Ann-Margaret Navarra


Ann-Margaret Navarra headshot

Ann-Margaret Navarra

Assistant Professor

1 212 998 9009

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

Accepting PhD students

Ann-Margaret Navarra's additional information

Ann-Margaret Navarra is an assistant professor at NYU Rory Meyers College of Nursing. Her current research interests include design and implementation of technology-supported behavioral interventions for improved disease self-management among HIV-infected youth. As an NIH-funded researcher and board-certified pediatric nurse practitioner, her research training includes NIH-funded pre- and post-doctoral fellowships (T-90 & T-32) supported by Columbia University School of Nursing. Navarra has presented at regional and national meetings and published in the Journal of Pediatric Health Care and the Journal of the Association of Nurses in AIDS Care.

Navarra completed a PhD, MPhil, and MS at Columbia University and BS at the College of New Rochelle.

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

Chronic disease
Underserved populations

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

Faculty Honors Awards

Alpha Zeta Chapter Award, Sigma Theta Tau (2012)
Student Research Award, Sigma Theta Tau-Alpha Zeta Chapter (2010)
Alumni Scholar, Columbia University (2008)
Sigma Theta Tau International Honor Society of Nursing, Alpha Zeta Chapter (2008)
Scholarship Recipient, Vancouver (1996)
Sigma Theta Tau International Honor Society of Nursing, Zeta Omega Chapter (1988)


Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus

Dunn Navarra, A. M., Whittemore, R., Bakken, S., Rosenberg, M. J., Gormley, M., Bethea, J., Gwadz, M., Cleland, C., Liang, E., & D’Eramo Melkus, G. (2020). Nursing Research, 69(3), 197-209. 10.1097/NNR.0000000000000422
BACKGROUND: Maintaining adherence to antiretroviral therapy (ART) is a significant challenge for human immunodeficiency virus (HIV)-infected racial and ethnic minority adolescents and young adults (youth). Given the consequences of suboptimal ART adherence, there is a pressing need for an expanded understanding of adherence behavior in this cohort. OBJECTIVES: As part of an exploratory sequential, mixed-methods study, we used qualitative inquiry to explore adherence information, motivation, and behavioral skills among HIV-infected racial and ethnic minority youth. Our secondary aim was to gain an understanding of the contextual factors surrounding adherence behavior. METHODS: The information-motivation-behavioral skills model (IMB model) was applied to identify the conceptual determinants of adherence behavior in our target population, along with attention to emergent themes. In-depth, individual, semistructured interviews, including open-ended questions with probes, were conducted with a convenience sample of HIV-infected racial and ethnic minority youth (ages 16-29 years), receiving ART and with evidence of virologic failure (i.e., detectable HIV viral load). New participants were interviewed until information redundancy was reached. Qualitative interviews were digitally recorded, transcribed verbatim, and analyzed using Atlas.ti (v8). Directed content analysis was performed to generate categories and broad themes. Coding was initially conceptually driven (IMB model) and shifted to a data-driven approach, allowing for the discovery of key contextual factors that influence adherence behavior in this population. Methodological rigor was ensured by member checks, an audit trail, thick descriptive data, and triangulation of data sources. RESULTS: Twenty racial and ethnic minority participants (mean age = 24.3 years, 55.0% male) completed interviews. We found adherence information was understood in relation to HIV biomarkers; adherence motivation and behavioral skills were influenced by stigma and social context. We identified five primary themes regarding ART self-management: (a) emerging adulthood with a chronic illness, (b) stigma and disclosure concerns, (c) support systems and support deficits, (d) mental and behavioral health risks and challenges, and (e) mode of HIV transmission and perceptions of power and control. DISCUSSION: Key constructs of the IMB model were applicable to participating HIV-infected youth yet did not fully explain the essence of adherence behavior. As such, we recommend expansion of current adherence models and frameworks to include known contextual factors associated with ART self-management among HIV-infected racial and ethnic minority youth.

Recruitment of US Adolescents and Young Adults (AYA) into Human Immunodeficiency Virus (HIV)–Related Behavioral Research Studies: A Scoping Review

Navarra, A. M. D., Handschuh, C., Hroncich, T., Jacobs, S. K., & Goldsamt, L. (2020). Current HIV/AIDS Reports, 17(6), 615-631. 10.1007/s11904-020-00530-1
Purpose of Review: The objective of this scoping review was to examine the range of published evidence on recruitment approaches and outcomes of US adolescents and young adults (AYA) ages (18–29 years) into human immunodeficiency virus (HIV)–related behavioral research studies during the past 10 years. Recent Findings: Implementation of effective behavioral research strategies among HIV at-risk and infected AYA is key to ending the HIV epidemic and necessitates successful recruitment strategies. Summary: A comprehensive search was executed across four electronic databases. Of the 1697 identified studies, seven met inclusion criteria with six of these seven directed to HIV prevention. Most studies used online recruitment as part of a hybrid strategy, and combined field-based/in-person and online methods. Recruitment strategies and outcomes, resources and compensation, procedures for consent, and timelines varied among all seven studies. Our results highlight the need for development of recruitment models in alignment with behavioral strategies aimed to treat and prevent HIV among US AYA.

Adherence connection for counseling, education, and support: Research protocol for a proof-of-concept study

Navarra, A. M. D., Gwadz, M. V., Bakken, S., Whittemore, R., Cleland, C. M., & Melkus, G. D. (2019). JMIR Research Protocols, 8(3). 10.2196/12543
Background: The highest rates of new HIV infections are observed in African Americans and Hispanics/Latinos (ethnic minority) adolescents and young adults (youth). HIV-infected ethnic minority youth are less likely to initiate and maintain adherence to antiretroviral treatment (ART) and medical care, as compared with their adult counterparts. Objective: The objective of this research protocol was to describe our proposed methods for testing a peer-led mobile health cognitive behavioral intervention, delivered via remote videoconferencing and smartphones with HIV-infected ethnic minority youth, Adherence Connection for Counseling, Education, and Support (ACCESS). Our secondary aim was to obtain initial estimates of the biobehavioral impact of ACCESS on HIV virologic outcomes and self-reported ART adherence, beliefs and knowledge about ART treatment, adherence self-efficacy, and health care utilization (retention in care). Methods: An exploratory, sequential mixed-methods study design will be used with conceptual determinants of adherence behavior informed by the information-motivation-behavioral skills model. HIV-infected ethnic minority youth aged 16 to 29 years with a detectable HIV serum viral load of more than 200 copies/ml (N=25) will be recruited. Qualitative pretesting will be conducted, including semistructured, in-depth, individual interviews with a convenience sample meeting the study inclusion criteria. Preliminary analysis of qualitative data will be used to inform and tailor the ACCESS intervention. Testing and implementation will include a one-group pre-posttest pilot, delivered by a trained successful peer health coach who lives with HIV and is well-engaged in HIV care and taking ART. A total of 5 peer-led remote videoconferencing sessions will be delivered using study-funded smartphones and targeting adherence information (HIV knowledge), motivation (beliefs and perceptions), and behavioral skills (self-efficacy). Participant satisfaction will be assessed with poststudy focus groups and quantitative survey methodology. Bivariate analyses will be computed to compare pre- and postintervention changes in HIV biomarkers, self-reported ART adherence, beliefs and knowledge about ART, adherence self-efficacy, and retention in care. Results: As of December 2018, we are in the data analysis phase of this pilot and anticipate completion with dissemination of final study findings by spring/summer 2019. The major outcomes will include intervention feasibility, acceptability, and preliminary evidence of impact on serum HIV RNA quantitative viral load (primary adherence outcome variable). Self-reported ART adherence and retention in care will be assessed as secondary outcomes. Findings from the qualitative pretesting will contribute to an improved understanding of adherence behavior. Conclusions: Should the ACCESS intervention prove feasible and acceptable, this research protocol will contribute to a shift in existent HIV research paradigms by offering a blueprint for technology-enabled peer-led interventions and models.

Association Between Health Literacy and Medication Adherence Among Hispanics with Hypertension

Lor, M., Koleck, T. A., Bakken, S., Yoon, S., & Dunn Navarra, A. M. (2019). Journal of Racial and Ethnic Health Disparities, 6(3), 517-524. 10.1007/s40615-018-00550-z
Background: Poor adherence to prescribed antihypertensive medication is a major contributor to disparities in effective blood pressure control among Hispanics. The purpose of this study was to investigate the association between health literacy level and adherence to antihypertensive medications among Hispanic adults, who self-reported hypertension, controlling for potential covariates of adherence and/or health literacy. Methods: We conducted a cross-sectional survey of 1355 Hispanic adults, primarily Dominicans, who self-reported hypertension. Antihypertensive medication adherence and health literacy were evaluated along with covariates, including sociodemographic characteristics, depression, anxiety, and sleep disturbance. Linear regression models were created for health literacy, each covariate, and adherence. Factors found to be significantly associated with adherence in the individual regression models at a p value of < 0.20 were included in a hierarchical multiple linear regression model. Results: Overall, the majority of participants had low adherence levels to antihypertensive medications (88.4%; n = 1026) and inadequate health literacy (84.9%; n = 1151). When controlling for age, sex, birth country, education level, recruitment location, depression, anxiety, and sleep disturbance, having adequate as compared to inadequate health literacy was associated with a higher adherence score (b = 0.378, p = 0.043). The full model explained 13.6% of the variance in medication adherence (p value < 0.001), but the unique contribution of health literacy to the model was minimal (R2 change = 0.003). Conclusions: Tailored interventions considering health literacy are needed to support medication adherence in order to improve hypertension outcomes of Hispanics. Additional studies are needed to identify and prioritize factors in the development of targeted and effective adherence interventions for Hispanics with hypertension.

Engaging and Supporting Youth to Promote Adherence Success (EASYPAS): A Cognitive Behavioral Intervention for Youth Living With HIV

Dunn Navarra, A. M., Ford, H., Cleland, C. M., Liang, E., Rodriguez, K., & Neu, N. (2019). The Journal of the Association of Nurses in AIDS Care : JANAC, 30(3), 372-378. 10.1097/JNC.0000000000000034

Music Therapy and Pain Management in Patients with End-Stage Liver Disease: An Evidence-Based Practice Quality Improvement Project

Pathania, S., Slater, L. Z., Vose, C., & Navarra, A. M. (2019). Pain Management Nursing, 20(1), 10-16. 10.1016/j.pmn.2018.07.004
Background: Pain can negatively affect the inpatient hospitalization experience; however, in patients with compromised metabolic pathways who are more vulnerable to medication side effects, pain control becomes even more challenging. Aims: This evidence-based practice quality improvement project explored the feasibility of implementing a music therapy intervention for improved pain management (pain intensity, analgesic volume) and patient satisfaction among patients with a diagnosis of cirrhotic end-stage liver disease in the acute care setting. Design: The plan–do–check–act cycle served as the implementation framework. Four nurse champions were trained to implement a 30-minute music intervention. Self-selected musical selections were delivered via unit-based iPads with earbud headphones during 3 consecutive days. Methods: Data collection was performed using unit-based measures for pain and patient satisfaction and an investigator-developed audit tool. Bivariate analyses and descriptive statistics were used to assess the effect of the intervention on the three outcomes of interest. Results: Overall results from data collected with eight participants during a 6-week period indicated a 10% reduction in pain intensity and a 30% improvement in patient satisfaction with pain management care. Conclusions: Findings from this evidence-based practice quality improvement project provide support for the effectiveness of music therapy as an adjunct to traditional pharmacologic modalities for pain management of the end-stage liver disease patient population.

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

Navarra, A. M., Stimpfel, A. W., Rodriguez, K., Lim, F., Nelson, N., & Slater, L. Z. (2018). Nurse Education Today, 61, 20-24. 10.1016/j.nedt.2017.10.009
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.

Faculty and Student Perspectives on Mentorship in a Nursing Honors Program

Nelson, N., Lim, F., Navarra, A. M., Rodriguez, K., Witkoski, A., & Slater, L. Z. (2018). Nursing Education Perspectives, 39(1), 29-31. 10.1097/01.NEP.0000000000000197
Honors programs in nursing can facilitate the professional development of high-achieving students, supporting their lifelong engagement in nursing practice, education, research, and health care policy issues. Strong mentoring relationships are commonly identified as essential to the success of nursing honors programs, but literature on mentoring relationships in an honors context is limited. The purpose of this study was to gain insight into faculty and student expectations for mentorship. Faculty and students shared similar expectations for both the mentor and mentee, highlighting key themes of engagement, facilitation, accountability, and collaboration as necessary for the success of an undergraduate nursing honors program.

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

Navarra, A. M. D., Gwadz, M. V., Whittemore, R., Bakken, S. R., Cleland, C. M., Burleson, W., Jacobs, S. K., & Melkus, G. D. (2017). AIDS and Behavior, 21(11), 3154-3171. 10.1007/s10461-017-1867-6
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)

Navarra, A. M., 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
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.