Faculty

Ann-Margaret Navarra headshot

Ann Margaret Navarra

Assistant Professor

1 212 998 9009

433 First Avenue
Room 410
New York, NY 10010
United States

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Professional overview

Dr. Navarra is a NIH funded researcher and board certified pediatric nurse practitioner, earning a PhD after a 19 year trajectory as an academic clinician. Her research training includes NIH funded pre and post-doctoral fellowships (T-90 & T-32) supported by Columbia University School of Nursing. Dr. Navarra has presented at regional and national meetings with recent publications in the Journal of Pediatric Health Care and the Journal of the Association of Nurses in AIDS Care. Current research interests include design and implementation of technology supported behavioral interventions for improved disease self-management among HIV-infected youth.

Education

College of New Rochelle, BS
Columbia University, MS
Columbia University, MPhil
Columbia University, PhD

Honors and awards

Alpha Zeta Chapter of Sigma Theta Tau Award (2012)
Student Research Award, Sigma Theta Tau-Alpha Zeta Chapter (2010)
Alumni Scholar, Columbia University, New York, NY (2008)
Sigma Theta Tau International Honor Society of Nursing, Alpha Zeta Chapter (2008)
Scholarship Recipient, Glaxo SmithKline, Funding for Poster Presentation at the XI International Conference on AIDS, Vancouver, BC (1996)
Sigma Theta Tau International Honor Society of Nursing, Zeta Omega Chapter (1988)

Specialties

HIV/AIDS
Pediatric
Chronic disease
Technology
Underserved populations

Professional membership

American Association of Nurses (ANA)
Eastern Nursing Research Society (ENRS)
Fellow, National Association of Pediatric Nurse Practitioners (NAPNAP)
Sigma Theta Tau International Nursing Honor Society, Alpha Zeta Chapter
Sigma Theta Tau International Nursing Honor Society, Zeta Omega Chapter
National Certification Board of Pediatric Nurse Practitioners and Nurses

Publications

Publications

Beliefs and perceptions of mentorship among nursing faculty and traditional and accelerated undergraduate nursing students

Margaret-Navarra, A., Stimpfel, A. W., Rodriguez, K., Lim, F., Nelson, N., & Slater, L. Z. (2017). Nurse Education Today, 61, 20-24. 10.1016/j.nedt.2017.10.009
Abstract
Background In order to meet the demands of a dynamic and complex health care landscape, nursing education must develop and implement programming to produce a highly educated nursing workforce. Interprofessional honors education in nursing with targeted mentorship is one such model. Purpose To describe undergraduate nursing student and faculty perceptions and beliefs of mentorship in the context of interprofessional honors education, and compare and contrast the perceptions and beliefs about mentorship in interprofessional honors education between undergraduate nursing students and faculty. Methods The study used a cross-sectional, descriptive design. Data were collected at an urban university in the northeast US, using a researcher-developed electronic survey. The sample included 24 full-time nursing faculty, and 142 undergraduate nursing students. Results Perceptions and beliefs regarding mentorship in the context of interprofessional honors education were similar for faculty and students, with both ranking mentorship among the most important components of a successful honors program. Conclusions Honors education with a dedicated mentorship component may be implemented to improve the undergraduate education experience, facilitate advanced degree attainment, and develop future nursing leaders.

Health Technology-Enabled Interventions for Adherence Support and Retention in Care Among US HIV-Infected Adolescents and Young Adults: An Integrative Review

Margaret-Navarra, A., Gwadz, M. V., Whittemore, R., Bakken, S. R., Cleland, C. M., Burleson, W., Jacobs, S. K., & Melkus, G. D. (2017). AIDS and Behavior, 1-18. 10.1007/s10461-017-1867-6
Abstract
The objective of this integrative review was to describe current US trends for health technology-enabled adherence interventions among behaviorally HIV-infected youth (ages 13–29 years), and present the feasibility and efficacy of identified interventions. A comprehensive search was executed across five electronic databases (January 2005–March 2016). Of the 1911 identified studies, nine met the inclusion criteria of quantitative or mixed methods design, technology-enabled adherence and or retention intervention for US HIV-infected youth. The majority were small pilots. Intervention dose varied between studies applying similar technology platforms with more than half not informed by a theoretical framework. Retention in care was not a reported outcome, and operationalization of adherence was heterogeneous across studies. Despite these limitations, synthesized findings from this review demonstrate feasibility of computer-based interventions, and initial efficacy of SMS texting for adherence support among HIV-infected youth. Moving forward, there is a pressing need for the expansion of this evidence base.

Assessing Nursing Care Needs of Children With Complex Medical Conditions: The Nursing-Kids Intensity of Care Survey (N-KICS)

Margaret-Navarra, A., Schlau, R., Murray, M., Mosiello, L., Schneider, L., Jackson, O., Cohen, B., Saiman, L., & Larson, E. L. (2016). Journal of Pediatric Nursing, 31(3), 299-310. 10.1016/j.pedn.2015.11.012
Abstract
Recent medical advances have resulted in increased survival of children with complex medical conditions (CMC), but there are no validated methods to measure their care needs. Objectives/methods: To design and test the Nursing-Kids Intensity of Care Survey (N-KICS) tool and describe intensity of nursing care for children with CMC. Results: The psychometric evaluation confirmed an acceptable standard for reliability and validity and feasibility. Intensity scores were highest for nursing care related to infection control, medication administration, nutrition, diaper changes, hygiene, neurological and respiratory support, and standing program. Conclusions: Development of a psychometrically sound measure of nursing intensity will help evaluate and plan nursing care for children with CMC.

Honors Programs: Current Perspectives for Implementation

Lim, F., Nelson, N., Stimpfel, A. W., Margaret-Navarra, A., & Slater, L. Z. (2015). Nurse Educator. 10.1097/NNE.0000000000000211
Abstract
The changing demographics of the nursing workforce, including large numbers of impending retirements, highlight the need for innovative programs to attract the next generation of nursing leaders, educators, and researchers. Nursing honors programs provide an enhanced educational experience for high-achieving and highly motivated students, developing them as future nursing leaders. This review describes the current perspectives, characteristics, and values of nursing honors programs, opportunities for implementation, and recommendations for integration within nursing education.

Health literacy and adherence to antiretroviral therapy among HIV-infected youth

Margaret-Navarra, A., Neu, N., Toussi, S., Nelson, J., & Larson, E. L. (2014). The Journal of the Association of Nurses in AIDS Care : JANAC, 25(3), 203-213. 10.1016/j.jana.2012.11.003
Abstract
Health literacy has been associated with adherence to antiretroviral therapy (ART) in HIV-infected adults, but this association has not been demonstrated in HIV-infected adolescents. Using an expanded health literacy model, we examined the relationship between health literacy, functional literacy, beliefs about ART, media use, and adherence to ART. Aconvenience sample of HIV-infected adolescents (n = 50) was recruited for this cross-sectional study. The primary outcome of adherence was measured with 3-day self-reports. Health literacy as measured by the Test of Functional Health Literacy in Adults (TOFHLA) was not predictive of adherence (p=.15). Participants with higher positive outcome expectancy scores regarding ART were more likely to report 100% adherence, and participants with below-grade-level reading were less likely to report 100% adherence (p < .05). Our findings highlight the importance of assessing both health beliefs and reading skills as part of adherence support for HIV-infected youth.

Measuring media use in college students with and without human immunodeficiency virus infection

Margaret-Dunn-Navarra, A., Toussi, S. S., Cohn, E., Neu, N., & Larson, E. L. (2014). Journal of Pediatric Health Care, 28(4), 342-349. 10.1016/j.pedhc.2013.07.017
Abstract
Introduction: Media applications have shown promise for health education. The aims of this study were to develop and evaluate a media survey measure and compare media use among college students with and without human immunodeficiency virus (HIV) infection. Methods: Using a cross-sectional, descriptive design, a convenience sample of college students (N = 53) were recruited. Psychometric testing of the media instrument was performed, and the tool was then used to compare media use among HIV-infected undergraduates (n = 15), other undergraduates (n = 23), and nursing students (n = 15). Results: Psychometric testing of the media instrument demonstrated a high degree of reliability (intraclass correlation = .998; 95% confidence intervals = .997, .999). All respondents had computers with Internet access and cellular phones. Among HIV-infected undergraduate students, 86.7% reported spending 5 minutes or more viewing television during the previous 24 hours outside of school and or work, in comparison with 34.8% of the other undergraduate students with no known chronic illness and 46.7% of the nursing students (p = .002 and .05, respectively). Preferred modes to access health information and communicate with health care providers for all respondents were the Internet (86.8%) and telephone (62.3%), respectively. Discussion: Assessment of media use among adolescents and young adults will aid in planning for their health education needs.

Parental health literacy, knowledge and beliefs regarding upper respiratory infections (uri) in an urban latino immigrant population

Margaret-Dunn-Navarra, A., Stockwell, M. S., Meyer, D., & Larson, E. (2012). Journal of Urban Health, 89(5), 848-860. 10.1007/s11524-012-9692-8
Abstract
Parents who are recent immigrants and/or non-native English speakers are at increased risk for poor health literacy. For example, misconceptions regarding treatment for upper respiratory infections (URIs), including nonjudicious use of antibiotics, have been described among Latinos. We sought to assess the influence of health literacy on knowledge and beliefs surrounding URI care and to explore the correlation between two health literacy measures among Latino parents in northern Manhattan. A descriptive survey design was used, and a total of 154 Latino parents were enrolled from four early head start programs between September 2009 and December 2009. Health literacy was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA) and Newest Vital Sign (NVS); parental knowledge and beliefs regarding antibiotic treatment for URIs were also assessed. Analyses were conducted in 2010 with multivariable logistic regression performed to examine predictors of health literacy. Inadequate health literacy was observed in 83.8 % of respondents using NVS and 35.7 % with the S-TOFHLA. College education was significantly associated with adequate health literacy using either the NVS or S-TOFHLA; however, other results varied between measures. Using NVS, there was a greater likelihood of adequate health literacy with US birth status (AOR 13.8; 95 % CI, 1.99-95.1), 95 years US residency (AOR 7.6; 95 % CI, 1.3-43.1) and higher antibiotic knowledge scores (AOR 1.7; 95% CI, 1.2-2.4). Using S-TOFHLA, the odds of adequate health literacy increased with access to a regular care provider (AOR 2.6; 95 % CI, 1.2-5.6). Scores consistent with adequate health literacy on the NVS, but not the S-TOFHLA, were associated with correct beliefs regarding antibiotic use for URIs in comparison to scores of participants with inadequate health literacy. Since health literacy levels were low in this population and the risk of viral URI was high during the first few years of life, targeted education to improve health literacy, knowledge, and beliefs about URI and related antibiotic treatment is needed.

Effect of probiotic bacteria on microbial host defense, growth and immune function in human immunodeficiency virus type-1 infection

Cunningham-Rundles, S., Ahrné, S., Johann-Liang, R., Abuav, R., Margaret-Dunn-Navarra, A., Grassey, C., Bengmark, S., & Cervia, J. S. (2011). Nutrients, 3(12), 1042-1070. 10.3390/nu3121042
Abstract
The hypothesis that probiotic administration protects the gut surface and could delay progression of Human Immunodeficiency Virus type1 (HIV-1) infection to the Acquired Immunodeficiency Syndrome (AIDS) was proposed in 1995. Over the last five years, new studies have clarified the significance of HIV-1 infection of the gut associated lymphoid tissue (GALT) for subsequent alterations in the microflora and breakdown of the gut mucosal barrier leading to pathogenesis and development of AIDS. Current studies show that loss of gut CD4+ Th17 cells, which differentiate in response to normal microflora, occurs early in HIV-1 disease. Microbial translocation and suppression of the T regulatory (Treg) cell response is associated with chronic immune activation and inflammation. Combinations of probiotic bacteria which upregulate Treg activation have shown promise in suppressing pro inflammatory immune response in models of autoimmunity including inflammatory bowel disease and provide a rationale for use of probiotics in HIV-1/AIDS. Disturbance of the microbiota early in HIV-1 infection leads to greater dominance of potential pathogens, reducing levels of bifidobacteria and lactobacillus species and increasing mucosal inflammation. The interaction of chronic or recurrent infections, and immune activation contributes to nutritional deficiencies that have lasting consequences especially in the HIV-1 infected child. While effective anti-retroviral therapy (ART) has enhanced survival, wasting is still an independent predictor of survival and a major presenting symptom. Congenital exposure to HIV-1 is a risk factor for growth delay in both infected and non-infected infants. Nutritional intervention after 6 months of age appears to be largely ineffective. A meta analysis of randomized, controlled clinical trials of infant formulae supplemented with Bifidobacterium lactis showed that weight gain was significantly greater in infants who received B. lactis compared to formula alone. Pilot studies have shown that probiotic bacteria given as a supplement have improved growth and protected against loss of CD4+ T cells. The recognition that normal bacterial flora prime neonatal immune response and that abnormal flora have a profound impact on metabolism has generated insight into potential mechanisms of gut dysfunction in many settings including HIV-1 infection. As discussed here, current and emerging studies support the concept that probiotic bacteria can provide specific benefit in HIV-1 infection. Probiotic bacteria have proven active against bacterial vaginosis in HIV-1 positive women and have enhanced growth in infants with congenital HIV-1 infection. Probiotic bacteria may stabilize CD4+ T cell numbers in HIV-1 infected children and are likely to have protective effects against inflammation and chronic immune activation of the gastrointestinal immune system.

Relationship between systems-level factors and hand hygiene adherence

Margaret-Dunn-Navarra, A., Cohen, B., Stone, P. W., Pogorzelska, M., Jordan, S., & Larson, E. (2011). Journal of Nursing Care Quality, 26(1), 30-38. 10.1097/NCQ.0b013e3181e15c71
Abstract
This study was a cross-sectional descriptive survey of acute care hospitals in California to describe staff hand hygiene compliance and related predictors and explore the relationship between hand hygiene adherence and health care-associated infections. Although there was a relatively small sample size, institutions with morning huddles reported a significantly higher proportion of 95% or more hand hygiene compliance. Huddles are an organizational tool to improve teamwork and communication and may offer promise to influence hand hygiene adherence.

Effects of protease inhibitors on glucose tolerance, lipid metabolism, and body composition in children and adolescents infected with human immunodeficiency virus

Ergun-Longmire, B., Lin-Su, K., M.-Dunn, A., Chan, L., Ham, K., Sison, C., Stavola, J., & Vogiatzi, M. G. (2006). Endocrine Practice, 12(5), 514-521.
Abstract
Objective: To evaluate the effects of protease inhibitors (PIs) as antiretroviral therapy in comparison with other antiretroviral (non-PI) medications on glucose tolerance, lipid metabolism, and body fat distribution in human immunodeficiency virus (HIV)-infected young patients. Methods: We conducted a cross-sectional clinical study in an outpatient HIV clinic. The study population consisted of 21 patients (15 female and 6 male) who had had at least 6 months of antiretroviral treatment. The mean age of the patients was 11.9 years (range, 6 to 16.5). Results: Fifteen patients treated with PIs and 6 patients treated with non-PIs were enrolled in the study. We found no significant differences in the lipid panel and insulin resistance, as determined by using the Quantitative Insulin Sensitivity Check Index formula, in the PI group in comparison with the non-PI group. Lipodystrophy was observed in 47% (7 of 15) of the PI group and 33% (2 of 6) of the non-PI group (P = 0.66). In the presence of lipodystrophy, serum triglyceride levels were higher in the PI group than in the non-PI group (P = 0.046). No such difference was found between the treatment groups when no lipodystrophy was present. There was no significant difference in insulin resistance between the treatment groups in the presence or absence of lipodystrophy. Conclusion: Our study found the presence of lipodystrophy in HIV-infected young patients regardless of whether they were taking PIs or not. In the patients who had lipodystrophy, those treated with PIs had higher serum triglyceride levels than those not treated with PIs.