Bonnie Gance-Cleveland, PhD, prolific researcher, child health advocate and champion of the underserved, recently received the eighth biennial Elisabeth H. Boeker Award for Faculty Excellence in Research.
Gance-Cleveland, also the University of Colorado College of Nursing’s Loretta C. Ford Endowed Professor, won the prestigious honor for her dedicated work toward equal access in healthcare.
Gance-Cleveland’s innovative studies have led to critical changes — from more effective pediatric obesity screening in indigent populations nationwide to better care of children with asthma in CU Nursing’s own Sheridan Health Services clinics.
Her chief words of advice during her distinguished lecture to her fellow faculty members were:
- Keep patients at the center of research.
- Maintain a strong connection with clinical practice.
Focused on translating evidence into practice, Gance-Cleveland’s talk highlighted phases in her own research that aligned with each step in the T0 to T4 classification system. The system’s steps, issued by the National Institutes of Health, streamline and track the process of moving science from laboratory to bedside.
What’s the problem?
In medical research, the first step (T0) often involves animal studies. During her years of nursing research (generally absent of animal trials), Gance-Cleveland has found the basic T0 research step should focus on “defining the problem.”
Example: During her dissertation study on school-based support groups for children with substance-abusing parents, Gance-Cleveland used student surveys and comparative studies to define the problem, the intervention and the outcome. “The work also defined what the interventions should look like,” she said.
Will the idea work?
In medical studies, T1 generally focuses on translating the animal trials to human studies. Gance-Cleveland uses the step to “establish feasibility” of the idea in clinical practice.
Example: During a project currently underway with her CU Nursing-Midwifery colleagues, the research team developed screening technology easily used by pregnant women in the waiting room to pinpoint issues important to maternal and fetal health, such as nutrition and substance abuse.
After gathering feedback from patients and providers during three phases, the researchers refined the technology, which is now being translated into Spanish for improved clinical success.
How do I make it work?
Step T2 in medical trials involves translation from human subjects to actual patients. Gance-Cleveland uses T2 to focus on how best to implement her idea and assure outcomes are meaningful, she said.
Example: Years ago, when a CU Nursing graduate student noted that she and fellow students were struggling with pediatric body mass index (BMI) calculating, charting and counseling, Professor Emeritus Lynn Gilbert engaged Kevin Gilbert, PhD, a Boulder engineer focused on creating technology to improve obesity care for vulnerable youth.
Gilbert, who was in the audience, developed the now commonly used HeartSmartKids technology, which screens pediatric patients and then calculates and plots the children’s BMI percentile. “So a clinician has it right there in a handout and can do the counseling,” Gance-Cleveland said.
Caregivers in the Sheridan school-based clinic began using the technology during the height of the childhood obesity epidemic and embraced it, Gance-Cleveland said. A graduate student then looked at whether the technology really helped.
“She did chart audits before HeartSmartKids was implemented and then two years after, and she found statistically significant improvements in documentation of everything,” Gance-Cleveland said.
Does it work in the real world?
Step T3 centers on translation to practice, and Gance-Cleveland focuses on establishing effectiveness of the idea, or how it works “in the real world,” she said.
Example: Her dissertation descriptive studies on support groups for children with substance-abusing parents grew into a randomized control trial in the Sheridan school-based clinic.
For the final T4 step, which NIH calls the translation to communities step, Gance-Cleveland determines how the idea works in multiple settings with different patient populations.
Example: One of her studies looking at the effectiveness of the HeartSmartKids technology involved 24 school-based health centers across six states. Half of the centers used the technology and half did not. HeartSmartKids clinics experienced statistically significant improvements in identifying and counseling children with obesity.
What’s the secret to success?
“For me, the most fun part of this (multistate study) is we have a ton of data, and we have had a number of honors students and PhD students who have now done their projects on this and published,” Gance-Cleveland said.
Asked for advice for new researchers hoping to emulate her success, she said find a passion and watch it grow.
“Who knew my passion for kids with parents with substance abuse would come around to screening of pregnant women for substance abuse? As you define what you really care about — I care about kids who don’t have access. I care about kids and families who don’t have all the resources — that goes a long way.”