Refugio Sepulveda

Interests

Teaching

Public Health Policy and Management, Healthcare Administration, Sociocultural and Behavioral Aspects of Public Health, Telehealth

Research

Public Health Policy and Administration; Racial and Ethnic Health Disparities; Economic, Social, Cultural, and Structural Determinants of Health; Community-Based Participatory Research; mHealth, eHealth, and digital innovations for health delivery; Epilepsy Self-Management among Hispanics

Courses

Scholarly Contributions

Journals/Publications

• Sepulveda, R., Chong, J., Shegog, R., Martin, K., Begley, C., Addy, R., Rosales, O., Nuño, T., Soto, S., Rosales, C., & Labiner, D. (2024). Experiences of using the MINDSET Self-Management mobile health app among Hispanic Patients:Results of a qualitative study. Epilepsy & behavior : E&B, 153, 109702.
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  Interventions focusing on epilepsy self-management (ESM) are vital for promoting the health of people living with epilepsy. E-technology and mobile health (mHealth) tools are becoming increasingly integrated into practice to promote self-management strategies for chronic diseases, enhance care delivery, and reduce health disparities. Management Information and Decision Support Epilepsy Tool (MINDSET), a bilingual decision support tool (available in English and Spanish), was found to be both feasible and effective in facilitating goal-based ESM in the clinic.
• Nuño, T., Torres, M., Soto, S., Sepulveda, R., Aceves, B., & Rosales, C. (2023).

  Feasibility and Outcomes of Meta Salud Diabetes Behavioral Health Intervention: A Pilot Study of a Community Health Worker-Administered Educational Intervention to Prevent Cardiovascular Disease and Its Complications among Hispanic Patients with Type-2 Diabetes

  . International Journal of Environmental Research and Public Health. doi:10.3390/ijerph20216968
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  Background: Hispanics in the United States experience a greater burden of type-2 diabetes (T2D), with a prevalence rate (17%) more than twice that of non-Hispanic whites (8%). Cardiovascular disease (CVD) is the leading cause of death among people with T2D. A culturally appropriate behavioral health intervention that addresses healthy lifestyle promotion is an impactful approach for health systems with scarce medical resources and a high prevalence of chronic conditions, including obesity and high blood pressure, which increase the likelihood of CVD mortality among type-2 diabetics. Purpose: To assess the feasibility and outcomes of a behavioral intervention to decrease CVD and complications in a Hispanic diabetic population. Methods: Meta Salud Diabetes (MSD), a behavioral intervention effective in a Mexican population, consists of a 13-week intervention addressing CVD and T2D knowledge and risk reduction. It was implemented in a sample of Hispanic diabetic patients from two federally qualified health centers (FQHCs). Clinical and behavioral variables were measured at baseline, postintervention, and 1-year follow-up. Results: The feasibility of MSD was rated as successful by all FQHC staff and well-received by both staff and study participants, with positive remarks about the culturally relevant components of the intervention. The sample size was n = 30 (baseline), n = 23 (postintervention), and n = 19 (1-year follow-up). Of note, quantitative results showed trending decreases in Hba1c (7.06; 6.80; 6.30), blood pressure (132/83; 126/80; 123/78), and total cholesterol (160; 159; 154). Conclusion: MSD is a feasible intervention and can address the need to improve health outcomes among Hispanic patients with T2D.
• Nuño, T., Sierra, L. A., Wilkinson-Lee, A., Carvajal, S., de Zapien, J., Coulter, K., Figueroa, C., Morales, M., Sepulveda, R., Sepulveda, R., & Ingram, M. (2022). The Arizona Prevention Research Center partnerships in Arizona to promote COVID-19 vaccine health equity. Frontiers in public health, 10, 944887.
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  Vaccine hesitancy in the face of the COVID-19 pandemic is a complex issue that undermines our national ability to reduce the burden of the disease and control the pandemic. The COVID-19 pandemic revealed widening health disparities and disproportionate adverse health outcomes in terms of transmission, hospitalizations, morbidity and mortality among Arizona's Latinx rural, underserved, farmworker, disabled and elderly populations. In March 2021, ~8.1% of those vaccinated were Latinx, though Latinxs make up 32% of Arizona's population. The Arizona Vaccine Confidence Network (AzVCN) proposed to leverage the expertise of the Arizona Prevention Research Center (AzPRC) and the resources of the Mel and Enid Zuckerman College of Public Health (MEZCOPH) Mobile Health Unit (MHU) to identify, implement and evaluate a MHU intervention to increase uptake of COVID-19 vaccines.
• Soto, S., Yoder, A. M., Aceves, B., Nuño, T., Sepulveda, R., & Rosales, C. B. (2022). Determining Regional Differences in Barriers to Accessing Health Care Among Farmworkers Using the National Agricultural Workers Survey. Journal of immigrant and minority health.
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  Farmworkers are an essential workforce in the U.S. We assessed the regions in the National Agricultural Workers Survey on the difficulty of accessing health care among farmworkers in the U.S. The study included 9577 farmworkers. Farmworkers in all regions were more likely to report having difficulty accessing health care because it was too expensive. The overall odds ratio for difficulty accessing health care was lower in the MW after adjusting. Farmworkers employed in the SE had greater difficulty accessing health care because of language barriers. Farmworkers employed in CA had difficulty accessing health care in the U.S. because it was too expensive or far away. Results follow previous studies on barriers to access health care among the farmworker population. Understanding regional disparities in the presence of barriers to accessing health care among farmworkers is an essential step to improving equitable health care access in the U.S.
• Soto, S., Yoder, A. M., Nuño, T., Aceves, B., Sepulveda, R., & Rosales, C. B. (2022). Health conditions among farmworkers in the Southwest: An analysis of the National Agricultural Workers Survey. Frontiers in public health, 10, 962085.
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  Agricultural jobs pose many challenges to the health and wellbeing of a disadvantaged population. In the Southwest region, the socioeconomic factors of living along the U.S.-Mexico border, migration patterns, lack of access to health care, low utilization of health care services, lack of health insurance, and highly demanding occupation may uniquely affect health outcomes for farmworkers. This paper presents descriptive information for professionals to improve access to care by tackling barriers afforded by the agricultural industry. The National Agricultural Worker Survey (NAWS) is an employment-based, random-sample survey of U.S. agricultural workers in six regions: East, Southeast, Midwest, Southwest, Northwest, and California. We examined farmworkers' self-reported health conditions, including asthma, diabetes, high blood pressure, other chronic conditions, or any condition by region from 2013 to 2016. We used logistic regression to determine differences in lifetime prevalence of health conditions between farmworkers in the Southwest region ( = 727) and farmworkers in other regions ( = 8,850) using weighted data. After adjusting for age, gender, income, insurance status, and English-speaking ability, the odds of high blood pressure and other condition were similar in all regions. The prevalence of diabetes was almost double in the Southwest (114.2 per 1,000 farmworkers). The odds of diabetes were 1.31 (95% CI 0.99, 1.74) times greater in the Southwest region than in the other regions. Asthma was the only condition that was lower in the Southwest (22 per 1,000 farmworkers) compared to the other regions. The odds of asthma were 0.61 (95% CI 0.36, 1.03) times lower in the Southwest region than in other regions. The results follow previous studies on the prevalence of asthma among the farmworker population and elevated probability of chronic diseases including diabetes among the Latino population in the U.S.
• Shegog, R., Sepulveda, R., Rosales, O., Martin, K., Labiner, D. M., Halavacs, N., Chong, J., Begley, C. E., & Addy, R. C. (2020). MINDSET: Clinic-based decision support demonstrates longitudinal efficacy for increased epilepsy self-management adherence among Spanish speaking patients.. Epilepsy & behavior : E&B, 113, 107552. doi:10.1016/j.yebeh.2020.107552
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  MINDSET, a bilingual (Eng./Span.) decision support tool was found feasible for facilitating goal-based epilepsy self-management (ESM) in the clinic..To evaluate the efficacy of MINDSET to increase ESM adherence among Hispanic patients..A RCT was conducted from August 2017 through January 2019. Spanish and English speaking Hispanic adult patients (n=94) with epilepsy in Arizona (n=53) and Texas (n=41) were randomly assigned within 6 neurology clinics to treatment (MINDSET plus Usual Care, hereafter referred to as MINDSET; n=46) and comparison (Usual Care Only; n=48) conditions. Self-reported self-management behavior (assessed through the Epilepsy Self-management scale) were categorized as adherent if performed 'usually' or 'always.' The proportion of adherence was compared between study conditions for 36 individual ESM behaviors and 5 ESM domains using Fischer's exact test..The average time between visit 1 through 3 was 350+/-79 days with retention at 96.8%. Participants in the treatment condition had more college education and less unemployment. Self-management adherence improved across visits for all self-management behaviors irrespective of study condition. Compared to usual care MINDSET use led to greater ESM adherence for 86.1% behaviors (5 with statistical significance; p
• Chong, J., Sepulveda, R., Shegog, R., Sepulveda, R., Martin, K., Labiner, D. M., Halavacs, N., Chong, J., Begley, C. E., & Addy, R. C. (2018). MINDSET: Clinical feasibility of utilizing the revised epilepsy self-management tool for Spanish speaking patients.. Epilepsy & behavior : E&B, 88, 218-226. doi:10.1016/j.yebeh.2018.09.021
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  This paper describes the expanded English/Spanish version of the Management Information and Decision Support Epilepsy Tool (MINDSET) as well as the methods and findings from a feasibility study conducted from July 2016 through February 2017 with 43 Spanish and English-speaking Hispanic people living with epilepsy (PWE) in Arizona (n = 23) and Texas (n = 20) over two consecutive regular clinic visits. The expansion of MINDSET added goal setting and strategy selection to improve self-management (S-M) in PWE. The previous study tested the feasibility of English MINDSET, which was designed to facilitate the identification and discussion of S-M issues between the patient and healthcare provider (HCP) during a regular clinic visit. Results indicate MINDSET feasibility for use in the following: 1) identifying S-M issues across several domains; 2) selecting and assessing confidence in tailored S-M goals/strategies for improvement; 3) discussing S-M issues/goals/strategies/confidence with a HCP; and 4) creating an action plan (AP) and tracking achievement during regular clinic visits. Across two visits, 80-90% of patients agreed that the revised version of MINDSET was helpful, understandable, trustworthy, promoted careful thinking about management, was of appropriate duration, and would be helpful in future management and communication with HCP. Participating HCPs agreed that MINDSET improved the ease, thoroughness, and accuracy in identifying patient S-M issues and establishing a plan for improvement.

Presentations

• Sepulveda, R., & Sepulveda, R. (2023). The health impact of Latinx faith-based organizations along the US-Mexico border: Understanding behaviors and adherence to the influenza vaccine following covid-19. American Public Health AssociationAmerican Public Health Association.
• Sepulveda, R., Sepulveda, R., Shegog, R., Czerniak4, K., Garcia Quintana, A., Martin, K., Addy, R., & Labiner, D. M. (2023). Advancing epilepsy care and self-management for Latino Spanish speaking patients through the use of a mobile web-based application (MINDSET 2.0). . American Public Health AssociationAmerican Public Health Association.
• Sepulveda, R., Shegog, R., Addy, R., Martin, K., & Labiner, D. M. (2023). Translation of MINDSETPlus Into Clinical Practice: Results of Clinical Feasibility Testing of Web-Based Epilepsy Self-Management Decision Support Tool. American Epilepsy SocietyAmerican Epilepsy Society.
• Sepulveda, R. (2022). The Science of Devices for the Prevention of Sudden and Unexpected Death in Epilepsy.. Annual Meeting of the Partners Against Mortality in Epilepsy.
• Sepulveda, R. (2022, July). Introduction to the Centers for Disease Control, Managing Epilepsy Well Network and MINDSET Epilepsy Self-Management Program. Epilepsy Leadership Council for the American Epilepsy Society.
• Sepulveda, R., & Sepulveda, R. (2022, November). Creating the Healthiest Nation: The Role of Faith Communities during COVID in Leading a Path Toward Health Equity; Program: Caucus on Public Health and the Faith Community. Topic: Covid-19 recommendations and Public Health considerations for faith-based communities and leaders along the US-Mexico border.. Annual Meeting and Expo of the American Public Health Association. Boston MA.
• Sepulveda, R. (2021, Oct). A New MINDSET: Identifying facilitators, barriers, and mitigating strategies for adoption and implementation of an integrated and scalable Community Health Worker (CHW) intervention in the Epilepsy Foundation Texas. Healthier Texas Summit 2021. Austin Texas.

Poster Presentations

• Sepulveda, R., Shegog, R., Addy, R., & Labiner, D. M. (2023). Considerations of Using the MINDSET Self-Management Mobile Health Application Among Latino Patients with Epilepsy: Results of a Qualitative Study. American Epilepsy SocietyAmerican Epilepsy Society.
• Sepulveda, R., Shegog, R., Czerniak, K., Garcia-Quintana,, A., Ardis, D., Guerrero, R., Moreau, R., Thomas, S., Addy, R., & Labiner, D. M. (2023). A New MINDSET: Assessing CHW Readiness for Implementing Epilepsy Self-Management Educational Support Using Adapted Knowledge, Self-Efficacy, and Attitude Scales. American Epilepsy SocietyAmerican Epilepsy Society.
• Sepulveda, R. (2022, December). Clinical Correlates Of Epilepsy Self-Management Competency Among Hispanic People With Epilepsy: Findings From The CDC’s Managing Epilepsy Well (MEW) Network Integrated Database. Annual Meeting of the American Epilepsy Society (AES).
• Sepulveda, R. (2022, December). Epilepsy and Public Health: MINDSET 2.0: Usability and Feasibility Testing of Internet Accessible Epilepsy Self-Management Decision-support Tool with Linkage to Other CDC-MEW Self-management Programs. . Annual Meeting of the American Epilepsy Society (AES). Nashville, TN.
• Sepulveda, R. (2022, November). Programs Supporting Special Populations and the CHW Workforce. Topic: A new MINDSET: Enhancing Community Health Worker-mediated assessment, education, and linkage using electronic decision support for people with epilepsy. . Annual Meeting and Expo of the American Public Health Association. Boston MA.
• Sepulveda, R. (2021, Dec). Advancing Epilepsy Self-Management by Community Health Workers (CHWs) using a Mobile Application (MINDSET 2.0). American Epilepsy Society, Annual Meeting 2021. Chicago, IL: American Epilepsy Society.
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  Better Patient Outcomes Through Diversity Poster SessionPoster# 2.425
• Sepulveda, R. (2021, Dec). MINDSET 2.0: Redesign of an Epilepsy Self-Management Decision-Support Tool to a Modern Web-Based Application That Empowers Patient Usage of Other MEW Self-Management Programs. American Epilepsy Society, Annual Meeting 2021. Chicago, IL: American Epilepsy Society.
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  Better Patient Outcomes Through Diversity Poster SessionPoster# 2.364