MyFoodRx: Pilot Study of a Personalized Food-as-Medicine Smartphone Application

Food insecurity is a persistent public health challenge, disproportionately affecting racial/ethnic minorities and increasing risk for diet-related chronic conditions (DRCCs). While food-as-medicine (FAM) programs aim to integrate nutrition into clinical care, traditional models often lack personalization and show limited clinical impact. Personalized nutrition, guided by the P4 medicine model, offers a promising enhancement by tailoring interventions to individual characteristics and lifestyle contexts. This pilot builds on preliminary work developing MyFoodRx, a modular, cloud-based mobile app that delivers personalized nutritional support to food-insecure individuals with DRCCs. The long-term goal is to improve food security and health outcomes through scalable, personalized FAM interventions. The objective of this pilot study is to adapt, optimize, and evaluate the MyFoodRx app in a clinic-based foodRx, laying the groundwork for a fully powered NIH study. Aim 1 will adapt the MyFoodRx app to optimize usability, acceptability, and feasibility among target users, guided by prior formative research and mHealth design principles. Aim 2 will evaluate the adapted app in a 3-arm, 12-week pilot RCT using the RE-AIM framework (n=45: usual care, app only, app plus coaching). Outcomes include food security, diet quality, psychosocial determinants (e.g., nutrition literacy, DRCC management skills), and health indicators. This project addresses a critical gap in FAM research by integrating AI-driven personalization. It is innovative in combining digital health, adaptive design, and lifestyle medicine. An experienced multidisciplinary team will lead this study in partnership with a clinical site. Findings will inform refinement and support a fully powered NIH RCT. MyFoodRx has potential to transform FAM delivery and reduce nutrition-related health disparities.

Using Artificial Intelligence to Identify Patient-Provider Communication Patterns Related to Glaucoma and Diabetic Retinopathy Management 

Glaucoma, a leading cause of irreversible blindness, affects 4.2 million adults and diabetic retinopathy (DR) affects 7.7 million Americans in the United States. Rural patients are especially vulnerable due to substantial challenges in DR and glaucoma care, including limited availability of specialists, long travel distances, health literacy challenges, disadvantageous social determinants of health and prohibitive costs. As part of patient-centered care, it is crucial that the patient-provider-communications (PPC) taking place during the clinic visit, i.e., verbal and nonverbal interactions between patient and provider, are sensitive to the need and barriers that rural patients face. Hence, this pilot study will examine PPC factors that promote or hinder DR and glaucoma management. Advancements in Artificial Intelligence (AI) offer promising and innovative solutions to uncover patterns, themes, and insights from PPC data that may be linked to eye care utilization and DR/glaucoma management. We will use mixed methods approach to accomplish two specific aims: Aim 1. Examine differences in PPC among patients with poor vs. good visit adherence to screening, monitoring and treatment. Aim 2. Develop and validate an LLM pipeline that automatically extracts PPC themes from visit transcripts. We will train and validate an open-source LLM to detect patterns in PPC that capture modifiable barriers and facilitators of disease management. A fully validated, scalable pipeline will provide near-real-time PPC metrics, enabling feedback loops for providers and patients in the planned R01 intervention.

Patient and Provider Patterns, Facilitators and Barriers to Diabetes Distress Screening and Referral Strategies for Rural Adults

Diabetes distress (DD) - the emotional burden of living with and managing diabetes every day - affects 36% of people and higher among vulnerable rural populations. DD has been demonstrated to negatively impact glycemic control, clinical outcomes, and mental health. This implementation science project aims to assess patient and provider patterns, facilitators and barriers to DD screening and referral strategies in primary care and endocrinology clinics in WV. We will use the Consolidated Framework for Implementation Research (CFIR) framework to accomplish two specific aims: Aim 1: Define patient patterns, facilitators, and barriers to optimize guideline-concordant DD screening and referral strategies in primary care and endocrinology clinics in WV; Aim 2. Define provider patterns, facilitators and barriers to optimize guideline-concordant clinic screening and referral service. It is our expectation that findings will enhance our understanding of clinic implementation readiness and evaluate patient and provider level DD screening barriers/facilitators for supportive implementation strategies to develop a culturally appropriate, population-based, DD treatment intervention for rural adults that address social determinants of health.

Disparities in Eye Care Utilization Among Rural Patients with Diabetic Retinopathy and Diabetic Macular Edema

This cross-sectional study will examine disparities in eye care utilization of rural adults with diabetes, diabetic retinopathy (DR) and DR$ with diabetic macular edema (DME). Data (demographic, behavioral, clinical and vision/eye care utilization) will be collected from electronic health records (EHRs) at West Virginia University Eye Institute and affiliated teleophthalmology clinics for patients who received eye care services between October 2015 and March 2024. Geographical residence (rural, suburban and urban) will be based on zip codes. This project will give us a better understanding of disparities in eye care utilization for rural populations. This study will also yield broader implications about gaps in care for timely screening and treatment to reduce or prevent vision loss, development of patient-centered approaches and addressing barriers to DR DME monitoring and treatment adherence in rural patients.  

SEVAK Project - Revolutionizing the Rural Healthcare Delivery Model to Provide Community-Centric Solutions for Rural and Underserved Populations in India and Guyana

The Sevak Project is a multi-state intervention of chronic disease prevention and management. The Sevak Project targets an evidence-based approach to chronic disease screenings (diabetes, hypertension, obesity, anemia, etc.), sanitation and health education in rural communities through improved awareness of chronic disease prevention and management. By training individuals as health coaches (called Sevaks) in each village, we are able to reach thousands of rural and impoverished community members across the country and provide essential screening and sanitation interventions to improve the overall health and wellbeing of individuals and families. Starting in 2010, The Sevak Project, operating out of over 120 villages, has touched the lives of over 140,000 people. For more information check our website https://sevakproject.org/

* Names in italics indicate current or former student or faculty mentees.

** Senior author

1. Misra R, Brenna Kirk, Raihan Khan, Rajashree Dahal, Gizem Dogan, Robin Chataut, Prashnna Gyawali (2026, in-press). Large Language Models in Qualitative Analysis: Comparing Traditional and Researcher-Interpreted Approaches. International Journal of Qualitative Methods.
2. Mahato S, Wen S, Misra R (2025). The Moderating Role of Social Support in the Association between Diabetes Distress and Health-Related Quality of Life in Rural Adults with Type 2 Diabetes. Medical Research Archives, online 13 (9). DOI: https://doi.org/10.18103/mra.v13i9.6 918.
3. Misra R, Sheppard AB, Wilson N, Govindan MC, Myers M, Acord-Vira A, Wheeler S, Henderson H, Ross CD, Cooper L, Goff R. (2025). Person-centered trauma-informed care (PCTIC): a training needs assessment for home and community-based services in West Virginia. Journal of Appalachian Health 2025;7(2/3):77-94. DOI: https://doi.org/10.13023/jah.0703.06.
4. Misra R, James D. (2025). The Role of Dietary Tracking on Changes in Dietary Behavior in a Community-Based Diabetes Prevention and Management Intervention. Public Health Nutrition. Mar 27:1-29. DOI:10.1017/S1368980025000436. Online ahead of print.
5. Misra R, Shawley-Brzoska S. (2024). A Community-Based Diabetes Prevention and Management Program for Adults with Diabetes and Prediabetes. Journal of Clinical and Translational Science. 8: e179, 1–12. DOI:10.1017/cts.2024.623.
6. Misra R, Nayeem, S. (2024). Social/Emotional Health, Mental Health and Quality of Life among Adults with Comorbid Diabetes and Hypertension: A Population-based Cross-sectional Study. Journal of Appalachian Health. 2024;6(1/2):117–132. DOI:https://doi.org/10.13023/jah.0601.08 
7. Misra R, Kirk B, Shawley-Brzoska S, Totzkay D, Morton C, Kuhn S, Harris M, McMillion M, Darling E. (2024). Educational Intervention to Increase COVID-19 Vaccine Up-take in Rural Patients with Chronic Diseases: Lessons Learned from an Innovative Academic-Community Partnership. Infectious Disease Epidemiology section, International Journal of Environmental Research and Public Health 2024, 21 (71). DOI: https://doi.org/10.3390/ijerph21010071. 
8. Misra R, Kirk B, Lewis WD. (2023). Perceptions of Diabetes Distress and Counseling During the Pandemic - Rural Provider Perspectives. Marshall Journal of Medicine. 2023; 9 (4). DOI: https://doi.org/10.33470/2379-9536.1412.
9. Giacobbi P, Loughman L, Brink C, Shawley-Brzoska S, Misra R. (2023). Thematic Analysis of Guided Imagery Scripts in a Multi-Health Behavior Change Intervention. American Journal of Lifestyle Medicine. August 23,2023, DOI: 10.1177/15598276231196531
10. Kirk B, Khan R, Davidov D, Sambamoorthi S, Misra R. (2023). Exploring facilitators and barriers to patient-provider communication regarding diabetes self-management. PEC Innovation. Jun 30; 3:100188. DOI:10.1016/j.pecinn.2023.100188. 
11. Ikram M, Shaikh NF, Siddiqui ZA, Dwibedi N, Misra R, Vishwanatha JK, Sambamoorthi S (2023). Factors associated with COVID-19-related mental health among Asian Indians in the United States. Journal of Affective Disorders Reports 11, 11:100472. doi: 10.1016/j.jadr.2023.100472.PMID: 36624854; PMCID: PMC9812469.
12. Misra R, Madhavan SA, Dhumal TA, Sambamoorthi S. (2023).Prevalence and Factors Associated with Diagnosed Diabetes Mellitus among Asian Indian Adults in the United States. PLOS Global Public Health, 2023, 3(2): e0001551. https://doi.org/10.1371/journal.pgph.0001551
13. Misra R, Adelman M, Kirk B, Sambamoorthi U. (2022). Relationship Among Diabetes Distress, Health Literacy, Diabetes Education, Patient-Provider Communication and Diabetes Self-Care. American Journal of Health Behavior, 2022; 46(5): 528-534. 
14. Alhussain K, Kido K, Dwibedi N, LeMasters T, Rose DE, Misra R, Sambamoorthi U.(2021). Identifying knowledge gaps in heart failure research among women using unsupervised machine-learning methods. Future Cardiology, Oct;17(7):1215-1224. doi: 10.2217/fca-2020-0083.
15. Minc SD, Budi S, Thibault D, Misra R, Armstrong DG, Smith GS, Marone L. (2021). Opportunities for diabetes and peripheral artery disease-related lower limb amputation prevention in an Appalachian state: A longitudinal analysis. Preventive Medicine Reports. doi: 10.1016/j.pmedr.2021.101505.
16. Misra R, Shawley-Brzoska S, Khan R, Kirk BO, Wen S, Sambamoorthi U. Addressing Diabetes Distress in Self-Management Programs: Results of a Randomized Feasibility Study. Journal of Appalachian Health 2021;3(3):68–85. 
17. Misra R, Farjo S, McGinnis R, Elavsky MA, Kuhn S, Morton-McSwain C. Diabetes Knowledge, Behaviors, and Perceptions of Risk in Rural West Virginia Counties. Journal of Appalachian Health 2021;3(3):51–67.
18. Tower C, Van Nostrand E, Misra R, Barnett DJ. (January/February 2021). Building collective efficacy to support public health workforce development. Journal of Public Health Management & Practice. Volume 27 - Issue 1 - p 55-61 doi: 10.1097/PHH.0000000000000987.
19. Misra R, Fitch C. (2020). A Model Exploring the Relationship Between Nutrition Knowledge, Behavior, Diabetes Self-management and Outcomes from the Dining with Diabetes Program. Preventive Medicine.Volume 141, 106296.  
20. Giacobbi, PR, Phillips K, Shawley-Brozaska S, Johnson K, Nolan R, & Misra R**. (2020). Women’s Use and Acceptability of Guided Imagery in a Multi-Behavior Intervention Focused on Psychological Stress, Food Cravings, and Exercise. Journal of Imagery Research in Sport and Physical Activity.15 (1). Published online: 11 Nov 2020.
21. Khan R, Misra R, Shawley-Brozaska S, Wen S. (2020). Predictors of Diabetes Risk Perception among College Students. Journal of American College Health.Oct 2020: 1-7, DOI: 10.1080/07448481.2020.1825222.
22. Minc S, Goodney PP, Misra R, Thibault D, Smith GS, Marone L. (2020). The Effect of Rurality on the Risk of Primary Amputation is Amplified by Race. Journal of Vascular Surgery. 72 (3) 1011-1017.
23. Mathew, NJ, Misra R, Wang J. (2020). Mediating Role of Acculturation and Lifestyle Behaviors on Cardiometabolic Risk Among a National Sample of U.S. Asian Indians. Journal of Immigrant and Minority Health.22, 727–735.
24. Minc S, Misra R, Holmes SD, Ren U, Marone L. (2020). Geographic variation in amputation rates among patients with diabetes and/or peripheral arterial disease in the rural state of West Virginia identifies areas for improved care. Journal of Vascular Surgery. 71 (5), 1708-1717.
25. Zhang Y, Misra R, Sambamoorthi S. (2020).Prevalence of Multimorbidity among Asian Indian, Chinese, and Non-Hispanic White Adults in the United States.International Journal of Environmental Research and Public Health, 2020 May 11;17(9):3336. doi: 10.3390/ijerph17093336.
26. Minc S, Misra R, Holmes SD, Ren U, Marone L. (2020). Impact of Rural versus Urban Geographic Location on Length of Stay after Carotid Endarterectomy. Vascular. 27 (4), 390-396.
27. Misra R, Sambamoorthi S. (2019). Five-year Trend in Diabetes Process of Care and Self-Management among Adults with Diabetes in West Virginia: 2010-2014. Journal of Health Disparities Research and Practice.12(1), 19-31.

2023    Chancellor’s Award for Outstanding Achievement in Community-Engaged Research Award, Health Science Center, WVU

2021    WVU Distinction in Graduate Research Mentoring Award, Biosciences & Health Sciences Category, Finalist.

2019    Women in Science and Health (WISH) Advanced Career Excellence Award, WVU Health Science Center

2018    Faculty Council Award for Faculty Excellence in Service, WVU School of Public Health

2017    Fellow, National Health Education Honor Society (Eta Sigma Gamma).

2016    Chancellor’s Award for Mentoring, WVU Health Science Center

2015    Chancellor’s Award for Outstanding Achievement in Community-Engaged Research Award, Health Science Center, WVU

2011    Fellow of the American School Health Association.

2008    Outstanding Health Disparities Research Award, MD Anderson Cancer Center, TX.

2007    Grantsmanship Award, Mexican American and Latino Research Center (MALRC)

2007    Research & Service Recognition Award, American Association of Physicians of Indian Origin

2005    Research Award, Division of Health and Safety, Texas A&M University

2005    Armstrong Scholar Award, Department of Health and Kinesiology, Texas A&M University

2004    Montague Scholar Award for Teaching Excellence, Texas A&M University

2025    Sweta Mahato, Cassie Heilman, Janani Sundar, Chloe Hatfield. Outstanding Poster Award at Van Liere and WV IDeA Research Conference.

2025     Sweta Mahato, West Virginia Rural Health Association Mini scholarship

Poster presentation at WV Rural Health Conference

2024-25     Sweta Mahato, Delta Omega Public Health Honor Society Poster Competition Winner

2022–24  Brenna Kirk,  NIH Ruth L. Kirschstein NRSA F31 Fellowship to Promote Diversity in Health-Related Research

2021-22   Brenna Kirk, Society for Public Health Education (SOPHE) Student Fellowship in Patient Engagement

2021    Samantha Minc, MD MPH, NIDDK K23 Award Implementing a Community-Engaged Amputation Prevention Intervention in Rural Patients with Diabetes and Peripheral Arterial Disease

2020–22      Brenna Kirk, Research Training Program in the Behavioral and Biomedical Sciences, National Institutes of Health/National Institute of General Medical Sciences, T32 Training Fellowship T32 GM132494

2020–22   Brenna Kirk, Summer Policy Institute Mini-Grant, West Virginia Center on Budget and Policy

2022         Brenna Kirk, West Virginia Rural Health Association Poster of the Year Award

2020         Brenna Kirk, West Virginia Rural Health Association Poster of the Year Award

2020         Brenna Kirk, Delta Omega Public Health Honor Society Poster Competition Winner