- Professional overview
Dr. Vorderstrasse is Associate Professor of Nursing with Tenure and Director of the Florence S. Downs PhD Program in Nursing Research and Theory. She received a B.S.N. from Mount Saint Mary College, a M.S.N. from Yale University School of Nursing, and a D.N.Sc. from Yale University School of Nursing.
Dr. Vorderstrasse’s research in the development and implementation of behavioral interventions for diabetes and cardiovascular disease (CVD) aims to expand preventive and self-management support for adults at risk for, or living with chronic diseases. Her contributions in chronic disease prevention have identified that genetic risk testing for chronic conditions may improve risk reduction in particular groups. She is also among the first to demonstrate that virtual environments are a feasible and effective way to provide self-management education and support to improve outcomes in diabetes and CVD. Her research has been supported with competitive funding from the Air Force Medical Sciences, NINR, NLM and NHLBI. As an expert in these areas, she has presented her work at the American Diabetes Association Scientific Sessions, American Heart Association Scientific Sessions, the International Society of Nurses in Genetics, and the American College of Preventive Medicine. She was an invited panelist for the first ANCC Advance Genetics Nursing certification portfolio. Through these presentations, consultations and research studies, she has been a thought leader for research, education and policy in nursing and the implementation of novel technologies, such as genomics and virtual environments.
Prior to joining the faculty at NYU, Dr. Vorderstrasse was Associate Professor of Nursing and Faculty Lead for Precision Health research at the Duke University School of Nursing.
Certificate NIH/NINR Summer Genetics InstituteDNSc, Yale University School of NursingMSN, Yale University School of NursingBSN, Mount Saint Mary College
- Professional membership
Fellow, American Academy of NursingInternational Society of Nursing in GeneticsAmerican Heart Association
Analyzing Unstructured Communication in a Computer-Mediated Environment for Adults With Type 2 Diabetes: A Research Protocol.Lewinski, A. A., Anderson, R. A., Vorderstrasse, A. A., Fisher, E. B., Pan, W., & Johnson, C. M. (2017). JMIR research protocols 6, (e65). 10.2196/resprot.7442
Individuals with type 2 diabetes have an increased risk for comorbidities such as heart disease, lower limb amputations, stroke, and renal failure. Multiple factors influence development of complications in a person living with type 2 diabetes; however, an individual's self-management behaviors may delay the onset of, or lessen the severity of, these complications. Social support provides personal, informal advice and knowledge that helps individuals initiate and sustain self-management and adherence.
Impact of Genetic Testing and Family Health History Based Risk Counseling on Behavior Change and Cognitive Precursors for Type 2 Diabetes.Wu, R. R., Myers, R. A., Hauser, E. R., Vorderstrasse, A., Cho, A., Ginsburg, G. S., & Orlando, L. A. (2017). Journal of genetic counseling 26, (133-140). 10.1007/s10897-016-9988-z
Family health history (FHH) in the context of risk assessment has been shown to positively impact risk perception and behavior change. The added value of genetic risk testing is less certain. The aim of this study was to determine the impact of Type 2 Diabetes (T2D) FHH and genetic risk counseling on behavior and its cognitive precursors. Subjects were non-diabetic patients randomized to counseling that included FHH +/- T2D genetic testing. Measurements included weight, BMI, fasting glucose at baseline and 12 months and behavioral and cognitive precursor (T2D risk perception and control over disease development) surveys at baseline, 3, and 12 months. 391 subjects enrolled of which 312 completed the study. Behavioral and clinical outcomes did not differ across FHH or genetic risk but cognitive precursors did. Higher FHH risk was associated with a stronger perceived T2D risk (pKendall < 0.001) and with a perception of "serious" risk (pKendall < 0.001). Genetic risk did not influence risk perception, but was correlated with an increase in perception of "serious" risk for moderate (pKendall = 0.04) and average FHH risk subjects (pKendall = 0.01), though not for the high FHH risk group. Perceived control over T2D risk was high and not affected by FHH or genetic risk. FHH appears to have a strong impact on cognitive precursors of behavior change, suggesting it could be leveraged to enhance risk counseling, particularly when lifestyle change is desirable. Genetic risk was able to alter perceptions about the seriousness of T2D risk in those with moderate and average FHH risk, suggesting that FHH could be used to selectively identify individuals who may benefit from genetic risk testing.
Social Support for Diabetes Self-Management via eHealth Interventions.Vorderstrasse, A., Lewinski, A., Melkus, G. D., & Johnson, C. (2016). Current diabetes reports 16, (56). 10.1007/s11892-016-0756-0
eHealth interventions have been increasingly used to provide social support for self-management of type 2 diabetes. In this review, we discuss social support interventions, types of support provided, sources or providers of support, outcomes of the support interventions (clinical, behavioral, psychosocial), and logistical and clinical considerations for support interventions using eHealth technologies. Many types of eHealth interventions demonstrated improvements in self-management behaviors, psychosocial outcomes, and clinical measures, particularly HbA1c. Important factors to consider in clinical application of eHealth support interventions include participant preferences, usability of eHealth technology, and availability of personnel to orient or assist participants. Overall, eHealth is a promising adjunct to clinical care as it addresses the need for ongoing support in chronic disease management.
Visualization of Multidimensional Data in Nursing Science.Docherty, S. L., Vorderstrasse, A., Brandon, D., & Johnson, C. (2016). Western journal of nursing research 10.1177/0193945916672448
Nursing scientists have long been interested in complex, context-dependent questions addressing individual- and population-level challenges in health and illness. These critical questions require multilevel data (e.g., genetic, physiologic, biologic, behavioral, affective, and social). Advances in data-gathering methods have resulted in the collection of large sets of complex, multifaceted, and often non-comparable data. Scientific visualization is a powerful methodological tool for facilitating understanding of these multidimensional data sets. Our purpose is to demonstrate the utility of scientific visualization as a method for identifying associations, patterns, and trends in multidimensional data as exemplified in two studies. We describe a brief history of visual analysis, processes involved in scientific visualization, and opportunities and challenges in the use of visualization methods. Scientific visualization can play a crucial role in helping nurse scientists make sense of the structure and underlying patterns in their data to answer vital questions in the field.
Evaluation of a depression screening and treatment program in primary care for patients with diabetes mellitus: insights and future directions.Palmer, C., Vorderstrasse, A., Weil, A., Colford, C., & Dolan-Soto, D. (2015). Journal of the American Association of Nurse Practitioners 27, (131-6). 10.1002/2327-6924.12149
To evaluate a collaborative depression care program by assessing adherence to the program by internal medicine clinic (IMC) staff, and the program's effectiveness in treating depression in patients with diabetes mellitus. We also describe the rate of depression among patients with diabetes in the IMC.
Internet delivered diabetes self-management education: a review.Pereira, K., Phillips, B., Johnson, C., & Vorderstrasse, A. (2015). Diabetes technology & therapeutics 17, (55-63). 10.1089/dia.2014.0155
Diabetes self-management education is a cornerstone of successful diabetes management. Various methods have been used to reach the increasing numbers of patients with diabetes, including Internet-based education. The purpose of this article is to review various delivery methods of Internet diabetes education that have been evaluated, as well as their effectiveness in improving diabetes-related outcomes.
Patient beliefs and behaviors about genomic risk for type 2 diabetes: implications for prevention.Gallagher, P., King, H. A., Haga, S. B., Orlando, L. A., Joy, S. V., Trujillo, G. M., … Vorderstrasse, A. (2015). Journal of health communication 20, (728-35). 10.1080/10810730.2015.1018563
Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing type 2 diabetes risk for many patients; however, to date, there is little evidence that genetic testing positively affects type 2 diabetes prevention. Genetic information may not fit patients' illness representations, which may reduce the chances of risk-reducing behavior changes. The present study aimed to examine illness representations in a clinical sample who are at risk for type 2 diabetes and interested in genetic testing. The authors used the Common Sense Model to analyze survey responses of 409 patients with type 2 diabetes risk factors. Patients were interested in genetic testing for type 2 diabetes risk and believed in its importance. Most patients believed that genetic factors are important to developing type 2 diabetes (67%), that diet and exercise are effective in preventing type 2 diabetes (95%), and that lifestyle changes are more effective than drugs (86%). Belief in genetic causality was not related to poorer self-reported health behaviors. These results suggest that patients' interest in genetic testing for type 2 diabetes might produce a teachable moment that clinicians can use to counsel behavior change.
Perspectives on genetic and genomic technologies in an academic medical center: the duke experience.Katsanis, S. H., Minear, M. A., Vorderstrasse, A., Yang, N., Reeves, J. W., Rakhra-Burris, T., … Simmons, L. A. (2015). Journal of personalized medicine 5, (67-82). 10.3390/jpm5020067
In this age of personalized medicine, genetic and genomic testing is expected to become instrumental in health care delivery, but little is known about its actual implementation in clinical practice.
Renal Disease Risk Factors Among Risk Groups Comprised of African American Women With Type 2 Diabetes: A Secondary Analysis.Migliore, C. L., Vorderstrasse, A., Pan, W., & Melkus, G. D. (2015). The Diabetes educator 41, (569-81). 10.1177/0145721715593814
The purpose of this study was to explore and describe the prevalence of renal disease risk factors and the categorization of renal disease risk groups among African American women with type 2 diabetes mellitus (T2DM) who participated in a self-management and coping skills training intervention. We also explored and described the change in renal disease risk factors within and between risk groups, determining if participation in a culturally relevant coping skills training intervention decreased renal disease risk.
Renal Disease Risk Factors Among Risk Groups Comprised of African American Women with Type 2 Diabetes: A Secondary Analysis.Migliore, C., Vorderstrasse, A., Pan, W. & Melkus, G.D. (2015). Diabetes Educator 41, (569-581). 10.1177/0145721715593814
A theoretical framework for a virtual diabetes self-management community intervention.Vorderstrasse, A., Shaw, R. J., Blascovich, J., & Johnson, C. M. (2014). Western journal of nursing research 36, (1222-37). 10.1177/0193945913518993
Due to its high prevalence, chronic nature, potential complications, and self-management challenges for patients, diabetes presents significant health education and support issues. We developed and pilot-tested a virtual community for adults with type 2 diabetes to promote self-management education and provide social support. Although digital-based programs such as virtual environments can address significant barriers to reaching patients (i.e., child care, transportation, location), they must be strongly grounded in a theoretical basis to be well-developed and effective. In this article, we discuss how we synthesized behavioral and virtual environment theoretical frameworks to guide the development of SLIDES (Second Life Impacts Diabetes Education and Support).
Feasibility and preliminary effects of a virtual environment for adults with type 2 diabetes: pilot study.Johnson, C., Feinglos, M., Pereira, K., Hassell, N., Blascovich, J., Nicollerat, J., … Vorderstrasse, A. (2014). JMIR research protocols 3, (e23). 10.2196/resprot.3045
Innovative interventions that empower patients in diabetes self-management (DSM) are needed to provide accessible, sustainable, cost-effective patient education and support that surpass current noninteractive interventions. Skills acquired in digital virtual environments (VEs) affect behaviors in the physical world. Some VEs are programmed as real-time three-dimensional representations of various settings via the Internet. For this research, a theoretically grounded VE that facilitates DSM was developed and pilot tested. It offered weekly synchronous DSM education classes, group meetings, and social networking in a community in which participants practiced real world skills such as grocery shopping, exercising, and dining out, allowing for interactive knowledge application. The VE was available 24/7 on the Internet, minimizing access barriers.
Nurse practitioner management of type 2 diabetes.Richardson, G. C., Derouin, A. L., Vorderstrasse, A. A., Hipkens, J., & Thompson, J. A. (2014). The Permanente journal 18, (e134-40). 10.7812/TPP/13-108
Multifactorial barriers prevent primary care clinicians from helping their adult patients with type 2 diabetes achieve good control of hemoglobin A1c (HbA1c) levels. Patients' depression and low self-efficacy can complicate diabetes management by impairing tasks needed for effective disease self-management.
Health coaching and genomics-potential avenues to elicit behavior change in those at risk for chronic disease: protocol for personalized medicine effectiveness study in air force primary care.Vorderstrasse, A. A., Ginsburg, G. S., Kraus, W. E., Maldonado, M. C., & Wolever, R. Q. (2013). Global advances in health and medicine 2, (26-38). 10.7453/gahmj.2013.035
Type 2 diabetes (T2D) and coronary heart disease (CHD) are prevalent chronic diseases from which military personnel are not exempt. While many genetic markers for these diseases have been identified, the clinical utility of genetic risk testing for multifactorial diseases such as these has not been established. The need for a behavioral intervention such as health coaching following a risk counseling intervention for T2D or CHD also has not been explored. Here we present the rationale, design, and protocol for evaluating the clinical utility of genetic risk testing and health coaching for active duty US Air Force (AF) retirees and beneficiaries.
Virtual worlds in nursing education: a synthesis of the literature.De Gagne, J. C., Oh, J., Kang, J., Vorderstrasse, A. A., & Johnson, C. M. (2013). The Journal of nursing education 52, (391-6). 10.3928/01484834-20130610-03
Although the literature has highlighted the use of virtual worlds in teaching-learning, little is known about the concepts associated with this technology in nursing education. Moreover, the application of virtual worlds to education has been underdeveloped theoretically, with much of the work being exploratory. Thus, the aim of this integrative review was to identify the current evidence on the use of virtual worlds in the education of nursing and other health professional students and to describe emerging themes surrounding this phenomenon. We searched seven electronic databases for relevant articles and used Whittemore's and Knafl's integrative review method to synthesize the literature. Twelve articles met the selection criteria for this review, from which three overarching themes emerged: (a) critical reasoning skills, (b) student-centered learning, and (c) instructional design considerations. This integrative review extends our understanding of virtual worlds in nursing education and the potential barriers and facilitators of their use.
Case studies for an accelerated Bachelor of Science in Nursing pathophysiology course.Vorderstrasse, A. A., & Zychowicz, M. E. (2012). The Journal of nursing education 51, (358). 10.3928/01484834-20120522-02
The effect of a diabetes education, coping skills training, and care intervention on physiological and psychosocial outcomes in black women with type 2 diabetes.D'Eramo Melkus, G., Chyun, D., Vorderstrasse, A., Newlin, K., Jefferson, V., & Langerman, S. (2010). Biological research for nursing 12, (7-19). 10.1177/1099800410369825
An 11-week culturally relevant group diabetes self-management training (DSMT), coping skills training (CST), and diabetes care intervention was compared to a 10-week usual diabetes education and diabetes care intervention on physiological and psychosocial outcomes in 109 Black women (aged 48 +/- 10 years) with type 2 diabetes in primary care (PC). Strong time effects for hemoglobin A1c improvement were seen in both groups from baseline to 3 months and remained similar at 12 and 24 months (p < .0001). Systolic blood pressure (p =.01) and low-density lipoprotein cholesterol levels (p = .05) improved in both groups from baseline to 24 months. Baseline quality of life ([QOL]; Medical Outcome Study Short Form-36) was low. Social function, role-emotional, and mental health domains increased initially in both groups then declined slightly, with less decline for the experimental group at 12 months. At 24 months, experimental group scores increased. General health (p = .002), vitality (p = .01), role-physical, and bodily pain (p = .02) domains increased in both groups over time. Perceived provider support for diet (p = .0001) and exercise (p = .0001) increased in both groups over time. Diabetes-related emotional distress decreased in the experimental compared to the control group (group x time, p = .01). Findings suggest that both methods of diabetes education combined with care can improve metabolic control, QOL, and perceptions of provider care. CST may further assist in long-term improvements in health outcomes. Behavioral interventions are needed in addition to routine diabetes care, particularly in PC.
Review: dietary interventions, with or without exercise, promote weight loss more than advice alone.Vorderstrasse, A. A. (2008). Evidence-based nursing 11, (44). 10.1136/ebn.11.2.44
Building a Virtual Environment for Diabetes Self-Management Education and Support.Johnson, C., Feenan, K., Setliff, G., Pereira, K., Hassell, N., Beresford, H. F., … Vorderstrasse, A. International journal of virtual communities and social networking 5,
The authors developed an immersive diabetes community to provide diabetes self-management education and support for adults with type 2 diabetes. In this article the authors describe the procedures used to develop this virtual environment (VE). Second Life Impacts Diabetes Education & Self-Management (SLIDES), the VE for our diabetes community was built in Second Life. Social Cognitive Theory, behavioral principles and key aspects of virtual environments related to usability were applied in the development in this VE. Collaboration between researchers, clinicians and information technology (IT) specialists occurred throughout the development process. An interactive community was successfully built and utilized to provide diabetes self-management education and support. VEs for health applications may be innovative and enticing, yet it must be kept in mind that there are substantial effort, expertise, and usability factors that must be considered in the development of these environments for health care consumers.
Diabetes Learning in Virtual Environments: Testing the Efficacy of Self-Management Training and Support in Virtual Environments (Randomized Controlled Trial Protocol).Vorderstrasse, A. A., Melkus, G. D., Pan, W., Lewinski, A. A., & Johnson, C. M. Nursing research 64, (485-93). 10.1097/NNR.0000000000000128
Ongoing self-management improves outcomes for those with Type 2 diabetes (T2D); however, there are many barriers to patients receiving assistance in this from the healthcare system and peers. Findings from our pilot study showed that a virtual diabetes community on the Internet with real-time interaction among peers with T2D-and with healthcare professionals-is feasible and has the potential to influence clinical and psychosocial outcomes.
Group diabetes self-management education in a primary care setting: a quality improvement project.Harris, T., Silva, S., Intini, R., Smith, T., & Vorderstrasse, A. Journal of nursing care quality 29, (188-93). 10.1097/NCQ.0b013e3182aa08b7
This quality improvement project evaluated the effectiveness of a monthly diabetes self-management education intervention on HbA1C and knowledge levels in patients with type 2 diabetes mellitus. A retrospective analysis evaluating 51 patients found no significant improvement in HbA1C levels; however, there was a significant improvement in knowledge levels. Race was an influential factor on HbA1C levels showing a significant elevation in mean HbA1C in African Americans, while there was a decrease in mean HbA1c in Caucasians over the 6-month evaluation period.
Implementation and evaluation of a low health literacy and culturally sensitive diabetes education program.Swavely, D., Vorderstrasse, A., Maldonado, E., Eid, S., & Etchason, J. Journal for healthcare quality : official publication of the National Association for Healthcare Quality 36, (16-23). 10.1111/jhq.12021
Low health literacy is more prevalent in persons with limited education, members of ethnic minorities, and those who speak English as a second language, and is associated with multiple adverse diabetes-related health outcomes. This study examined the effectiveness of a low health literacy and culturally sensitive diabetes education program for economically and socially disadvantaged adult patients with type 2 diabetes. A pre-post prospective study design was used to examine outcomes over 12 months. Outcome measures included diabetes knowledge, self-efficacy, and self-care, measured using reliable and valid survey tools, and A1C. Over this period of time 277 patients were enrolled in the program, with 106 participants completing survey data. At the completion of the program patients had significant improvements in diabetes knowledge (p < .001), self-efficacy (p < .001), and three domains of self-care including diet (p < .001), foot care (p < .001), and exercise (p < .001). There were no significant improvements in the frequency of blood glucose testing (p = .345). Additionally, A1C values significantly improved 3 months after completing the program (p = .007). In conclusion, a diabetes education program designed to be culturally sensitive and meet the needs of individuals with low health literacy improves short-term outcomes.
Neurobiological Basis of Insight in Schizophrenia: A Systematic Review.Xavier, R. M., & Vorderstrasse, A. Nursing research 65, (224-37). 10.1097/NNR.0000000000000159
Insight in schizophrenia is defined as awareness into illness, symptoms, and need for treatment and has long been associated with cognition, other psychopathological symptoms, and several adverse clinical and functional outcomes. However, the biological basis of insight is not clearly understood.
Perceptions of Personalized Medicine in an Academic Health System: Educational Findings.Vorderstrasse, A., Katsanis, S. H., Minear, M. A., Yang, N., Rakhra-Burris, T., Reeves, J. W., … Ann Simmons, L. Journal of contemporary medical education 3, (14-19). 10.5455/jcme.20150408050414
Prior reports demonstrate that personalized medicine implementation in clinical care is lacking. Given the program focus at Duke University on personalized medicine, we assessed health care providers' perspectives on their preparation and educational needs to effectively integrate personalized medicine tools and applications into their clinical practices.
The implementation and evaluation of an evidence-based protocol to treat diabetic ketoacidosis: a quality improvement study.Evans, K. J., Thompson, J., Spratt, S. E., Lien, L. F., & Vorderstrasse, A. Advanced emergency nursing journal 36, (189-98). 10.1097/TME.0000000000000021
This retrospective observational quality improvement study was conducted to determine whether an evidence-based protocol for the treatment of diabetic ketoacidosis improved patient outcomes in our academic medical center. This study evaluated fidelity of providers to the protocol, as well as time to resolution of diabetic ketoacidosis as measured by closure of the anion gap (AG). Other secondary outcomes included time to intravenous fluids, time to potassium replacement, and rates of hypoglycemia and hypokalemia.Two cohorts including historical (N = 41) and current (N = 37) were compared to evaluate the effectiveness of the protocol. There were no differences between group demographics at baseline. After implementation of the protocol, 43.2% of patients were treated using full protocol fidelity, 21.6% were treated with partial fidelity, and 35.1% were not treated using the protocol. Although none of the outcomes reached statistical significance, patients in the current group who were treated with full protocol fidelity had an average time to AG closure that was 3 hr less than those who were not treated according to the protocol, and an average time to potassium replacement that was 2 hr less. When comparing the historical cohort with the patients treated with full protocol fidelity, there was improvement in protocol-treated patients in time to AG closure (2 hr), time to dextrose replacement (1.7 hr), and time to potassium replacement (2 hr). The rates of hypokalemia were improved with protocol treatment; 37.5% of protocol-treated patients had hypokalemia as opposed to 63.4% of those not treated according to protocol.Overall, despite the low fidelity in our institution, the protocol promoted evidence-based practice and patients treated according to the protocol had decreased time to treatment outcomes including quicker AG closure, improved intravenous fluids resuscitation, and more accurate and timely electrolyte correction.