Beth Pyatak PhD, OTR/L, CDE
Room: CHP 133
Phone: (323) 442-2615
Beth Pyatak has primary research interests in the intersection of chronic care management, occupational engagement and health and well-being among individuals with chronic illness and/or disability. She is currently the Prinicipal Investigator on a NIH-funded, three-year mentored career development award to pilot-test an innovative intervention targeting underserved minority young adults with poorly-controlled diabetes (NIH #K01DK099202). In 2011 she was awarded a Mentored Career Development Award through the Southern California Clinical and Translational Science Institute (SC CTSI) to develop a lifestyle intervention aimed at improving health and quality of life outcomes among young adults with both type 1 and type 2 diabetes (NIH/NCRR #KL2RR031991). In addition, she is collaborating with faculty at the Keck School of Medicine of USC to implement a transition program aimed at improving health and psychosocial outcomes, and increase medical follow-up, among young adults with type 1 diabetes transitioning from pediatric to adult healthcare settings (Helmsley Foundation 2010PG-T1D011; PI: A. Peters). As a postdoctoral research associate at USC she worked on the Lifestyle Redesign® for Pressure Ulcer Prevention in SCI (LR-PUPS) study (NIH/NCMRR #1R01 HD056267-01; PI F. Clark).
Doctor of Philosophy (PhD) in Occupational Science
University of Southern California
Master of Arts (MA) in Occupational Therapy
University of Southern California
Bachelor of Arts (BA) in Psychology
University of Southern California
Clark, F. A., Jackson, J., & Pyatak, E. A. (2013). Developing an integrated occupational science research program: The USC Well Elderly and Pressure Ulcer Prevention studies. In D. Pierce (Ed.), Occupational science for occupational therapy. (pp. 291-310). Thorofare, NJ: Slack, Inc. Link to full text
Pyatak, E. A., Sequeira, P. A., Whittemore, R., Vigen, C. P., Peters, A. L., & Weigensberg, M. J. (2014). Challenges contributing to disrupted transition from paediatric to adult diabetes care in young adults with Type 1 diabetes. Diabetic Medicine, Advance online publication. doi:10.1111/dme.12485. Link to full text
AIM: To examine challenges contributing to disruptions in care during the transition from paediatric to adult care among young adults with Type 1 diabetes who are primarily in ethnic minority groups and have low socio-economic status.
METHODS: Participants (n = 20) were newly enrolled patients in a transition clinic for young adults with Type 1 diabetes with a history of loss to medical follow-up. Participants completed qualitative semi-structured interviews detailing their transition experiences in addition to demographic, HbA1c and psychosocial measures. Descriptive statistics were completed for quantitative data, and narrative thematic analysis of interviews was used to identify common themes. A mixed-method analysis was used to identify the associations between stressors identified in interviews and clinical and psychosocial variables.
RESULTS: Three categories of challenges contributing to loss to follow-up were identified: psychosocial challenges, health provider and health system challenges and developmental challenges. Participants experienced a high degree of stressful life circumstances which were associated with higher HbA1c (r = 0.60, P = 0.005), longer duration of loss to follow-up (r = 0.51, P = 0.02), greater emergency department utilization (r = 0.45, P = 0.05), and lower life satisfaction (r = -0.62, P = 0.003).
CONCLUSIONS: A confluence of challenges, including stressful life circumstances, healthcare system barriers and the developmental trajectory of young adulthood, contributes to a high risk of loss to follow-up and poor health in this population of young adults with Type 1 diabetes. An integrated approach to transition addressing medical and psychosocial needs may facilitate improved follow-up and health outcomes in clinical settings.
Clark, F., Pyatak, E. A., Carlson, M., Blanche, E. I., Vigen, C., Hay, J., Mallinson, T., Blanchard, J., Unger, J. B., Garber, S. L., Diaz, J., Florindez, L. I., Atkins, M., Rubayi, S., & Azen, S. P. (2014). Implementing trials of complex interventions in community settings: The USC-Rancho Los Amigos Pressure Ulcer Prevention Study (PUPS). Clinical Trials, 11, 218-229. doi:10.1177/1740774514521904. Link to full text
BACKGROUND: Randomized trials of complex, non-pharmacologic interventions implemented in home and community settings, such as the University of Southern California (USC)-Rancho Los Amigos National Rehabilitation Center (RLANRC) Pressure Ulcer Prevention Study (PUPS), present unique challenges with respect to (1) participant recruitment and retention, (2) intervention delivery and fidelity, (3) randomization and assessment, and (4) potential inadvertent treatment effects.
PURPOSE: We describe the methods employed to address the challenges confronted in implementing PUPS. In this randomized controlled trial, we are assessing the efficacy of a complex, preventive intervention in reducing the incidence of, and costs associated with, the development of medically serious pressure ulcers in people with spinal cord injury.
METHODS: Individuals with spinal cord injury recruited from RLANRC were assigned to either a 12-month preventive intervention group or a standard care control group. The primary outcome is the incidence of serious pressure ulcers with secondary endpoints including ulcer-related surgeries, medical treatment costs, and quality of life. These outcomes are assessed at 12 and 24 months after randomization. Additionally, we are studying the mediating mechanisms that account for intervention outcomes.
RESULTS: PUPS has been successfully implemented, including recruitment of the target sample size of 170 participants, assurance of the integrity of intervention protocol delivery with an average 90% treatment adherence rate, and enactment of the assessment plan. However, implementation has been replete with challenges. To meet recruitment goals, we instituted a five-pronged approach customized for an underserved, ethnically diverse population. In intervention delivery, we increased staff time to overcome economic and cultural barriers to retention and adherence. To ensure treatment fidelity and replicability, we monitored intervention protocol delivery in accordance with a rigorous plan. Finally, we have overcome unanticipated assessment and design concerns related to (1) determining pressure ulcer incidence/severity, (2) randomization imbalance, and (3) inadvertent potential control group contamination.
LIMITATIONS: We have addressed the most daunting challenges encountered in the recruitment, assessment, and intervention phases of PUPS. Some challenges and solutions may not apply to trials conducted in other settings.
CONCLUSIONS: Overcoming challenges has required a multifaceted approach incorporating individualization, flexibility, and persistence, as well as the ability to implement needed mid-course corrections.
Pyatak, E. A., Florindez, D., Peters, A. L., & Weigensberg, M. J. (2014). “We are all gonna get diabetic these days:” The impact of a living legacy of type 2 diabetes on Hispanic young adults' diabetes care. The Diabetes Educator, Advance online publication. doi:10.1177/0145721714535994. Link to full text
PURPOSE: The purpose of this study was to investigate how an intergenerational legacy of type 2 diabetes affected the knowledge, attitudes, and treatment strategies of Hispanic young adults with diabetes.
METHODS: Eight Hispanic young adults (ages 18-30 years) participated in a series of in-home longitudinal qualitative interviews, and 11 of their family members completed single in-home interviews, regarding their diabetes management practices. Interview transcripts were analyzed thematically by a team of researchers.
RESULTS: Five themes emerged that characterized the influence of an intergenerational legacy of diabetes on young adults: food and family (how meal preparation and eating are shared within families), doing together (activity participation is contingent on others’ participation), knowledge and expectations (expectations for the future and understandings of diabetes are shaped by family members), miscarried helping (well-intentioned actions have negative consequences), and reciprocal support (children and parents support each other’s diabetes care).
CONCLUSIONS: Hispanic young adults’ knowledge, attitudes, and self-care practices related to diabetes are strongly influenced by the diabetes management practices of family members with diabetes, which often depart from current standards of diabetes care. Care providers should consider family members as a potentially significant influence, either positive or negative, on the diabetes self-care practices of this population.
Pyatak, E. A., Blanche, E. J., Garber, S. L., Diaz, J., Blanchard, J., Florindez, L., & Clark, F. A. (2013). Conducting intervention research among underserved populations: Lessons learned and recommendations for researchers. Archives of Physical Medicine and Rehabilitation, 94, 1190-1198. doi:10.1016/j.apmr.2012.12.009. Link to full text
Randomized controlled trials (RCTs) are considered the criterion standard in research design for establishing treatment efficacy. However, the rigorous and highly controlled conditions of RCTs can be difficult to attain when conducting research among individuals living with a confluence of disability, low socioeconomic status, and being a member of a racial/ethnic minority group, who may be more likely to have unstable life circumstances. Research on effective interventions for these groups is urgently needed, because evidence regarding approaches to reduce health disparities and improve health outcomes is lacking. In this methodologic article, we discuss the challenges and lessons learned in implementing the Lifestyle Redesign for Pressure Ulcer Prevention in Spinal Cord Injury study among a highly disadvantaged population. These issues are discussed in terms of strategies to enhance recruitment, retention, and intervention relevance to the target population. Recommendations for researchers seeking to conduct RCTs among socioeconomically disadvantaged, ethnically diverse populations are provided.
Pyatak, E. A., Sequeira, P., Peters, A. L., Montoya, L., & Weigensberg, M. J. (2013). Disclosure of psychosocial stressors affecting diabetes care among uninsured young adults with Type 1 diabetes. Diabetic Medicine, 30, 1140-1144. doi:10.1111/dme.12248. Link to full text
AIMS: To determine the disclosure rates of psychosocial issues affecting routine diabetes care.
METHODS: A total of 20 young adults were interviewed regarding the impact of psychosocial stressors on their diabetes care. The interviewer, endocrinologist and case manager reported the prevalence rates of psychosocial stressors. Disclosure rates were compared to determine the prevalence of psychosocial issues and the different patterns of disclosure.
RESULTS: Participants reported a high number of psychosocial stressors, which were associated with poorer glycaemic control (r = 0.60, P = 0.005). Approximately half of all disclosed stressors (50.9%) were identified in routine care; other stressors were identified only through intensive case management and/or in-depth interviews.
CONCLUSIONS: Identifying psychosocial stressors in routine care, and providing referrals to psychological or social services, is a significant unmet need and may improve glycaemic control among certain populations with diabetes. Systematic mechanisms of capturing this information, such as by screening surveys, should be considered.
Pyatak, E. A., Florindez, D., & Weigensberg, M. J. (2013). Adherence decision making in the everyday lives of emerging adults with type 1 diabetes. Patient Preference and Adherence, 7, 709-718. doi:10.2147/PPA.S47577. Link to full text
PURPOSE: The purpose of this study was to explore motivations underlying nonadherent treatment decisions made by young adults with type 1 diabetes.
METHODS: Eight emerging adults each completed a series of semi-structured interviews concerning their approaches to diabetes care, relationships with clinicians, and everyday activities and routines. A narrative thematic analysis was used to develop initial themes and refine them through continued data collection and review of the research literature.
RESULTS: FIVE THEMES WERE IDENTIFIED AS MOTIVATING NONADHERENCE: (1) efforts to mislead health care providers, (2) adherence to alternative standards, (3) treatment fatigue and burnout, (4) social support problems, and (5) emotional and self-efficacy problems.
CONCLUSION: Instances of nonadherence generally involved a combination of the five identified themes. Participants reporting nonadherence also described difficulties communicating with care providers regarding their treatment. Nonjudgmental communication between providers and emerging adults may be particularly important in promoting positive health outcomes in this population.
Pyatak, E. A. (2011). Participation in occupation and diabetes self-management in emerging adulthood. American Journal of Occupational Therapy, 65, 462-469. doi:10.5014/ajot.2011.001453. Link to full text
I present the findings of a study aimed at developing an in-depth understanding of how engagement in occupation influences young adults’ ability to effectively manage diabetes and, conversely, how their diabetes self-management strategies shape their occupational participation. The qualitative interview-based study of 8 people ages 19–25 with Type 1 diabetes revealed that study participants often experienced tension between diabetes self-management and participation in valued occupations, which required them to make calculated decisions about how to balance these competing priorities in their everyday lives. Seven themes are discussed in detail that characterized the relationship between participating in valued occupations and attending to the complex factors that dictate successful diabetes self-management. This research offers a preliminary framework for occupational therapists to assist young adults with diabetes and other chronic illnesses in reconciling these competing demands.
Pyatak, E. A. (2011). The role of occupational therapy in diabetes self-management interventions. OTJR: Occupation, Participation and Health, 31, 89-96. doi:10.3928/15394492-20100622-01. Link to full text
Approximately 23.6 million people in the United States are living with diabetes, a disease that is a leading cause of disabling conditions including blindness, kidney failure, amputations, heart disease, and stroke. Although these complications of diabetes can be delayed or prevented through intensive diabetes self-management (DSM), maintaining control of the disease can be burdensome and negatively impact quality of life. Occupational therapy has a largely untapped potential to assist individuals who struggle with managing diabetes in the context of everyday life, yet there is little discussion of DSM in the occupational therapy literature. The author conducts a systematic review of the existing occupational therapy literature on diabetes, examines the current state of DSM interventions, and discusses a potential role for occupational therapy using programs such as Lifestyle Redesign®.
Pyatak, E. A., & Muccitelli, L. (2011). Rap music as resistive occupation: Constructions of Black American identity and culture for performers and their audiences. Journal of Occupational Science, 18, 48-61. doi:10.1080/14427591.2011.554154. Link to full text
Rap music and hip-hop culture represents a contested space within contemporary culture in the United States, often stigmatized by members of the dominant culture as an offshoot of inner city gang and drug culture. However, this dismissal fails to consider the complex historical, social, and political factors that have contributed to the development and evolution of this form of cultural expression. This article argues that rap music constitutes a resistive occupation, employed by marginalized Black American youth to communicate thoughts and concerns that are often discounted by the dominant culture, and in doing so makes a significant contribution to Black American identities and culture. To support that perspective, the authors critically analyze the conceptualization of ‘culture’ in occupational science, reinterpreting the term through a postcolonial lens that considers the influence of power, domination, and resistance in the production of culture.