetes-related complications and face more problems with diabetes self-management than non-Hispanic whites. Increasingly, the community health worker (CHW) model has been implemented in an effort to improve health outcomes in underserved populations. While diabetes CHW interventions in the literature have been successful, the majority of CHWs as well as the participants have been women. Further research is needed regarding men’s perceptions of how community-based interventions to promote diabetes self-management might best be implemented. The purpose of this qualitative study is to explore how African American men living with type 2 diabetes perceive the role and duties of the community health worker in the context of a community-delivered diabetes management program. Methods: Four ninety-minute focus groups were guided by a trained moderator with a written guide to facilitate discussion on the topic of community health workers (CHWs) and diabetes management. Participants were recruited from the diabetes education database at Cooper Green Mercy Hospital in Birmingham, AL. Two independent reviewers performed content analysis to identify major themes using an iterative, combined deductive and inductive approach. Results: There were 25 male participants. Mean years living with diabetes was 9.6 (range 1-20). Participants demonstrated knowledge of self-management strategies and identified various hardships including emotional and physical manifestations of diabetes, dietary restrictions and non-adherence, and institutional frustrations with the medical system that contributed to self-management barriers. Participants preferred CHWs be knowledgeable with a shared experience. Their preferred CHW duties were to educate, hold support groups, help track daily activities, and help find resources. Potential concerns regarding CHWs included cultural competency and confidentiality. The participants also discussed the importance of family-focused support dynamics. Conclusions: Participants identified critical self-management strategies but endure hardships that present barriers to achieving these methods. Many of the strategies and barriers to self-management that participants identified mirrored their preferred CHW duties and traits. Results from this study suggest that African American men in Alabama would participate in and benefit from a community-delivered diabetes management program.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
  • Andrea Cherrington, April A. Agne, James Willig, Alfredo Guzman
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    ABSTRACT: Community Health Worker interventions offer a promising strategy for improving diabetes self-management and health outcomes, with evidence to support its effectiveness, particularly in underserved communities. However, there is limited evidence on how to most effectively integrate CHW programs with primary care efforts. Mobile health technology (mHealth) can connect CHWs to members of the health care team, creating synergy through the bidirectional exchange of information. This project represents a partnership between an academic institution, a safety net health system, and a local community based organization of African American Churches. Our overarching goal was to develop an effective model for the integration of a community health worker (CHW) delivered peer support program with primary care-based efforts to improve glycemic control and health outcomes. We employed an iterative, user-centered approach to develop an mHealth tool that allows for the effective and secure exchange of information between CHWs and the primary care team, allowing patients to benefit from coordinated efforts. Five CHWs and three health care providers were trained to use the system and provide real time feedback to the study team. To date, satisfaction with the system is high. We have enrolled 120 low-income African American patients with diabetes into an ongoing randomized controlled trial designed to demonstrate feasibility and provide an estimate of the intervention’s effectiveness. In this presentation we will describe development of the mHealth communication system in terms of both the process and the content. The integration of mHealth technology into CHW programs is innovative, advancing the science of developing and delivering sustainable community-based interventions.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Objectives: Research and interventions have been directed at physicians in order to attempt to address perceived racial/ethnic discrimination in medical care and potentially provide more equitable care across the US population. However, little is known about the contributions of other ancillary medical staff (e.g., nurses, medical assistants, and receptionists) to perceived discrimination in medical care. Methods: We conducted focus group interviews with African-American (AA) and European-American (EA) participants stratified by race and gender who interacted with the Alabama health care system in the previous 12 months. We utilized a focus group topic guide, based on Social Cognitive Theory, in order to probe for personal, behavioral, and environmental factors that contribute to perceived discrimination in health care. Group interviews were audio recorded. Two investigators independently analyzed the transcribed focus group interviews for relevant themes. Results: 29 AA women (mean age and standard deviation, 47±10 years), 24 AA men (53±11 years), 18 EA women (54±15 years), and 19 EA men (39±13 years) participated in 12 focus groups. We identified several main themes related to perceptions of staff bias including communication and personal attitudes/behaviors. Communication included both verbal and non-verbal forms of communication. For example, “It’s the way they talk to you…they can talk to you like you’re below average, you know, just the tone of the voice.” Personal attitudes/behavior themes were identified with words such as “personable”, “respectful”, and “takes their time.” Some focus group response examples included, “I mean, [they] look at you, like, up and down, like you ain’t nothing,” and “they’re kind to somebody right before you, and they’re not to you. They’re short-spoken to you.” Conclusions: The behaviors of ancillary staff in the health care setting can potentially contribute to patients’ perceptions of discrimination. Future efforts to reduce health care discrimination interventions should include a focus on staff’s cultural competence and customer service skills.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Purpose: Trust in your physician has been previously linked to better glycemic control. We examined the relationship between general trust in physicians and diabetic outcomes as measured through blood pressure and glycemic control (HbA1c). Methods: This is a secondary data analysis using cross-sectional data from a community-based trial. Patients were mostly African Americans with diabetes living in southern, rural Alabama. Face-to-face interviews by trained interviewer assessed general trust in physicians using a previously validated instrument (TMP-11). HbA1c and blood pressure were measured at baseline using a standardized protocol. Categorical variables were compared using chi square tests. Continuous variables were compared using bivariate linear regression. Multivariable analyses included general linear regression models adjusted for gender, income, education, insulin use, medication adherence, number of ambulatory visits, perceived discrimination, and depressive symptoms. Results: 418 patients provided information for the trust scale (6 were missing). Mean age was 59, 75% were female and 87% were African American. High Trust (TMP > 30) was associated with older age, less perceived discrimination, and lower medication adherence. In bivariate analyses, HbA1c (p=0.26) and mean blood pressure (p=0.64) showed no significant association with provider trust. Discussion: General trust in physicians was not associated with change in glycemic control or blood pressure at follow-up in unadjusted analyses. Though it did not reach statistical significance, higher general trust was associated with higher systolic blood pressure. Future research should further explore these relationships.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: Background: Diabetes Connect is a small-randomized control trial designed to test a 6 month community-based peer support intervention that is integrated into primary care efforts for low-income African American patients with type 2 diabetes in Jefferson County, Alabama. The study is a collaboration between a university, a local safety-net health system, and a community-based organization (CBO) of 10 African American Churches. This paper describes the recruitment activities employed in the study along with lessons learned. Methods: Potential participants with type 2 diabetes were identified from the health system database. Patients were sent letters inviting them to recruitment events near their homes. An average of 144 letter invitations was sent for each event. Study staff also made phone calls to personally invite the patients. An average of 120 calls was made per event date. Of those who were called, 58% did not answer or were disconnected numbers, 27% declined, and 15% accepted the invitation. All potential participants received a 5-hour diabetes education program; events were held at local churches or at the local safety-net health system. Following the class, eligible individuals were invited to participate in the study. Food was provided at the class and all potential participants received a $15 gift card. Individuals who qualified for the study and completed the baseline questionnaire received an additional $15. Results: There were 18 recruitment events. Fourteen were hosted by local churches and 4 were held at diabetes education classes. On average, 8% of those who the study team attempted to contact by phone attended recruitment events, making up 39% of total attendees. The other 61% of attendees had either received a letter invitation, were referred to diabetes education class by their health care provider, or both. All were consented and screened for participation in the study. Of the 239 patients who attended the events, 120 met inclusion criteria and were enrolled into the study. A mean of 13 (range 1 to 23) patients was screened and a mean of 6 (range 1 to 15) was enrolled at each event. Conclusions: For this study, recruitment strategies included letters followed by personal phone calls, provision of education to all interested individuals, classes at trusted community locations with food provided, and small incentives for all potential participants. Recruitment in underserved communities can be enhanced by strong community partnerships, a flexible, iterative approach that acknowledges and attempts to address participants’ potential barriers to participation.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The last decade has seen many changes in graduate medical education training in the USA, most notably the implementation of duty hour standards for residents by the Accreditation Council of Graduate Medical Education. As educators are left to balance more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed.
    Postgraduate medical journal. 10/2014;
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    ABSTRACT: We examined the efficacy of a community-based, culturally relevant intervention to promote healthy eating and physical activity among African American (AA) women between the ages of 45-65, residing in rural Alabama.
    Preventive medicine. 08/2014;
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    ABSTRACT: This study evaluated a culturally relevant, social cognitive theory-based, Internet-enhanced physical activity (PA) pilot intervention developed for overweight/obese African American (AA) female college students.
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    ABSTRACT: In community-based interventions involving lay health workers, or "community health workers," peer-client interactions are not typically observed by investigators, creating challenges in assessing intervention fidelity. In the context of a community-based randomized controlled trial of the effectiveness of peer support on diabetes outcomes of people with diabetes in rural Alabama, a region characterized by poverty and low literacy, we developed a video assessment tool that assessed participant perceptions of peer-client interactions. The video assessment consisted of four short skits on areas of emphasis during peer training: directive versus nondirective counseling style and setting a specific versus a more general goal. The video tool was evaluated for association with questionnaire-derived measures of counseling style and goal setting among 102 participants. For counseling style, 44% of participants reported that their peer advisor was most similar to the nondirective skit. For goal setting, 42% reported that their peer advisor was most similar to the specific goal skit. There was no statistically significant relationship between skit selection and questionnaire-derived measures. The video assessment was feasible, but results suggest that video and questionnaire assessments in this population yield different results. Further validation to better understand the differences between questionnaire reports and video assessment is warranted.
    Health Promotion Practice 01/2014; · 0.55 Impact Factor
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    ABSTRACT: Innovative approaches are needed to promote physical activity among young adult overweight and obese African American women. We sought to describe key elements that African American women desire in a culturally relevant Internet-based tool to promote physical activity among overweight and obese young adult African American women. A mixed-method approach combining nominal group technique and traditional focus groups was used to elicit recommendations for the development of an Internet-based physical activity promotion tool. Participants, ages 19 to 30 years, were enrolled in a major university. Nominal group technique sessions were conducted to identify themes viewed as key features for inclusion in a culturally relevant Internet-based tool. Confirmatory focus groups were conducted to verify and elicit more in-depth information on the themes. Twenty-nine women participated in nominal group (n = 13) and traditional focus group sessions (n = 16). Features that emerged to be included in a culturally relevant Internet-based physical activity promotion tool were personalized website pages, diverse body images on websites and in videos, motivational stories about physical activity and women similar to themselves in size and body shape, tips on hair care maintenance during physical activity, and online social support through social media (eg, Facebook, Twitter). Incorporating existing social media tools and motivational stories from young adult African American women in Internet-based tools may increase the feasibility, acceptability, and success of Internet-based physical activity programs in this high-risk, understudied population.
    Preventing chronic disease 01/2014; 11:E09. · 1.82 Impact Factor
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    ABSTRACT: Intuitive eating programs that improve self-efficacy and dietary habits could enhance glycemic control in African-American women with type 2 diabetes. The goal of our study was to investigate how current eating practices and beliefs of African-American women living with diabetes aligned with intuitive eating concepts. African-American women with type 2 diabetes referred for diabetes education class during 2009-2012 were recruited for a qualitative study using focus groups for data collection. Verbatim group transcriptions were analyzed by two independent reviewers for themes using a combined inductive-deductive approach. Participants (n=35) had an average age 52±9 years, mean body mass index 39±7, and mean time with a type 2 diabetes diagnosis of 10±10 years. Participants' self-reported dietary practices were poorly aligned with intuitive eating concepts. The women reported a lack of self-control with food and regularly eating in the absence of hunger, yet stated that the determinant factor for when to stop eating was to recognize a feeling of fullness. Participants reported knowing they were full when they felt physically uncomfortable or actually became sick. Women frequently cited the belief that individuals with diabetes have to follow a different diet than that recommended for the general public. Many women also discussed diabetes-related stigma from family/friends, and often did not tell others about their diabetes diagnosis. These findings demonstrate that intuitive eating techniques are not currently applied by the women in this sample. Future studies should assess the influence of intuitive eating interventions on dietary habits among low-income African-American women with type 2 diabetes.
    Journal of the American Academy of Nutrition and Dietetics 01/2014; · 3.80 Impact Factor
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    ABSTRACT: The Internet presents a widely accessible, 24-h means to promote chronic disease management. The objective of this review is to identify studies that used Internet based interventions to promote lifestyle modification among adults with type 2 diabetes. We searched PubMed using the terms: [internet, computer, phone, smartphone, mhealth, mobile health, web based, telehealth, social media, text messages] combined with [diabetes management and diabetes control] through January 2013. Studies were included if they described an Internet intervention, targeted adults with type 2 diabetes, focused on lifestyle modification, and included an evaluation component with behavioral outcomes. Of the 2803 papers identified, nine met inclusion criteria. Two studies demonstrated improvements in diet and/or physical activity and two studies demonstrated improvements in glycemic control comparing web-based intervention with control. Successful studies were theory-based, included interactive components with tracking and personalized feedback, and provided opportunities for peer support. Website utilization declined over time in all studies that reported on it. Few studies focused on high risk, underserved populations. Web-based strategies provide a viable option for facilitating diabetes self-management. Future research is needed on the use of web-based interventions in underserved communities and studies examining website utilization patterns and engagement over time.
    Journal of diabetes and its complications 12/2013; · 2.11 Impact Factor
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    ABSTRACT: Objective: To examine and compare the relationships among diet, physical activity, and adiposity between home-schooled children (HSC) and traditionally-schooled children (TSC). Design and Methods: Subjects were HSC (n=47) and TSC (n=48) aged 7 to 12 years old. Dietary intakes were determined via two 24-hour recalls and physical activity was assessed with 7 days of accelerometry. Fat mass (FM), trunk fat, and percent body fat (%BF) were measured by dual-energy x-ray absorptiometry (DXA). Results: Relative to HSC, TSC demonstrated significantly higher BMI percentiles, FM, trunk fat, and %BF; consumed 120 total kilocalories more per day; and reported increased intakes of trans fats, total sugar, added sugars, calcium, and lower intakes of fiber, fruits, and vegetables (p<0.05). At lunch, TSC consumed significantly more calories, sugar, sodium, potassium, and calcium compared to HSC (p<0.05). Physical activity did not differ between groups. Traditional schooling was associated with increased consumption of trans fat, sugar, calcium (p<.05); lower intakes of fiber, and fruits and vegetables (p<.05); and higher FM, %BF, and trunk fat (p<0.01), after adjustment for covariates. Conclusions: These data suggest HSC may consume diets that differ in energy and nutrient density relative to TSC, potentially contributing to differences in weight and adiposity.
    Obesity 08/2013; · 3.92 Impact Factor
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    ABSTRACT: The National Institutes of Health convened a workshop to engage researchers and practitioners in dialogue on research issues viewed as either unique or of particular relevance to rural areas, key content areas needed to inform policy and practice in rural settings, and ways rural contexts may influence study design, implementation, assessment of outcomes, and dissemination. Our purpose was to develop a research agenda to address the disproportionate burden of cardiovascular disease (CVD) and related risk factors among populations living in rural areas. Complementary presentations used theoretical and methodological principles to describe research and practice examples from rural settings. Participants created a comprehensive CVD research agenda that identified themes and challenges, and provided 21 recommendations to guide research, practice, and programs in rural areas. (Am J Public Health. Published online ahead of print April 18, 2013: e1-e11. doi:10.2105/AJPH.2012.300984).
    American Journal of Public Health 04/2013; · 3.93 Impact Factor
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    ABSTRACT: Despite interest in family-centered obesity and diabetes prevention programs for Latinos, few studies have assessed men's perspectives on obesity-related behaviors. The objective of this study was to explore Mexican immigrant men's perspectives regarding weight, diet, and physical activity as they relate to the individual and the family. This was a focus group study with a convenience sample of Mexican immigrant men (n = 16). A moderator's guide was used to elicit perceptions of personal and family behaviors influencing weight and lifestyle. Mean age of participants was 41 years (SD ± 12.7), and 100% were born in Mexico. Mean time in Alabama was 8 years. Perceived benefits of a healthy weight included improved mobility and decreased morbidities. Perceived barriers to a healthy lifestyle included demanding work schedules and an environment not conducive to walking. Participants described immigration as having a negative impact on family unity and established meal structures. Previous studies among Latinas cite husband resistance as a barrier to sustained diet and lifestyle change; however, men in this study voiced openness to programs for obesity and diabetes prevention. Future family centered programs should engage men and promote communication within the family on common goals related to health and illness prevention.
    Public Health Nursing 11/2012; 29(6):490-8. · 0.78 Impact Factor
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    ABSTRACT: OBJECTIVE: The study had 2 objectives: (1) to gather the observations of community health advisors (CHAs) on the role of social support in the lives of African Americans; and (2) to develop a lay support intervention framework, on the basis of the existing literature and observations of CHAs, depicting how social support may address the needs of African American patients with heart failure. METHODS: Qualitative data were collected in semistructured interviews among 15 CHAs working in African American communities in Birmingham, Alabama. RESULTS: Prominent themes included the challenge of meeting clients' overlapping health care and general life needs, the variation in social support received from family and friends, and the opportunities for CHAs to provide multiple types of social support to clients. CHAs also believed that their support activities could be implemented among populations with heart failure. CONCLUSION: The experience of CHAs with social support can inform a potential framework of a lay support intervention among African Americans with heart failure.
    Heart & lung: the journal of critical care 08/2012; · 1.04 Impact Factor
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    ABSTRACT: The purpose of this study is to assess factors related to diabetes medication nonadherence in a sample of predominantly Spanish-speaking Mexican-origin adults residing along the US-Mexico border. As part of a randomized controlled trial, 302 patients randomly sampled from a clinic roster completed a baseline interview. Medication nonadherence was assessed with the Morisky Medication Adherence Scale. Consistent with the framework proposed by Venturini et al, four factors were examined: patient-related attributes, drug regimen characteristics and complexity, health status, and patient-provider interaction characteristics. Sixty percent of the patients were classified as nonadherent. Men, those who engaged in diabetes control behaviors less frequently, and individuals with depression were more likely to be classified as nonadherent. Among those who were Spanish-dominant, education and self-rated health also were significantly and negatively related to medication adherence; patients with a high school education or greater and those who more positively rated their health were more likely to be classified as nonadherent compared to those with less than a high school education and those who rated their health as poor. Results reflect potentially higher medication nonadherence rates for Latinos with type 2 diabetes living in rural communities along the US-Mexico border. Additionally, this study supports the need to address strategies to support medication adherence, including addressing depression, for diabetes control. Strategies to promote adherence among Latino men are sorely needed, as are strategies to address forgetfulness and carelessness regarding diabetes medicine taking.
    The Diabetes Educator 04/2012; 38(4):552-61. · 1.94 Impact Factor
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    ABSTRACT: We are conducting a community-based cluster-randomized trial in rural Alabama, testing a peer-support intervention designed to improve diabetes self-care behaviors. We describe recruitment and data collection approaches used, focusing on strategies that created community partnerships and facilitated recruitment in underserved, rural, largely minority communities. Key recruitment and data collection strategies included early community engagement; pilot testing of procedures; inclusion of community members as study team members, recruiters, and data collectors; data collection at community venues to minimize participant travel requirements; and provision of a multi-disciplinary diabetes education program to both intervention and control participants. A total of 424 participants were recruited and enrolled (400 targeted). Of the 759 referrals received, 78.9% (n=599) successfully completed telephone screening. Of these, 78.8% (n=472) were eligible and scheduled for a local enrollment day, and 81.4% (n=384) attended and enrolled in the study. In addition, community members who walked in and expressed interest were screened, and 40 eligible and willing individuals were consented and enrolled. We exceeded recruitment goals in underserved, rural communities in Alabama. This success was due in large part to community partnerships that facilitated community involvement on several levels: engaging the community early in study proposal and design; hiring community members to fill various capacities as research team members, recruiters, and data collectors; conducting data collection within communities; and collecting additional contact information to maintain communication. Providing diabetes education to all participants, including intervention and control, helped ensure that everyone stood to benefit and likely enhanced overall participation.
    Contemporary clinical trials 02/2012; 33(3):499-506. · 1.51 Impact Factor
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    ABSTRACT: Peer support is a promising strategy for the reduction of diabetes-related health disparities; however, few studies describe the development of such strategies in enough detail to allow for replication. The objective of this article is to describe the development of a 1-year peer support intervention to improve diabetes self-management among African American adults with diabetes in Alabama's Black Belt. We used principles of intervention mapping, including literature review, interviews with key informants, and a discussion group with community health workers, to guide intervention development. Qualitative data were combined with behavioral constructs and principles of diabetes self-management to create a peer support intervention to be delivered by trained peer advisors. Feedback from a 1-month pilot was used to modify the training and intervention. The resulting intervention includes a 2-day training for peer advisors, who were each paired with 3 to 6 clients. A one-on-one in-person needs assessment begins an intensive intervention phase conducted via telephone for 8 to 12 weeks, followed by a maintenance phase of at least once monthly contacts for the remainder of the intervention period. A peer support network and process measures collected monthly throughout the study supplement formal data collection points at baseline, 6 months, and 12 months. Intervention mapping provided a useful framework for the development of culturally relevant diabetes peer support intervention for African Americans living in Alabama's Black Belt. The process described could be implemented by others in public health to develop or adapt programs suitable for their particular community or context.
    Preventing chronic disease 01/2012; 9:E36. · 1.82 Impact Factor
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    ABSTRACT: This study used focus group methodology to examine perceptions of obesity and weight management among Latina immigrant women in Alabama. Four focus groups (N = 25) were conducted in Spanish as part of a participatory intervention development process. Participants were obese/overweight Latina immigrant women (BMI > 25) primarily recruited from a community hospital. The majority of participants were from Mexico. Participants described obesity in the context of short-term effects such as physical symptoms and aesthetics. Perceived weight gain was related to lifestyle changes since moving to the US. Social isolation, depression, and stress were reported to contribute to weight gain. Participants expressed interest in weight loss but emphasized a desire for programs that preserve traditional foods and include family. Weight-management programs designed for Latina immigrants should address their perceptions of obesity. This data also suggests that those interventions that preserve culture and incorporate family may have increased community buy-in.
    Journal of Immigrant and Minority Health 12/2011; · 1.16 Impact Factor

Publication Stats

388 Citations
64.62 Total Impact Points


  • 2007–2013
    • University of Alabama at Birmingham
      • • Department of Medicine
      • • Division of Preventive Medicine
      • • Division of General Internal Medicine
      Birmingham, Alabama, United States
  • 2010–2011
    • San Diego State University
      • Graduate School of Public Health
      San Diego, California, United States
    • University of Alabama
      Tuscaloosa, Alabama, United States
  • 2007–2008
    • Vanderbilt University
      • • Division of General Internal Medicine & Public Health
      • • School of Nursing
      Nashville, MI, United States
  • 2006
    • University of North Carolina at Chapel Hill
      • Cecil G. Sheps Center for Health Services Research
      Chapel Hill, NC, United States