Faculty

S. Raquel Ramos headshot

S Raquel Ramos

FNP-BC MBA MSN PhD

Assistant Professor

1 212 992 5994

433 First Avenue
Room 402
New York, NY 10010
United States

Accepting PhD students

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Professional overview

S. Raquel Ramos, PhD, MBA, MSN, FNP-BC, is an assistant professor at New York University Rory Meyers College of Nursing. She has over a decade of direct-care experience in various settings, such as intensive care, cardiac cath lab, long-term care, LGBTQ community health, and clinical research. Ramos's research examines how user-centered design and technology-enabled interventions can facilitate informed decision-making in sexual minority men of color living with HIV or at risk of HIV. She designs interventions that prioritize health-information needs from the perspectives of patients, providers, and non-clinical personnel. As a nurse investigator, her research falls under the realm of consumer health informatics, specifically focusing on user-centered design, preference, health literacy, and autonomy support as tools for enhancing informed decision-making.

Ramos's earlier work focused on the facilitators and barriers to health information exchange consent. Using a sociotechnical analysis, she found that comprehension was a strong barrier. She also found that patients preferred both human and computer interaction. This highlights the importance of maintaining personal interaction while recognizing the ubiquity of mobile devices used in research. As part of her international work, she traveled to two academic teaching hospitals in Accra and Kumasi, Ghana, to study how literacy and numeracy influenced decision-making in Ghanaian caregivers of children living with HIV. Through the use of formative informatics-based approaches, Ramos found that multiple complexities inherent to cultural norms, gender, and education influenced decision-making.

Ramos has two active grants: the NIH-funded HIV Prevention Trials Network and a five-year NIH/NHLBI K01. She is examining PrEP use and discontinuation in Black sexual minority men (HIV Prevention Trials Network).  For her mentored career development award, she will test the feasibility and acceptability of a virtual environment to prevent HIV-related comorbid conditions (NIH/NHLBI K01). 

Ramos was a postdoctoral fellow at Yale University. She earned her PhD from Columbia University and her MSN as a family nurse practitioner, MBA in management, and BSN in nursing from Purdue University. 

Education

PhD - Columbia University
MS, Family Nurse Practitioner - Purdue University
MBA, Management - Purdue University
BS, Nursing - Purdue University
AS, Nursing - Ivy Tech State College
Technical Certificate Licensed Practical Nursing - Ivy Tech State College

Specialties

Informatics
HIV/AIDS
LGBTQ
Technology
Underserved populations
Chronic disease

Professional membership

American Medical Informatics Association (AMIA)
American Nurses Credentialing Center (ANCC)
Association of Nurses in AIDS Care (ANAC)
Eastern Nursing Research Society (ENRS)
National Research Mentoring Network (NRMN)
Sigma Theta Tau International (STTI)

Honors and awards

Faculty Honors Awards

mHealth Scholar, MD2K Summer Training Institute (U54EB020404) (2019)
Visiting Fellow 2016–2019, Research Education Institute for Diverse Scholars (R25MH087217) (2016)
40 Under 40 Leader in Minority Health, National Minority Quality Forum (2016)
Predoctoral Trainee, Training Nurse Scientists in Interdisciplinary & Translational Research (D09HP14667)
Predoctoral Trainee, Reducing Health Disparities Through Informatics (T32NR007969)
Postdoctoral Trainee, Self and Family Management of Chronic Illness (T32NR008346)

Publications

Publications

Prototype development, usability, and preference of a culturally-relevant pictorial aid to facilitate comprehension of likert-type levels of agreement in caregivers of children living with HIV in Ghana

Ramos, S. R., Paintsil, E., Ofori-Atta, A., Kusah, J. T., Amissah, K. A., Alhassan, A., Ofori, I. P., & Reynolds, N. R. (2020). CIN - Computers Informatics Nursing, 38(1), 45-52. 10.1097/CIN.0000000000000584
Abstract
Pictorial illustrations of Likert-type scales are culturally useful and may reduce error associated with usage of Westernized self-report measures in low- and middle-income countries. Pictorial illustrations can be encounter-specific decision aids in populations with low literacy or English proficiency. In an unanticipated finding from the SANKOFA study, caregivers of children living with human immunodeficiency virus experienced challenges comprehending Likert-type scales. A cross-sectional, qualitative study was conducted with a SANKOFA participant subset (n = 30) in Ghana. Using an informatics-based formative design approach, we developed a culturally-relevant pictorial aid to assess usability and preference when compared to a Likert-type self-report measure. Ninety percent (n = 27) of substudy participants preferred the pictorial of a traditional Bolga basket over a shallow basket. Forty-three percent (n = 13) preferred the pictorial aid over the Likert-type measure. Fifty percent reported the pictorial aid was easy to use. Fifty-seven percent preferred the Likert-type measure, potentially because English proficiency is regarded in Ghana as a means of upward social and financial mobility. Such cultural norms may have contributed to the lack of consensus and must be considered for pictorial aids to be meaningful. Pictorial aids have been designed for use in clinical and research settings. They reduce barriers associated with lower textual literacy while facilitating comprehension and decision-making.

A web-based intervention to reduce decision conflict regarding HIV pre-exposure prophylaxis: A clinical trial protocol

Nelson, L., Ajiboye, W., Osei-Twum, J., Odhiambo, J., Pedersen, C., Ramos, S. R., Lofters, A., Mbuagbaw, L., & Williams, G. (2020). JMIR Research Protocols.

A Framework for Using eHealth Interventions to Overcome Medical Mistrust Among Sexual Minority Men of Color Living with Chronic Conditions

Ramos, S. R., Warren, R., Shedlin, M., Melkus, G., Kershaw, T., & Vorderstrasse, A. (2019). Behavioral Medicine, 45(2), 166-176. 10.1080/08964289.2019.1570074
Abstract
The purpose of this paper is to present a stepwise, multi-construct, innovative framework that supports the use of eHealth technology to reach sexual minority populations of color to establish trustworthiness and build trust. The salience of eHealth interventions can be leveraged to minimize the existing paradigm of medical mistrust among sexual minority populations of color living with chronic illnesses. These interventions include virtual environments and avatar-led eHealth videos, which address psychosocial and structural-level challenges related to mistrust. Our proposed framework addresses how eHealth interventions enable technology adoption and usage, anonymity, co-presence, self-disclosure, and social support and establish trustworthiness and build trust.

LEveraging A viRtual eNvironment (LEARN) to Enhance Prevention of HIV-related Comorbidities in at-risk Minority MSM (Men who have sex with men)

Ramos, S. R. (2019). Ethnicity and Disease, 29. 10.18865/ed.29.S1.209

Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey

Bond, K. T., & Ramos, S. R. (2019). JMIR Formative Research, 3(2), e9995. 10.2196/formative.9995
Abstract
BACKGROUND: Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format.OBJECTIVE: The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women.METHODS: A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants' perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video.RESULTS: Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=-.814; P=.004), not having unprotected sex in the last 3 months (beta=-.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=-.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=-.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women.CONCLUSIONS: Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women.

User-Centered Design, Experience, and Usability of an Electronic Consent User Interface to Facilitate Informed Decision-Making in an HIV Clinic

Ramos, S. R. (2017). CIN - Computers Informatics Nursing, 35(11), 556-564. 10.1097/CIN.0000000000000356
Abstract
Health information exchange is the electronic accessibility and transferability of patient medical records across various healthcare settings and providers. In some states, patients have to formally give consent to allow their medical records to be electronically shared. The purpose of this study was to apply a novel user-centered, multistep, multiframework approach to design and test an electronic consent user interface, so patients with HIV can make more informed decisions about electronically sharing their health information. This study consisted of two steps. Step 1 was a cross-sectional, descriptive, qualitative study that used user-centric design interviews to create the user interface. This informed Step 2. Step 2 consisted of a one group posttest to examine perceptions of usefulness, ease of use, preference, and comprehension of a health information exchange electronic consent user interface. More than half of the study population had college experience, but challenges remained with overall comprehension regarding consent. The user interface was not independently successful, suggesting that in addition to an electronic consent user interface, human interaction may also be necessary to address the complexities associated with consenting to electronically share health information. Comprehension is key factor in the ability to make informed decisions.

Sociotechnical Analysis of Health Information Exchange Consent Processes in an HIV Clinic

Ramos, S. R., Gordon, P., Bakken, S., & Schnall, R. (2016). Journal of the Association of Nurses in AIDS Care, 27(6), 792-803. 10.1016/j.jana.2016.08.001
Abstract
Federal regulations have encouraged the electronic sharing of protected health information (PHI). As an opt-in state, New York abides by an affirmative consent model where PHI is electronically shared only after written consent is obtained. The purpose of our study was to describe sociotechnical factors that influence health information exchange (HIE) consent for persons living with HIV (PLWH) at one clinic in New York City. We employed mixed methods to gather perceptions of facilitators and barriers to HIE consent. Study participants included PLWH, staff, and clinicians. The mixed-methods approach revealed multiple interruptions in clinical workflow, staff and providers' time constraints, and lack of dedicated personnel focused on HIE consent as the major barriers to HIE consent. Although there is no one strategy to resolve barriers to HIE consent, having a dedicated person was identified as the most salient factor for facilitating HIE consent.

Central Trends in Nursing Informatics: Students' Reflections from International Congress on Nursing Informatics 2014 (Taipei, Taiwan)

Topaz, M., Ronquillo, C., Pruinelli, L., Ramos, R., Peltonen, L. M., Siirala, E., Atique, S., Hamann, G., & Badger, M. K. (2015). CIN - Computers Informatics Nursing, 33(3), 85-89. 10.1097/CIN.0000000000000139

Qualitative study of patient consent for health information exchange in an HIV clinic

Ramos, S. R., & Bakken, S. (2014). In , & , Nursing Informatics 2014 (pp. 418-424). IOS Press. 10.3233/978-1-61499-415-2-418
Abstract
Introduction/Background: Health information exchange (HIE) is the secure, electronic transfer and/or accessibility of clinical data among healthcare providers. In the United States (US), the consent process for participation varies state to state. New York State (NYS) mandates written patient consent. The purpose of this study was to examine workflow and perceptions related to obtaining HIE consent in an HIV clinic. Methods: We used contextual inquiry to observe the HIE consent-related workflow of four registration clerks for a total of 4 hours on two weekdays and subsequently created a flow chart and sequence model diagram. Clerks were also interviewed and the resulting narrative data were coded into themes. Results: Observational and interview data suggested that patient privacy/confidentiality/trust, high volume workflow, and multiple competing demands affect the patient HIE consent process. Conclusions: Additional qualitative data needs to be gathered from the perspectives of patients and clinicians about the HIE consent process.

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