University of Southern California
University of Southern California
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
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Research
Research

Current PhD Students

Kristine Carandang

Faculty Mentor: Beth Pyatak PhD, OTR/L, CDE

Research Lab: Chronic Conditions in Young Adulthood

Year of Entry: 2013

Kristine Carandang

Education

Master of Science (MS) in Occupational Therapy
Washington University in St. Louis

Bachelor of Arts (BA) in Psychology
University of Virginia

Research Interests

I am extending upon lessons I learned from conducting diabetes research with Dr. Pyatak to conducting an exploratory analysis of young adults’ activity engagement while living with a rheumatic disease. My work privileges young adulthood as a unique developmental stage that is often overlooked in chronic illness research. My dissertation involves a three-phase mixed methods design, starting with quantitative surveys that ask participants about daily functioning, semi-structured interviews that explore participants’ occupational decisions outside of standardized variables, and ending with narrative interviews that allow for a richer understanding of participants’ experiences and views. With this data, I hope to develop occupational science theory around lifestyle tradeoffs, which involves the decisions that individuals make around activities that promote or deter from various health outcomes. Outside of my dissertation, I am actively concerned with promoting patients’ involvement within healthcare research planning and design. As such, I am involved with multiple patient-directed projects in my role as a researcher, healthcare professional, and patient.

Publications

Journal Articles

Pyatak, E. A., Carandang, K., Vigen, C. L., Blanchard, J., Díaz, J., Concha-Chavez, A., Sequeira, P. A., Wood, J. R., Whittemore, R., Spruijt-Metz, D., & Peters, A. L. (2018). Occupational therapy intervention improves glycemic control and quality of life among young adults with diabetes: The Resilient, Empowered, Active Living With Diabetes (REAL Diabetes) randomized controlled trial. Diabetes Care, 41(4), 696-704. https://doi.org/10.2337/dc17-1634 Show abstractHide abstract

Objective. To assess the efficacy of a manualized occupational therapy (OT) intervention (Resilient, Empowered, Active Living with Diabetes [REAL Diabetes]) to improve glycemic control and psychosocial well-being among ethnically diverse young adults with low socioeconomic status (SES) who have type 1 or type 2 diabetes.
 
Research Design and Methods. Eighty-one young adults (age 22.6 ± 3.5 years; hemoglobin A1c [HbA1c] = 10.8%/95 mmol/mol ± 1.9%/20.8 mmol/mol) were randomly assigned to the REAL Diabetes intervention group (IG) or an attention control group (CG) over 6 months. IG participants received biweekly sessions guided by a manual composed of seven content modules; CG participants received standardized educational materials and biweekly phone calls. Blinded assessors collected data at baseline and 6 months. The primary outcome was HbA1c; secondary outcomes included diabetes self-care, diabetes-related quality of life (QOL), diabetes distress, depressive symptoms, and life satisfaction. Change scores were analyzed using Wilcoxon rank sum tests.
 
Results. Intent-to-treat analyses showed that IG participants showed significant improvement in HbA1c (-0.57%/6.2 mmol/mol vs. +0.36%/3.9 mmol/mol, P = 0.01), diabetes-related QOL (+0.7 vs. +0.15, P = 0.04), and habit strength for checking blood glucose (+3.9 vs. +1.7, P = 0.05) as compared with CG participants. There was no statistically significant effect modification by sex, ethnicity, diabetes type, recruitment site, or SES. No study-related serious adverse events were reported.
 
Conclusions. The REAL Diabetes intervention improved blood glucose control and diabetes-related QOL among a typically hard-to-reach population, thus providing evidence that a structured OT intervention may be beneficial in improving both clinical and psychosocial outcomes among individuals with diabetes.

Carandang, K. M., & Pyatak, E. A. (2018). Feasibility of a manualized occupation-based diabetes management intervention. American Journal of Occupational Therapy, 72(2), 7202345040p1–7202345040p6. https://doi.org/10.5014/ajot.2018.021790 Show abstractHide abstract

Objective. We investigated the feasibility and acceptability of an occupational therapy intervention targeting diabetes management for underserved young adults.
 
Method. Eight participants completed the intervention and a battery of assessments at baseline and after the intervention. At completion, the participants and occupational therapist were interviewed about their experiences with the study. Four categories of assessment questions were used to guide the study: process, resource, management, and scientific.
 
Results. Successes included recruitment; fulfillment of tasks by staff and partnering clinics; adequate space, financial support, and equipment; and meaningfulness of the intervention for participants. Challenges included scheduling participants for the intervention and follow-up focus groups and providing client centeredness and flexibility while reducing burden on the intervener.
 
Conclusion. This feasibility study allowed us to make necessary revisions to our study protocol before implementing a larger pilot study.

Carandang, K., & Pyatak, E. A. (2018). Analyzing occupational challenges through the lens of body and biography. Journal of Occupational Science, 25(2), 161-173. https://doi.org/10.1080/14427591.2018.1446353 Show abstractHide abstract

Introduction. Occupational scientists are tasked with the responsibility of examining the relationship between occupational engagement and health, yet as occupations are explored in situ, these concepts only become more complex. For example, lifestyle trade-offs occur when individuals make conscious decisions between two competing sets of actions: actions taken in promotion of physical health versus actions in agreement with an identity-driven biography. In this study, these dilemmas are viewed as parts of an ongoing occupational challenge to balance physical health with subjective well-being in everyday life.
 
Methods. Anselm Strauss’s concepts of body state and biographical moment are conceptualized as analytic tools to study dimensions within which occupation is performed. A descriptive, single-case analysis of a young adult diagnosed with diabetes is presented as an exemplar of how Strauss’s tools may be utilized.
 
Results. Four themes emerged within the presented narrative: (1) by the book versus reality, (2) testing the boundaries of diabetes, (3) diabetes burnout and the struggle for perfection, and (4) the inevitable merge between body and biography.
 
Conclusion. Sadie’s narrative exemplifies the multiple contexts in which agentic decisions to engage in specific occupations are made. Sadie’s experiences of diabetes burnout and actions taken while “on vacation” are not uncommon within chronic illness literature and warrant further analyses that consider physical and psychological domains of health. By dismantling situational factors using analytic tools, such as Strauss’s body state and biographical moment, occupational scientists may further understand lived experiences and clarify the link between occupation and health.

Pyatak, E. A., Carandang, K., Vigen, C., Blanchard, J., Sequeira, P. A., Wood, J. R., Spruijt-Metz, D., Whittemore, R., & Peters, A. L. (2017). Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemporary Clinical Trials, 54, 8-17. https://doi.org/10.1016/j.cct.2016.12.025 Show abstractHide abstract

Overview. This paper describes the study protocol used to evaluate the Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) intervention and reports on baseline characteristics of recruited participants. REAL Diabetes is an activity-based intervention designed to address the needs of young adults diagnosed with type 1 (T1D) or type 2 diabetes (T2D) from low socioeconomic status or racial/ethnic minority backgrounds. The REAL intervention incorporates tailored delivery of seven content modules addressing various dimensions of health and well-being as they relate to diabetes, delivered by a licensed occupational therapist.
 
Methods. In this pilot randomized controlled trial, participants are assigned to the REAL Diabetes intervention or an attention control condition. The study's primary recruitment strategies included in-person recruitment at diabetes clinics, mass mailings to clinic patients, and social media advertising. Data collection includes baseline and 6-month assessments of primary outcomes, secondary outcomes, and hypothesized mediators of intervention effects, as well as ongoing process evaluation assessment to ensure study protocol adherence and intervention fidelity.
 
Results. At baseline, participants (n=81) were 51% female, 78% Latino, and on average 22.6years old with an average HbA1c of 10.8%. A majority of participants (61.7%) demonstrated clinically significant diabetes distress and 27.2% reported symptoms consistent with major depressive disorder. Compared to participants with T1D, participants with T2D had lower diabetes-related self-efficacy and problem-solving skills. Compared to participants recruited at clinics, participants recruited through other strategies had greater diabetes knowledge but weaker medication adherence.
 
Discussion. Participants in the REAL study demonstrate clinically significant medical and psychosocial needs.

Carandang, K., Pyatak, E. A., & Vigen, C. P. (2016). Systematic review of educational interventions for rheumatoid arthritis. American Journal of Occupational Therapy, 70(6), 7006290020p1-7006290020p12. https://doi.org/10.5014/ajot.2016.021386 Show abstractHide abstract

Objective. In this study, we systematically reviewed the effectiveness of educational interventions falling within the scope of occupational therapy practice for people with rheumatoid arthritis (RA). These interventions included disease education, joint protection and energy conservation, psychosocial techniques, pain management, and a combination category.
 
Method. Two databases, MEDLINE and CINAHL, and select journals were searched for randomized controlled trials published between January 2002 and June 2015. Qualitative synthesis was used for between-study comparisons.
 
Results. Twenty-two studies, with approximately 2,600 participants, were included. The interventions were found to have strong evidence for constructs that dealt with increasing coping with pain and fatigue as well as maintaining positive affect. There was limited or no evidence supporting the effectiveness of these interventions on most other measured constructs.
 
Conclusion. Interventions in which a combination of educational techniques is used may complement pharmacological therapies in the care of people with RA. Future research is needed to identify specific mechanisms of change.

Pyatak, E. A., Carandang, K., & Davis, S. (2015). Developing a manualized occupational therapy diabetes management intervention: Resilient, Empowered, Active Living With Diabetes. OTJR: Occupation, Participation and Health, 35(3), 187-194. https://doi.org/10.1177/1539449215584310 Show abstractHide abstract

This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage 1 intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline.