Stephanie Fonda, Ph.D.

Dr. Fonda is an Assistant Investigator in the Section on Eye Research at Joslin as well as an Instructor in Medicine at Harvard Medical School. Dr. Fonda received her doctorate in sociology from Duke University and completed her postdoctoral training in demography and aging at the University of Michigan. Specializing in understanding barriers to healthcare access, she conducts research primarily focused on facilitating improvements in the care process, with particular emphasis on the ways in which mental and emotional state affect how a patient uses resources for care. Her work brings her into close contact with colleagues in Joslin’s Section on Behavioral and Mental Health.

Patients’ behavior and mental health can have profound effects on their general health. This is particularly true of patients with diabetes, who must factor blood glucose control into almost every aspect of their lives. A sociologist by training, Dr. Fonda is concerned with making sure that all patients can access the resources they need for proper healthcare and health maintenance.

To this end, she has developed a questionnaire-based screening tool designed to quickly identify potential problem areas that prevent people with diabetes from exercising proper control over the disease. A patient’s answers may indicate symptoms of depressive mood, poor nutritional control or other issues that may require intervention by a specialist.

Through two clinical behavioral studies, she hopes to prove the questionnaire’s value and encourage physicians to employ it in their clinics as a triaging tool.

Dr. Fonda also conducts studies on the use of electronic means for improved diabetes control. She is leading a program to encourage patients with diabetes to keep photo diaries of their meals as a new approach to nutritional care. She and her collaborators hope that the process of photographing and discussing their meals with a nutritionist will give patients a better sense of their dietary choices and help them be more intentional about what they eat.

These themes of access and digitally supplemented medicine carry over into the third major area of Dr. Fonda’s work. Telemedicine, the delivery of medicine at a distance, allows specialists to screen patients cost-effectively without having to bring them in for an office visit. Dr. Fonda investigates the impact of telemedicine on ocular health for patients with and without diabetes. Through the Joslin Vision Network (JVN)—a web of remote digital ophthalmologic imaging stations developed by Lloyd M. Aiello, M.D., and Sven-Erik Bursell, Ph.D.—she is studying telemedicine’s cost-effectiveness as a way for low-risk patients (those not yet manifesting gross indications of retinopathy or other eye disease) to receive regular screenings without going to an ophthamologist’s office until necessary.

Also, in collaboration with the Veterans Administration Hospital in Jamaica Plain, Mass., she is conducting a health services research study comparing the effectiveness of ocular telehealth systems like the JVN to the traditional mode of healthcare referral (i.e., referral to specialists following a primary care visit) for both diabetic and non-diabetic eye care. If the telemedicine system compares well, it could greatly enhance the access of geographically remote, rural or underserved urban populations to specialized care. For example, residents of the Hawaiian island of Molokai (where diabetes is highly prevalent) have access to an ophthalmologist for only a few days each month; having a telemedicine system in place would allow patients to receive frequent, high-tech ocular exams that can be assessed by specialists off the island, with referrals generated as needed. The benefits extend beyond the strictly medical to the educational; reviewing eye scans with their physician gives patients an opportunity to learn how their overall health, particularly in the context of diabetes control, can affect what happens in the eye.

Selected References
Fonda SJ, Bertrand R, O’Donnell A, Longcope C, McKinlay JB. Age, hormones and cognitive functioning among middle-aged and elderly men: cross-sectional evidence from the Massachusetts Male Aging Study. J Gerontol A Biol Sci Med Sci 60:385-390, 2005.

Jones RN, Fonda SJ. Use of an IRT-based latent variable model to link different forms of the CES-D from the Health and Retirement Study. Social Psychiatry  Psychiatr Epidemiol 39:828-835, 2004.

Fonda SJ, Clipp EC, Maddox GL. Patterns in functioning among residents of an affordable assisted living housing facility. Gerontologist 42:178-187, 2002.

Fonda SJ, Herzog AR. Patterns and risk factors of change in somatic and mood symptoms among older adults. Ann Epidemiol 11:361-368, 2001.