Roberta E Goldman

• PhD
• Professor at Brown University

The Medicare Annual Wellness Visit (AWV) involves a personalized risk assessment and prevention plan to help prevent disease and disability among older adults. Though studies have shown that AWV uptake is suboptimal, little is known about the perspectives and experiences of patients completing it. Family medicine physicians are conducting AWVs at a...

Objectives To examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days—gestation through age 2 years—among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity. Methods A multilevel framewor...

While the PCMH is the primary care model of choice for many healthcare systems, it is a relatively new area for college communities. The college health setting provides an important and challenging primary care platform because of developmental milestones that young adults face at this time of their lives. The Brown Primary Care Transformation Init...

Background: Novel approaches to reduce sugar-sweetened beverage (SSB) consumption during the first 1000 days-pregnancy through age 2 years-are urgently needed. Objective: To examine perceptions of SSB consumption and acceptability of potential intervention strategies to promote SSB avoidance in low-income families in the first 1000 days. Method...

Rationale, aims, and objectives The patient‐centred medical home (PCMH) is an innovative approach to health care reform. Despite a well‐established process for recognizing PCMH practices, fidelity to, and/or adaptation of, the PCMH model can limit health care and population health improvements. This study explored the connection between fidelity/ad...

Objectives Patient-centered medical home transformation initiatives for enhancing team-based, patient-centered primary care are widespread in the United States. However, there remain large gaps in our understanding of these efforts. This article reports findings from a contextual, whole system evaluation study of a transformation intervention at ei...

Brown_provider_and_staff_interview_questions.pdf – Supplemental material for What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

Brown_Adult_patient_interview_questions – Supplemental material for What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

Brown_Process_evaluation_focus_group_questions – Supplemental material for What matters in patient-centered medical home transformation: Whole system evaluation outcomes of the Brown Primary Care Transformation Initiative

This study characterizes patient understanding of hypertension and its management in a Cape Verdean immigrant community. We conducted 20 semi-structured interviews with Cape Verdean Creole-speaking adults about their beliefs and behaviors regarding hypertension. Fourteen women and six men ages 35–87 were interviewed. The majority of the participant...

Background: Concussion education for children early in their participation in organized sport may help shape lasting attitudes about concussion safety. However, existing programming and research focus on older ages. Methods: Qualitative interviews about concussions were conducted with twenty children between the ages of six and eight. Structural...

Background Although the patient-centered medical home (PCMH) model is considered important for the future of primary care in the USA, it remains unclear how best to prepare trainees for PCMH practice and leadership. Following a baseline study, the authors added a new required PCMH block rotation and resident team to an existing longitudinal PCMH im...

The proliferation of mobile devices and emergence of interoperable ‘mHealth’ apps is accelerating development and deployment of patient-facing risk assessments in primary care. The present study describes a user-centered design and an agile development approach to creation of an app for assessing lung function as part of a randomized controlled tri...

Our qualitative study examined how stresses of daily life affected substance use and perceived risk among Black and Hispanic adolescents. We conducted 11 focus groups with students aged 13–25 in public and alternative schools in Providence, Rhode Island, using Bourdieu’s Social Practice theoretical approach to guide questioning and data analysis. D...

Background: Development, evaluation and dissemination of primary care innovations are essential for the future of health care; however, primary care physicians including family physician, lag behind hospital-based physicians in research productivity. Family medicine residencies struggle to implement scholarly skills training programmes for busy fa...

Brown Family Medicine, funded by a five-year HRSA grant, facilitated PCMH transformation at primary care teaching practices in Rhode Island. Objective: To measure the transformation of primary care teaching practices in accordance with the PCMH model. Design: Mixed-method case series approach. Transformation facilitation was tailored to practices’...

Patient engagement is essential to any successful PCMH effort. Adolescents are a particularly difficult demographic to engage due to their resistance to seeking care and high behavioral health needs. Innovative approaches are necessary to provide appropriate, adolescent-responsive primary care. Of paramount importance is hearing from youth themselv...

Background: The patient-centered medical home (PCMH) is an accepted framework for delivering high-quality primary care, prompting many residencies to transform their practices into PCMHs. Few studies have assessed the impact of these changes on residents' and faculty members' PCMH attitudes, knowledge, and skills. The family medicine program at Br...

This qualitative research aimed to explore how health information sources inform decision-making among Hispanic mothers during their children's first 1000 days of life (conception-age 24 months), and to generate appropriate health information sources and communication strategies for future interventions. We conducted seven focus groups with 49 Hisp...

To explore outcomes and measures of success that matter most to 'positive outlier' children who improved their body mass index (BMI) despite living in obesogenic neighborhoods. We collected residential address and longitudinal height/weight data from electronic health records of 22,657 children ages 6-12 years in Massachusetts. We defined obesity "...

Objectives: Modifiable behaviors during the first 1000 days (conception age 24 months) mediate Hispanic children's obesity disparities. We aimed to examine underlying reasons for early life obesity risk factors and identify potential early life intervention strategies. Methods: We conducted 7 focus groups with 49 Hispanic women who were pregnant...

Smoking cessation is the primary goal for managing patients with chronic obstructive pulmonary disease (COPD) who smoke. However, previous studies have demonstrated poor cessation rates. The "lung age" concept (an estimate of the age at which the FEV1 would be considered normal) was developed to present spirometry data in an understandable format a...

There is a strong push in the United States to evaluate whether the patient-centered medical home (PCMH) model produces desired results. The explanatory and contextually based questions of how and why PCMH succeeds in different practice settings are often neglected. We report the development of a comprehensive, mixed qualitative-quantitative evalua...

This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social cont...

Osteoarthritis (OA) places a significant burden on worldwide public health because of the large and growing number of people affected by OA and its associated pain and disability. Pain coping skills training (PCST) is an evidence-based intervention targeting OA pain and disability. To reduce barriers that currently limit access to PCST, we develope...

New approaches for obesity prevention and management can be gleaned from positive outliers-that is, individuals who have succeeded in changing health behaviors and reducing their body mass index (BMI) in the context of adverse built and social environments. We explored perspectives and strategies of parents of positive outlier children living in hi...

Disordered eating behaviors and restrictive dieting can have negative health consequences for female athletes. Teammates can play an important role in primary and secondary prevention of these unhealthy eating practices through verbal and non-verbal communication about what behaviors are normative and desirable. The present study tested two tested...

Background: Many athletes fail to report concussion symptoms to coaches or medical personnel, putting them at risk for potentially catastrophic neurologic consequences if additional brain trauma is sustained prior to full recovery. Purpose: The purpose of this study was to determine whether concussion reporting norms prior to the start of the at...

By training future physicians to care for patients with backgrounds different from their own, medical schools can help reduce health disparities. To address the need for education in this area, the leaders of the Family Medicine Clerkship at the Warren Alpert Medical School of Brown University developed the Social and Community Context of Care proj...

Background: Residency training is a critical time for physicians' professional formation. However, few structured interventions exist to support residents in this transformative process of integrating personal and professional values, a process that is essential to physician identity formation and preservation of core values such as service and co...

The objective of this study was to consider strategies used by two similarly competitive female collegiate cross country running teams to address teammate eating behaviors perceived to be unhealthy and problematic. Data were obtained through semi-structured individual interviews with team members (n = 35). Teams differed in how they addressed probl...

Parental misconceptions and even “demand” for unnecessary antibiotics were previously viewed as contributors to overuse of these agents. We conducted focus groups to explore the knowledge and attitudes surrounding common infections and antibiotic use in the current era of more judicious prescribing. Among diverse groups of parents, we found widespr...

To characterize practices in subspecialist physicians' communication styles, and their potential effects on shared decision-making, in second-opinion consultations. Theme-oriented discourse analysis of 20 second-opinion consultations with subspecialist hematologist-oncologists. Physicians frequently "broadcasted" information about the disease, trea...

Childhood obesity rates may have plateaued in some U.S. population subgroups, yet overall rates remain high and racial/ethnic and socioeconomic disparities appear to be widening. Successful strategies and best practices to inform obesity interventions and accelerate progress in reducing disparities in childhood obesity can be found among people who...

Background Chronic obstructive pulmonary disease (COPD) is a progressive, debilitating disease associated with significant clinical burden and is estimated to affect 15 million individuals in the US. Although a large number of individuals are diagnosed with COPD, many individuals still remain undiagnosed due to the slow progression of the disorder...

Purpose: This study examined how college students choose beverages and whether behavioral interventions might reduce their heavy consumption of sugar-sweetened beverages. Methods: From April to June 2010, 90 students participated in 12 focus groups at 6 colleges in Massachusetts and Louisiana. The study team undertook a group content analysis of...

Introduction: The availability of comprehensive and accurate medication history information in electronic medical records and through electronic prescribing provides the opportunity to create tailored interventions based on individuals' particular medication information needs. To meet the challenges of providing medication information to low-liter...

Understanding parents’ perceptions of their young children’s viewing behaviors and environments is critical to the development of effective television reduction interventions. To explore parents’ attitudes, perceptions, and experiences regarding their children’s television viewing and the use of televisions in their children’s bedrooms, we conducte...

Colorectal cancer screening (CRC) disparities between non-Latino Whites and Latinos remain, and may have increased. The goal of this analysis was to examine the association between Latino race/ethnicity, gender, and English-proficiency and CRC screening. Analysis of the CDC's BRFSS 2008 survey. We estimated crude and adjusted screening rates and od...

Little is known about communication with patients suffering from hematologic malignancies, many of whom are seen by subspecialists in consultation at tertiary-care centers. These subspecialized consultations might provide the best examples of optimal physician-patient communication behaviors, given that these consultations tend to be lengthy, to oc...

Purpose: We compared physicians' self-reported attitudes and behaviours regarding electronic health record (EHR) use before and after installation of computers in patient examination rooms and transition to full implementation of an EHR in a family medicine training practice to identify anticipated and observed effects these changes would have on...

Objective: Discussions between physicians and patients in primary care regarding medications and lifestyle change alternatives are often suboptimal, resulting in poor adherence to medication therapy. Our objective was to investigate perceptions of communication with physicians about medications among a racially/ethnically diverse sample of low-inco...

Self-directed learning (SDL) skills serve as the basis for physician lifelong learning; however, residency training does not typically emphasize SDL skills. To understand residents' needs regarding SDL curricula, the authors used qualitative methods to examine the residency learning culture and residents' views of SDL. The authors conducted individ...

PURPOSE We wanted to determine whether an intervention based on patient activation and a physician decision support tool was more effective than usual care for improving adherence to National Cholesterol Education Program guidelines. METHODS A 1-year cluster randomized controlled trial was performed using 30 primary care practices (4,105 patients)...

Purpose: To understand the beliefs of ethnically diverse older adults regarding their primary care physicians' (PCP) prescription information housed in the computer and how these beliefs affect their communication during medical visits. Background: Older adults frequently see many specialists and physicians to address their health care needs. Presc...

Objective: To investigate a racially/ethnically diverse sample of low-income older adults' perceptions of communication with their physicians regarding medications. Design: Telephone surveys Participants: 330 telephone survey respondents (English and Spanish speaking) Methods: Three sampling frames were used to reach low income white, black,...

Understanding factors that promote or prevent adherence to recommended health behaviors is essential for developing effective health programs, particularly among lower income populations who carry a disproportionate burden of disease. We conducted in-depth qualitative interviews (n = 64) with low-income Black and Latina women who shared the experie...

This study evaluated whether measures of psychological well-being, including coping style, are associated with advance care planning (ACP). Data were from the Hematology Communications Study (HEMA-COMM), a prospective observational study of physician-patient communication in patients with hematologic malignancies. ACP was defined as having a living...

To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. Literature review, expert panel and focus group. Primary care with access to e-prescribing systems. Primary care physicians using e-prescribing systems receiving me...

The purpose of this study was to examine pediatricians’ familiarity with expert committee recommendations on the management of childhood obesity and their use of health information technology for obesity-related care. The authors interviewed 35 pediatricians from 17 primary care practices using an electronic health record; immersion crystallization...

To explore colorectal cancer risk perceptions among Latinos. Focus groups discussions among Spanish-speaking Latinos conducted between February and July 2007 with 37 men and women who were age-eligible for colorectal cancer screening. Predominant themes of perceived colorectal cancer risk included: general cancer risks, risks related to nutrition a...

Laboratory monitoring has been increasingly recognized as an important area for improving patient safety in ambulatory care. Little is known about doctors' attitudes towards laboratory monitoring and potential ways to improve it. Six focus groups and one individual interview with 20 primary care doctors and nine specialists from three Massachusetts...

Self-directed learning (SDL) skills are essential for the formation and ongoing competence of today's physicians who work in the context of expanding scientific knowledge and changing health care systems. In 2007-2008, the authors developed a program to promote SDL in the Brown University Family Medicine Residency. Through an iterative process, the...

Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient comm...

E-prescribing is part of a new generation of electronic solutions for the medical industry that may have great potential for improving work flow and communication between medical practices and pharmacies. In the US, it has been introduced with minimal monitoring of errors and general usability. This paper examines refill functionality in e-prescrib...

Learning procedural skills requires supervised practice with feedback. Observation of performance provides an opportunity for feedback, but the quality of feedback is often poor. We developed an instrument to improve feedback during procedural skills training in residency. The Global Procedural Skills Evaluation (GPSE) was drafted based on qualitat...

Although discrimination has been identified as a potential determinant of existing racial/ethnic health disparities, no studies have investigated whether racial discrimination contributes to disparities in physical activity. The primary aim of the current study was to examine the association between interpersonal racial discrimination and physical...

68 Introduction Communications literature suggests that optimal doctor-patient communication in medical encounters should include several specific behaviors to enhance successful communication. Very little is known about how often hematologic malignancy subspecialists engage in these behaviors, but several studies have documented that patients are...

72 Background Previous studies in patients with hematologic malignancies who underwent hematopoietic cell transplantation show only 50% have participated in advance care planning (ACP) at the time of transplant. Moreover, the group that lacked ACP had a higher mortality rate, suggesting that the group least likely to have ACP is the group most lik...

Colorectal cancer is the second most common cancer among Latinos, but a lower percentage of Latinos are screened than Whites and Blacks. Along with recognized economic barriers, differences in knowledge and perceptions might impede colorectal screening among Latinos. We conducted 147 individual, qualitative interviews with Dominicans and Puerto Ric...

The nature of communication between patients and their second-opinion hematology consultants may be very different in these one-time consultations than for those that are within long-term relationships. This study explored patients' perceptions of their second-opinion hematology-oncology consultation to investigate physician-patient communication i...

This article presents a framework for quality care that attends to culture and ethnicity. Tools and approaches for achieving cultural competency and humility are provided that may help improve the care of the patients, irrespective of their backgrounds or beliefs.

While e-health tools have been designed for patient/consumer empowerment and for decision support focusing on healthcare providers, they have had only modest success in primary care settings. Creating complementary e-health tools that provide patient activation and decision support for a common clinical problem such as hyperlipidemia using a behavi...

Language barriers among some Latinos may contribute to the lower rates of colorectal cancer (CRC) screening between Latinos and non-Latino Whites. The purpose of this study was to examine the relationship between language and receipt of CRC screening tests among Latinos and non-Latinos using a geographically diverse, population-based sample of adul...

To understand factors that women feel facilitate or hinder their receipt of diagnostic services following an abnormal screening mammogram. This qualitative study used a purposive sampling strategy to identify low-income, ethnically diverse women aged 40 or over who had a recent abnormal mammogram. Working with a community health center, breast eval...

Many patients do not receive guideline-recommended care for diabetes and other chronic conditions. Automated speech-recognition telephone outreach to supplement in-person physician-patient communication may enhance patient care for chronic illness. We conducted this study to inform the development of an automated telephone outreach intervention for...

Aims: To explore the attitudes of a voluntary subset of Rhode Island residents towards the potential development of a large, prospective, population-based study of sudden cardiac arrest, which will include a biobank to store blood for future biochemical and molecular analyses. Methods: A mailed survey and focus groups. Results: Survey responde...

Spontaneous urban growth frequently occurs in the absence of, or in spite of, urban planning. Following a disaster, should a city be rebuilt on the model of the pre-disaster city, or should time be invested to design and construct a "better" city? Divergent images of the urban environment result from class origins, ethnicity, and other differentiat...

This qualitative study examined chronic obstructive pulmonary disease (COPD) knowledge and attitudes among patients at risk for or with COPD. Participants perceived lung cancer as the primary lung disease of concern to their health and were largely unaware of COPD. Overall, the primary care patients expressed a desire to obtain additional informati...

Despite the impact of high-visibility evidence-based clinical practice guidelines, physician adherence to guidelines remains low. This study explored primary care physicians' perceptions of barriers and facilitators in following the National Cholesterol Education Program guidelines. The authors conducted 9 focus groups and performed qualitative con...

Background: Childhood obesity is a growing epidemic in the US, especially amongst traditionally underserved communities, and novel partnerships between the health care industry and new media technologies may hold promising solutions. Methods: A panel of experts from the health care, technology/gaming, and obesity prevention/treatment fields was con...

Assessing medical student competence in non-traditional domains can be challenging. Conventional methods of assessment are generally unsatisfactory. The authors discuss the approach taken at the Brown Medical School, USA to assess students at the beginner, intermediate, and advanced levels in the social and community contexts of health care - one o...

The Healthy Directions-Small Business randomized, controlled study aimed to reduce cancer risk among multiethnic workers in small manufacturing businesses by increasing fruit and vegetable consumption, physical activity, and daily multivitamin in take and decreasing consumption of red meat. The intervention incorporated participatory strategies and...

Novel approaches to worksite health promotion are needed for high-risk workers who change job sites frequently, and thus may have limited access to worksite health promotion efforts. The objective of this study was to test a behavioral intervention among construction laborers. Using a randomized-controlled design, we tested the efficacy of a tailor...

Multimethodenonderzoek (mixed methods research) verwijst naar onderzoeken of vraagstellingen waarbij een of meer kwalitatieve en kwantitatieve technieken voor gegevensverzameling en -analyse worden geïntegreerd.

A social-contextual approach to cancer prevention among participants associated with the working class may result in behavior-change messages that are more relevant to them and contribute to a reduction in health disparities among classes. This article reports findings from a qualitative study of adults in working-class occupations and/or living in...

Despite some recent improvement in knowledge about cholesterol in the United States, patient adherence to cholesterol treatment recommendations remains suboptimal. We undertook a qualitative study that explored patients' perceptions of cholesterol and cardiovascular disease (CVD) risk and their reactions to 3 strategies for communicating CVD risk....

Purpose Labor unions are a largely unevaluated channel for health promotion interventions for working class populations, who are at increased risk for smoking and poor diet. We conducted qualitative and quantitative research to understand the meaning and function of union membership in workers' lives and applied this information to health promotion...

Purpose: Previous studies of patient-physician communication have noted that patients (pts) want to know “as much information as possible” about their diseases, but very little is known about successful ways to communicate this information. Patients and Methods: We report interim results of an ongoing, longitudinal study of patient-physician commun...

This study explored perceptions of cancer, risk, and screening among Dominicans and Puerto Ricans in Rhode Island. Qualitative interviews were conducted with a community-based sample of 147 adults. Perceived risks for breast cancer were predominantly associated with carelessness about health care, trauma to the breast, and breastfeeding. Cervical c...

Overweight and obesity have reached epidemic proportions in the United States, with black women disproportionately affected. SisterTalk is a weight control program designed specifically for delivery to black women via cable TV. The theoretical and conceptual frameworks and formative research that guided the development and cultural tailoring of Sis...

We report demographic and social contextual characteristics of multiethnic, blue-collar workers from the baseline survey of a study conducted in 24 small businesses. We discuss ways in which we incorporated these characteristics into the design of the intervention. We used a randomized controled design, with 12 small businesses assigned to a social...

There is an urgent need to develop and test health promotion strategies that both address health disparities and elucidate the full impact of social, cultural, economic, institutional, and political elements on people's lives. Qualitative research methods, such as life history interviewing, are well suited to exploring these factors. Qualitative me...

This article proposes a conceptual framework for addressing social contextual factors in cancer prevention interventions, and describes work that operationalizes this model in interventions for working class, multiethnic populations. The Harvard Cancer Prevention Program Project Includes Three Studies: (1) an intervention study in 25 small business...

African Americans bear a disproportionate burden of mortality from colorectal cancer. Because the majority of excess deaths are linked to delayed detection (after the cancer has spread), interventions to promote acceptance of and compliance with screening are urgently needed. Tins article considers strategies to overcome barriers to screening for c...