About

Heike Thiel de Bocanegra is an Adjunct Professor and Vice Chair of Research in the Department of Obstetrics & Gynecology at the UC Irvine School of Medicine. She also holds positions as an Adjunct Professor in the Department of Population Health & Disease Prevention at the Joe C. Wen School of Population & Public Health and as a Volunteer Clinical Professor at the Public Health Sciences Department at UC Davis School of Medicine. She earned her Ph.D. from New York University in 1997, her M.P.H. from the University of North Carolina, Chapel Hill in 1991, and her M.A. from Universitaet Bielefeld in 1982. Her research interests encompass reproductive health, postpartum contraception, health disparities, immigrant health, refugee health, access to primary care, health care reform, and intimate partner violence. Her work involves addressing health disparities and improving reproductive health services, especially among immigrant and refugee populations, and she has contributed extensively to the literature on these topics.

Research topics

• Environmental health
• Medicine
• Political Science
• Family medicine
• Nursing
• Sociology
• Obstetrics
• Gender studies
• Internal medicine
• Intensive care medicine
• Economic growth
• Psychiatry
• Social psychology
• Psychology
• Emergency medicine

Selected publications

• Evaluating the Effectiveness of Group Sessions with Pre-recorded Presentations on Digital and Postpartum Health Literacy Among Arab American Women

  Maternal and Child Health Journal · 2026-02-26

  articleOpen accessSenior author

  INTRODUCTION: Arab refugees, immigrants, and migrants (RIMs) experience barriers in accessing accurate health information. To combat this, the Refugee Reproductive Health Network (ReproNet) developed Arabic, culturally concurrent health literacy sessions that included pre-recorded presentations on postpartum care. We evaluated the impact of these group sessions on postpartum knowledge and health literacy in the Arab RIM community in Southern California. METHODS: We recruited a convenience sample of 51 Arab RIMs through community organizations and the ReproNet client list for one in-person and three virtual informational sessions on postpartum care. We administered pre- and 2-4 week post-session surveys to measure e-Health Literacy (eHL) and Postpartum Health Literacy (PHL). We conducted descriptive analyses and t-tests to assess mean differences using SAS 9.4. RESULTS: Of the 51 attendees, 47 participants completed both the pre- and post-tests. Most participants were college-educated, single, and had never had a live birth. The average age was 39.3 years. We observed a significant increase in both eHL and PHL after the informational sessions. Females under the age of 35 had improved more in PHL than those over 35. Nulliparous females had a lower PHL baseline than parous females. DISCUSSION: Group health literacy training sessions that implement culturally concurrent methods, including pre-recorded presentations, are effective in increasing postpartum knowledge and health literacy in the Arab RIM community, regardless of parity. Enhancing PHL has the potential to reduce the risks of postpartum complications, such as postpartum depression (PPD), and can potentially contribute to postpartum females' mental and physical health.

  PublisherOA PDFDOI

• Assessing Oral Health Awareness Among Arab Immigrants & Refugees

  Journal of Public Health Dentistry · 2026-01-25

  articleSenior author

  BACKGROUND: There is limited information about oral health awareness among Arab immigrants and refugees (AIR) in the United States, though research conducted on this demographic globally has shown a major correlation between poor oral health outcomes and sociodemographic factors. This study examined oral health practices and awareness of the increased gingivitis risk during pregnancy among AIR in Southern California. METHODS: This was a cross-sectional survey on oral health knowledge and access barriers among male and female AIR participants recruited via community organizations and dental clinics. Bivariate and multivariate analyses evaluated the association between oral health awareness and demographics, oral health literacy, general health knowledge, and knowledge of pregnancy-related gingivitis risk. RESULTS: The sample included 73 participants (31 males, 42 females), mostly aged 18-30; 67% held bachelor's degrees or higher, and 41% had immigrated due to war or violence. Females showed higher Oral Health Risk Awareness Scores than males (0.75 vs. 0.61, p < 0.006), with no significant differences by age or ethnicity. Most respondents reported financial and language barriers to dental care. Although over 75% recognized a link between oral and general health, only 38% knew of the increased periodontal risk during pregnancy. CONCLUSION: The financial, linguistic, and educational obstacles that AIR populations must overcome to obtain dental care pose challenges and have an impact on their awareness of the risks to their oral health. These findings highlight the importance of culturally sensitive health education and outreach efforts. PRACTICAL IMPLICATIONS: Culturally appropriate programs and multilingual materials are necessary to improve care by addressing AIR's knowledge of gingivitis risks and promoting preventative dental care.

  PublisherDOI

• Assessing the Effectiveness of Reproductive Health Literacy Trainings on Access To Care for Arab and Afghan Refugee Communities

  Journal of Immigrant and Minority Health · 2025-07-16 · 2 citations

  articleOpen access1st authorCorresponding

  This study assessed the impact of reproductive health literacy training for general, digital, and reproductive health literacy among Afghan and Arab refugees. From September 2023 to June 2024, the research team offered reproductive health literacy training (RHLT) series to Dari-, Pashto-, and Arabic-speaking refugees online and at public libraries in Sacramento, California. The RHLT series presented information on cervical cancer prevention, family planning, and maternal health with an emphasis on participants' ability to independently find reliable health information and use it for their own and their families' health decisions. A total of 203 participants completed the pre-assessment and post-assessment, administered two weeks after the final training session. Each assessment included validated scales, including the European Health Literacy Survey Questionnaire 6 (HLS-EU-Q6) and the eHealth Literacy Scale (eHEALS). Study participants in all three language groups significantly improved general health literacy, reproductive health literacy and reproductive knowledge (p < 0.05). Improvements in the digital health literacy scale (eHEALS) were borderline significant (p = 0.0506) and significant for Dari speakers (p < 0.05). There were no differences among the three language groups when controlling for age, education, and length of stay in the United States. These results showed that reproductive health literacy training that focuses on understanding and using health information is effective in increasing health literacy among Afghan and Arab refugee women with diverse cultural and demographic backgrounds. Scalable health literacy modules have the potential to reduce health disparities and empower informed decision-making within underserved populations.

  PublisherOA PDFDOI

• Reproductive health literacy scale: a tool to measure the effectiveness of health literacy training

  Reproductive Health · 2025-01-30 · 3 citations

  articleOpen accessSenior author

  BACKGROUND: Refugee women's reproductive health (RH) outcomes have been impacted by several factors, including experiencing war, lack of access to healthcare, and possible gender-based violence. After resettlement, low health literacy, financial difficulties, cultural and linguistic barriers, and unfamiliarity with the healthcare system also add to the preexisting barriers. Although several efforts have focused on health education and improving health literacy among refugee women, there has not been a validated tool to measure the effectiveness of these trainings and their possible impact. This study aims to adapt a culturally and linguistically appropriate survey that helps address this gap. METHODS: We conducted a literature review to identify the existing tools and identified possible domains and items supporting RH literacy measures. The identified items were collected and adapted as a single scale with three domains: (a) general health literacy, measured with HLS-EU-Q6, (b) digital health literacy, measured with eHEALS, and (c) reproductive health literacy, measured through a composite of the Cervical Cancer Literacy Assessment Tool (C-CLAT) and the Refugee Reproductive Health Network (ReproNet) postpartum literacy scale. After content validity and face validity of the adapted scale, it was translated into Dari, Arabic, and Pashto and was administered to participants of RH literacy training sessions. RESULTS: A total of 67 Dari, 53 Arabic, and 64 Pashto-speaking refugee women completed the survey. The mean scores obtained between the three language groups were similar in the domains of digital health literacy and reproductive health literacy (p > 0.05), whereas the scores for general health literacy were not (p > 0.05). The inter-item reliability score for the domains of general health literacy, digital health literacy and RH literacy across all three language groups was above α = 0.7. CONCLUSION: This scale addresses the need for validated tools to measure reproductive health literacy. It has the promise to provide a tool for assessing the effectiveness of health interventions on health literacy. Future applications can utilize this scale to investigate the differences in health literacy in refugee populations speaking Dari, Pashto, and Arabic.

  PublisherOA PDFDOI

• Improving cervical cancer health literacy in Arabic-speaking immigrant women in the United States through an online patient education tool

  Women s Health · 2025-01-01 · 3 citations

  articleOpen accessSenior author

  Background: Low health literacy rates especially among the medically underserved have called for more understandable and actionable resources to involve patients in their health. The online audio-visual Reproductive Health Network (ReproNet) cervical cancer tool was shown to improve cervical cancer health literacy among marginalized English- and Spanish-speaking populations and Arab and Afghan immigrants in a group setting. Objective: This study aimed to determine whether or not the cervical cancer tool positively impacts health literacy for Arabic-speaking Middle Eastern or North African first- and second-generation immigrant women in the United States when self-administered. Design: In this single-group pre–post interventional study, a convenience sample of 95 Arabic-speaking immigrant women in the United States, ages 18 and over, reviewed an online cervical cancer patient education tool and completed pre- and post-tests. Methods: Participants received links to the tool and to pre- and post-tests, using the cervical cancer literacy assessment tool. We conducted McNemar tests and paired t-tests to compare pre- and post-test results in health literacy per participants. A multivariate regression model was fitted to test the association between demographic variables and the change of cervical cancer literacy content domains, controlling for the baseline scores before administering the tool. Results: Out of 118 participants, 95 participants had complete pre- and post-tests. Health literacy increased overall after self-administration of the tool, specifically in terms of cervical cancer prevention and control ( p &lt; 0.01). There were no significant differences in knowledge in U.S.-born versus foreign-born Arabic-speaking women ( p = 0.6660). Conclusion: The self-administration of the ReproNet cervical cancer tool most significantly increases awareness and knowledge of cervical cancer prevention in Arabic-speaking first- and second-generation immigrant women, thus pointing to increased quality of the provider–patient relationship.

  PublisherDOI

• Results of cardiovascular testing among pregnant and postpartum persons undergoing standardized cardiovascular risk assessment

  American Journal of Obstetrics & Gynecology MFM · 2025-02-22 · 2 citations

  articleOpen accessSenior author

  BACKGROUND: Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States, accounting for one in three pregnancy-related deaths. A standardized CVD Risk Assessment can guide clinicians in identifying patients at risk for CVD. OBJECTIVE: The objective of this study was to evaluate whether a standardized CVD risk assessment yields more abnormal findings on follow-up CVD testing among pregnant and postpartum patients compared to assessments based on clinician judgment alone. STUDY DESIGN: A retrospective chart review was performed across three geographically and ethnically diverse hospital networks that had implemented the CVD Risk Assessment algorithm. The analysis included a total of 31,232 pregnant and postpartum patients who had presented for obstetric care visit from September 2020 to August 2024. We calculated the proportion of patients with abnormal composite brain natriuretic peptide (BNP), electrocardiogram (EKG), and/or echocardiogram test results by risk assessment group, and a two Proportion Z-Test was conducted to compare proportions. We then calculated the odds of having abnormal tests for each risk assessment group. RESULTS: Standardized CVD risk assessment yielded more abnormal composite test results than clinician judgment alone (6.9% vs. 4.2%; p<.0001). There was a greater proportion of abnormal test results among the risk-positive than the risk-negative group (23.4% vs. 6.6%; P<.0001). Patients assessed for CVD had 1.69 times the odds of having an abnormal test than those tested based on clinician judgment alone (P<.0001). Risk-positive patients had 4.31 times the odds of having an abnormal test than risk-negative patients (P<.0001). CONCLUSION: Implementing a standardized CVD Risk Assessment algorithm may enhance the detection of cardiovascular disease in pregnant and postpartum patients with previously unknown CVD or at risk of developing CVD, providing a valuable tool that complements clinician judgment for improved perinatal outcomes.

  PublisherOA PDFDOI

• Factors Influencing Treatment Strategy for Overactive Bladder in the National Institute of Health All of Us Research Program

  Urogynecology · 2025-03-04 · 1 citations

  article

  IMPORTANCE: Overactive bladder (OAB) is a condition characterized by urinary urgency, frequency, and incontinence, affecting up to 43% of women. While treatment disparities are well-documented, this study sheds light on broader systemic barriers and the need for equitable approaches to improve diagnosis and management. OBJECTIVE: This study aimed to examine the types of OAB treatments (no treatment, pharmacotherapy, advanced therapy) received by patients in the United States, stratified by race, ethnicity, and socioeconomic factors, using data from the All of Us Research Hub. STUDY DESIGN: Data were collected from 20,941 female patients diagnosed with OAB in the All of Us Research Hub. Patients were categorized into 3 treatment groups: (1) no treatment, (2) pharmacotherapy, or (3) advanced therapy. Demographic factors such as race, ethnicity, age, income, and health status were analyzed using univariate and multivariate logistic regression models to determine the influence on treatment type. RESULTS: Of the participants, 71% received no treatment, 27% were treated with pharmacotherapy, and 2% underwent advanced therapy. On multivariate analysis, Asian and Hispanic patients were less likely to receive pharmacotherapy compared to White patients (odds ratio (95% CI), 0.47 (0.31-0.72) and 0.84 (0.74-0.95) respectively). Additionally, factors such as increasing age, unemployment, and lower income were associated with greater odds of receiving pharmacotherapy. CONCLUSIONS: Significant differences exist in the treatment of OAB, particularly among Asian and Hispanic patients. Socioeconomic factors and self-reported health status also affect access to treatment. Addressing these disparities is crucial to improving health care equity and access for patients with OAB.

  PublisherDOI

• Patient Experiences and Behavioral Changes Following Cardiovascular Risk Assessment During Pregnancy and Postpartum

  Journal of Patient Experience · 2025-04-13

  articleOpen accessSenior authorCorresponding

  Cardiovascular disease (CVD) is the leading cause of maternal mortality in the United States. Two major hospital networks implemented a novel CVD risk assessment of pregnant and postpartum patients to standardize identification of patients with previously unknown CVD or at risk to develop CVD. This qualitative study explored the experience of being identified as at CVD risk in a purposive sample of 10 obstetric patients. Participants varied by age, race/ethnicity, language (English/Spanish), and comorbidities. Interviews focused on patients' awareness, emotional responses, clinician-patient communication, and behavioral intentions. Thematic analysis using Atlas.ti 8 revealed a limited understanding of the association between CVD and pregnancy complications and lifetime CVD risk. Positive risk assessments triggered surprise and concern. Overall, patients evaluated the clinician-patient communication positively but found information too cursory and varied in strategies to find out more details. Several patients initiated immediate lifestyle changes, while others waited for guidance from clinicians. The study underscores the need to engage patients in the implementation of screening tests and to improve health literacy to facilitate follow up care and behavior change.

  PublisherDOI

• Impact of management guidelines for abnormal cervical cytology on colposcopy procedure rates among young women

  Gynecologic Oncology · 2024-08-27 · 2 citations

  articleOpen access
  PublisherOA PDFDOI

• 379 Differences in Cardiovascular Disease Symptoms per Trimester Among Risk Screen Positive Pregnant Patients

  American Journal of Obstetrics and Gynecology · 2024-01-01

  articleOpen access
  PublisherOA PDFDOI

Frequent coauthors

• Philip D. Darney

  University of California, San Francisco

  79 shared

• Eleanor Bimla Schwarz

  University of California, San Francisco

  56 shared

• Leslie A. Watts

  California Department of Health Care Services

  50 shared

• Kevin Kong

  Kaiser Permanente

  49 shared

• Emese C. Parker

  Kaiser Permanente

  49 shared

• Mary Bradsberry

  University of California, San Francisco

  15 shared

• Francesca Gany

  Cornell University

  13 shared

• Carrie Lewis

  Center For Policy Research

  12 shared

Education

• Ph.D., Public Health

  New York University

  1997

• Other, Health Behavior and Health Education

  University of North Carolina, Chapel Hill

  1991

• M.A., Social Psychology

  Universitaet Bielefeld

  1982