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Kandula NR, Shah NS, Kumar S, Charley M, Clauson M, Lancki N, Finch EA, Ehrlich-Jones L, Rao G, Spring B, Shah NS, Siddique J. Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors: The SAHELI Randomized Clinical Trial. JAMA Cardiol 2024:2823190. [PMID: 39259546 PMCID: PMC11391361 DOI: 10.1001/jamacardio.2024.2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Importance South Asian adults in the US experience excess cardiovascular disease (CVD) compared with other racial and ethnic groups. The effectiveness and reach of guideline-recommended lifestyle interventions have not been evaluated in this population. Objective To evaluate whether a culturally adapted, group lifestyle intervention will improve CVD risk factors more effectively than written health education materials among US South Asian adults. Design, Setting, and Participants This single-blind randomized clinical trial was conducted from March 6, 2018, to February 11, 2023 at community sites in the Chicago, Illinois, metropolitan area. South Asian adults aged 18 to 65 years who were overweight or obese, had no history of CVD events, and had at least 1 additional CVD risk factor (hypertension, dyslipidemia, prediabetes, or diabetes) were eligible for inclusion. Intervention A 16-week, culturally adapted, group-based lifestyle intervention led by community health coaches. Lifestyle modification counseling was delivered in English, Gujarati, Hindi, and Urdu. Participants tracked their diet and physical activity (PA) and received 4 optional group maintenance sessions between months 5 and 11 of follow-up. The intervention was delivered in person prior to the onset of the COVID-19 pandemic and via videoconference starting in March 2020. The control group received written health education materials, delivered monthly. Main Outcomes and Measures Primary outcomes were the between-group differences in CVD risk factor changes from baseline to 12 months, including weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), glycated hemoglobin (HbA1c), and total cholesterol, estimated using multivariate mixed-effects regression models. Secondary outcomes were self-reported diet quality, PA, and self-efficacy, estimated using univariate mixed-effects regression models. Results Among 549 randomized participants, 318 (57.9%) were women, and mean (SD) participant age was 49.2 (9.5) years. Mean differences in CVD risk factor changes from baseline to 12 months in the intervention vs control group were calculated for weight (mean difference, -0.07 kg; 95% CI, -0.55 to 0.42), SBP (mean difference, 0.47 mm Hg; 95% CI, -1.85 to 2.79), DBP (mean difference, 0.44 mm Hg; 95% CI, -1.06 to 1.95), cholesterol (mean difference, -2.47 mg/dL; 95% CI, -8.51 to 3.57), and HbA1c (mean difference, -0.07%; 95% CI -0.20% to 0.07%). Intervention participation was associated with greater improvements in dietary quality, PA, and self-efficacy than control. Conclusions and Relevance In the SAHELI randomized clinical trial, a culturally adapted, group lifestyle intervention was not more effective than written health education materials for CVD risk factor reduction among US South Asian adults, but the intervention was associated with small improvements in self-reported health behaviors. Effective CVD prevention interventions for this elevated-risk population require further investigation. Trial Registration ClinicalTrials.gov Identifier: NCT03336255.
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Affiliation(s)
- Namratha R Kandula
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, Illinois
| | - Michael Charley
- Village of Skokie Health and Human Services Department, Skokie, Illinois
| | | | - Nicola Lancki
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Northwestern University Data Analysis & Coordinating Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily A Finch
- Division of General Internal Medicine, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Linda Ehrlich-Jones
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Shirley Ryan AbilityLab Center for Rehabilitation Outcomes Research, Chicago, Illinois
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | - Bonnie Spring
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nilay S Shah
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Juned Siddique
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Northwestern University Data Analysis & Coordinating Center, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Kandula NR, Patel KM, Lancki N, Welch S, Bouris A, Marquez DX, Liem R, Rastogi M, Roy R, Bharucha H, Bever J, Kwon S. South Asians Active Together (SAATH): Protocol for a multilevel physical activity intervention trial for South Asian American mother and daughter dyads. Contemp Clin Trials 2022; 120:106892. [PMID: 36007709 DOI: 10.1016/j.cct.2022.106892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/11/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022]
Abstract
South Asian (SA), including Asian Indian and Pakistani Americans, have a high burden of cardiometabolic risk factors and low levels of physical activity (PA). Increasing PA in the U.S. population is a national priority; however, SA American women and girls experience unique barriers to PA that are not addressed by current promotion efforts. To address this gap, our community-based participatory research partnership developed the South Asians Active Together (SAATH) intervention. This study is a two-arm randomized clinical trial to evaluate the effects, mediators, and implementation of the 18-week SAATH intervention. A total of 160 mother-daughter dyads will be randomized in a 1:1 ratio to the SAATH intervention and control groups. The intervention was designed for mother-daughter dyads and targets individual, interpersonal, and family levels through (1) group exercise classes, (2) mother-daughter discussions, and (3) peer group discussions. The intervention targets the environment level through community partner meetings aimed at creating environment changes to enhance PA opportunities for SA women and girls. The control group will receive PA education materials. We hypothesize that dyads who receive the intervention will have significantly greater increases in moderate- and vigorous-intensity PA (MVPA) from baseline to 4 months, compared to the control group. MVPA will be measured at 12 months in intervention participants to examine if changes are sustained. A process evaluation will use the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. This study will fill knowledge gaps about the effectiveness and implementation of culturally adapted, community-based PA interventions for SA women and girls.
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Affiliation(s)
- Namratha R Kandula
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States; Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Kajal M Patel
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Nicola Lancki
- Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, United States.
| | - Sarah Welch
- Feinberg School of Medicine, Buehler Center for Health Policy and Economics, Northwestern University, Chicago, IL, United States.
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, Chicago, IL, United States.
| | - David X Marquez
- Department of Kinesiology and Nutrition, Center for Research on Health and Aging, University of Illinois at Chicago, Chicago, IL, United States.
| | - Robert Liem
- Center for Cancer and Blood Disorders, Ann & Robert H. Lurie Children's Hospital of Chicago, Pediatrics, Chicago, IL, United States; Feinberg School of Medicine, Department of Pediatrics, Northwestern University, Chicago, IL, United States.
| | - Mudita Rastogi
- The Family Institute, Northwestern University, Chicago, IL, United States.
| | - Rency Roy
- Feinberg School of Medicine, Division of General Internal Medicine, Northwestern University, Chicago, IL, United States.
| | - Himali Bharucha
- Metropolitan Asian Family Services, Chicago, IL, United States.
| | | | - Soyang Kwon
- Division of Pediatric Surgery, Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
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Kandula N, Ahmed M, Dodani S, Gupta L, Hore P, Kanaya A, Khowaja A, Mathur A, Mehta D, Misra R, Paracha M, Bharmal N, Aghhi M, Leng J, Gany F. Cardiovascular Disease & Cancer Risk Among South Asians: Impact of Sociocultural Influences on Lifestyle and Behavior. J Immigr Minor Health 2019; 21:15-25. [PMID: 28493115 PMCID: PMC7646689 DOI: 10.1007/s10903-017-0578-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A comprehensive literature review revealed cultural beliefs, societal obligations, and gender roles within the South Asian community to be indirect contributors to the health of South Asian immigrants (SAIs). Health professionals need to increase their work with SAI communities to change less beneficial cultural elements such as misconceptions about health and exercise, and lack of communication when using alternative medicines. Community engaged efforts and continuing medical education are both needed to improve the health of the South Asian immigrant population in a culturally appropriate manner.
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Affiliation(s)
- Namratha Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Munerah Ahmed
- Bureau of Environmental Surveillance and Policy, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sunita Dodani
- Division of Cardiology, Department of Medicine & Center for Health Equity and Quality Research, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Leena Gupta
- Life Sciences Research and Surveys, Gerson Lehrman Group, New York, NY, USA
| | - Paromita Hore
- Bureau of Environmental Disease and Injury Prevention, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Alka Kanaya
- Division of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Ashish Mathur
- South Asian Heart Center, El Camino Hospital, Mountain View, CA, USA
| | - Darshan Mehta
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ranjita Misra
- Department of Health and Kinesiology, College of Education and Human Development, Center for the Study of Health Disparities, Texas A&M University, College Station, TX, USA
| | - Muhammad Paracha
- Asian Human Services Family Health Center, Inc., Chicago, IL, USA
| | - Nazleen Bharmal
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, CA, USA
| | | | - Jennifer Leng
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Francesca Gany
- Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY, 10017, USA.
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA.
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
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Tharmaratnam T, Iskandar MA, Doherty S, D'Urzo KA, Kopalakrishnan S, Tabobondung TC, Gopee-Ramanan P, Sivagurunathan S, Sivananthan N. The Role of Physical Activity Prescription in Cardiovascular Disease Prevention Amongst South Asian Canadians. Front Cardiovasc Med 2018; 5:165. [PMID: 30488037 PMCID: PMC6246639 DOI: 10.3389/fcvm.2018.00165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023] Open
Abstract
Unequivocal evidence suggests an increased prevalence of cardiovascular disease (CVD) amongst South Asian Canadians (SACs) compared to other ethnic cohorts, due to a combination of their unique cardiometabolic profile and environmental factors. This unfavorable CVD profile is characterized by an elevated risk of dyslipidemia, high apolipoprotein B/apolipoprotein A1 ratio, hypertension, glucose intolerance, type 2 diabetes mellitus, as well as increased BMI, body fat percentage, abdominal and visceral adiposity. Despite the overwhelming evidence for the effectiveness of physical activity (PA) in circumventing the onset of CVD and in the reduction of CVD risk factors, SACs are among the most physically inactive cohorts in Canada. This relates to a set of common and unique socio-cultural barriers, such as gender, beliefs and perceptions about illness, immigration, unfavorable PA environments, and their high prevalence of debilitating chronic diseases. Several strategies to improve PA participation rates in this high-risk population have been suggested, and include the implementation of culturally sensitive PA interventions, as well as clinician training in PA prescription through workshops that emphasize knowledge translation into clinical practice. Therefore, the purpose of this mini-review is to highlight and discuss: (1) the burden of heart disease in SACs (2) the cardiovascular benefits of PA for SACs; (3) factors affecting PA participation among SACs and how they can be addressed; (4) the impact of culturally sensitive PA prescription on CVD prevention; (5) barriers to culture-specific PA prescription by clinicians, and strategies to improve its use and impact.
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Affiliation(s)
| | - Mina A. Iskandar
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Sally Doherty
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Medicine, Royal College of Surgeons in Ireland, Adliya, Bahrain
| | - Katrina A. D'Urzo
- School of Kinesiology and Health Studies, Queens University, Kingston, ON, Canada
| | | | - Tyler Cameron Tabobondung
- Department of Family Medicine, Michael G. DeGroote School of Medicine, Brantford General Hospital, McMaster University, Hamilton, ON, Canada
| | - Prasaanthan Gopee-Ramanan
- Department of Diagnostic Radiology, Hamilton Health Sciences Centre, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Seyon Sivagurunathan
- Department of Family Medicine, Stonechurch Family Health Clinic, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Nirunthan Sivananthan
- Department of Pharmacology & Toxicology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kokab F, Greenfield S, Lindenmeyer A, Sidhu M, Tait L, Gill P. The experience and influence of social support and social dynamics on cardiovascular disease prevention in migrant Pakistani communities: A qualitative synthesis. PATIENT EDUCATION AND COUNSELING 2018; 101:619-630. [PMID: 29031424 DOI: 10.1016/j.pec.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The objective of this research was to synthesise qualitative literature about the perceived influence and experience of social support, in relation to cardiovascular disease (CVD) prevention in migrant Pakistani communities. METHODS Articles were systematically reviewed, critically appraised, and analysed using an adapted meta-ethnography approach. RESULTS Sixteen qualitative studies on health behaviours related to CVD prevention were included. FINDINGS include four sub-themes under two substantive thematic areas that focus on: 1) family dynamics and 2) community dynamics influenced by discrimination. For members of the Pakistani community, gendered family dynamics and discrimination from outside and within community networks influenced behaviour change. CONCLUSION The authors of the synthesis developed multi-layered, contextualised interpretations of the care needs of an established multi-generational community. Future qualitative studies taking an intersectional approach to interpreting the role of social networks in migrant communities should take into account gender, identity, culture and faith. PRACTICE IMPLICATIONS Health care providers should focus on cultural awareness and sensitivity during consultations. In particular, general practitioners can benefit from the insight they gain from patient experiences, allowing for more appropriate recommendations.
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Affiliation(s)
- Farina Kokab
- Institute of Applied Health Research, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Sheila Greenfield
- Institute of Applied Health Research, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Antje Lindenmeyer
- Institute of Applied Health Research, The University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Manbinder Sidhu
- Department of Health Sciences, College of Medicine, Biological Sciences, and Psychology, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH, UK.
| | - Lynda Tait
- School of Health Sciences, The University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Paramjit Gill
- Warwick Medical School, Warwick, Coventry, CV4 7AL, UK.
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Thapar-Olmos N, Myers HF. Stigmatizing attributions towards depression among South Asian and Caucasian college students. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1340969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Hector F. Myers
- Department of Psychology, University of California, Los Angeles, USA
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Dave SS, Craft LL, Mehta P, Naval S, Kumar S, Kandula NR. Life stage influences on U.S. South Asian women's physical activity. Am J Health Promot 2016; 29:e100-8. [PMID: 24717067 DOI: 10.4278/ajhp.130415-qual-175] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE South Asian (SA) women in the United States report extremely low rates of leisure time physical activity (PA) compared with women in other ethnic minority groups. This study explored SA women's perspectives on PA during different life stages. DESIGN This is a community-based participatory research study that used focus groups. SETTING The study setting was a community-based organization that provides social services to SA immigrants in Chicago, Illinois. PARTICIPANTS The study team conducted six focus groups (in English and Hindi) with 42 SA women, ages 18 to 71 years. METHOD A semistructured interview guide was used to foster discussion about perceptions of, barriers to/facilitators of, and suggestions for PA programs. Discussions were transcribed and independently coded by two reviewers using thematic content analysis and guided by a coding scheme that was developed a priori. RESULTS Participants said that different life stages strongly influenced their PA. PA decreased after marriage and having children. Chronic diseases constrained older women from more vigorous PA. Barriers to PA among younger women were family disapproval and perceptions that PA is unnecessary if you are "skinny." Women agreed that PA is not a priority within the culture, and that interventions must take into account cultural, religious, and family context. CONCLUSION Sociocultural norms, family constraints, and lack of awareness about the benefits of PA strongly influenced PA among SA women. Culturally salient intervention strategies might include programs in trusted community settings where women can exercise in women-only classes with their children, and targeted education campaigns to increase awareness about the benefits of PA across life stages.
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Goltz HH, Bergman M, Goodson P. Explanatory Models of Genetics and Genetic Risk among a Selected Group of Students. Front Public Health 2016; 4:111. [PMID: 27376052 PMCID: PMC4893687 DOI: 10.3389/fpubh.2016.00111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 05/19/2016] [Indexed: 11/30/2022] Open
Abstract
This exploratory qualitative study focuses on how college students conceptualize genetics and genetic risk, concepts essential for genetic literacy (GL) and genetic numeracy (GN), components of overall health literacy (HL). HL is dependent on both the background knowledge and culture of a patient, and lower HL is linked to increased morbidity and mortality for a number of chronic health conditions (e.g., diabetes and cancer). A purposive sample of 86 students from three Southwestern universities participated in eight focus groups. The sample ranged in age from 18 to 54 years, and comprised primarily of female (67.4%), single (74.4%), and non-White (57%) participants, none of whom were genetics/biology majors. A holistic-content approach revealed broad categories concerning participants’ explanatory models (EMs) of genetics and genetic risk. Participants’ EMs were grounded in highly contextualized narratives that only partially overlapped with biomedical models. While higher education levels should be associated with predominately knowledge-based EM of genetic risk, this study shows that even in well-educated populations cultural factors can dominate. Study findings reveal gaps in how this sample of young adults obtains, processes, and understands genetic/genomic concepts. Future studies should assess how individuals with low GL and GN obtain and process genetics and genetic risk information and incorporate this information into health decision making. Future work should also address the interaction of communication between health educators, providers, and genetic counselors, to increase patient understanding of genetic risk.
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Affiliation(s)
- Heather Honoré Goltz
- University of Houston-Downtown, Houston, TX, USA; Baylor College of Medicine, Houston, TX, USA
| | - Margo Bergman
- Milgard School of Business, University of Washington-Tacoma , Tacoma, WA , USA
| | - Patricia Goodson
- Department of Health & Kinesiology, Texas A&M University , College Station, TX , USA
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Jayaprakash M, Puri-Taneja A, Kandula NR, Bharucha H, Kumar S, Dave SS. Qualitative Process Evaluation of a Community-Based Culturally Tailored Lifestyle Intervention for Underserved South Asians. Health Promot Pract 2016; 17:802-813. [PMID: 27225217 DOI: 10.1177/1524839916650165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction There are few examples of effective cardiovascular disease prevention interventions for South Asians (SAs). We describe the results of a process evaluation of the South Asian Heart Lifestyle Intervention for medically underserved SAs implemented at a community-based organization (CBO) using community-based participatory research methods and a randomized control design (n = 63). Method Interviews were conducted with 23 intervention participants and 5 study staff using a semistructured interview guide focused on participant and staff perceptions about the intervention's feasibility and efficacy. Data were thematically analyzed. Results Intervention success was attributed to trusted CBO setting, culturally concordant study staff, and culturally tailored experiential activities. Participants said that these activities helped increase knowledge and behavior change. Some participants, especially men, found that self-monitoring with pedometers helped motivate increased physical activity. Participants said that the intervention could be strengthened by greater family involvement and by providing women-only exercise classes. Staff identified the need to reduce participant burden due to multicomponent intervention and agreed that the CBO needed greater financial resources to address participant barriers. Conclusion Community-based delivery and cultural adaptation of an evidence-based lifestyle intervention were effective and essential components for reaching and retaining medically underserved SAs in a cardiovascular disease prevention intervention study.
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Affiliation(s)
| | | | | | | | - Santosh Kumar
- Metropolitan Asian Family Services, Chicago, IL, USA
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Kandula NR, Dave S, De Chavez PJ, Bharucha H, Patel Y, Seguil P, Kumar S, Baker DW, Spring B, Siddique J. Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial. BMC Public Health 2015; 15:1064. [PMID: 26475629 PMCID: PMC4609098 DOI: 10.1186/s12889-015-2401-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background South Asians (Asian Indians and Pakistanis) are the second fastest growing ethnic group in the United States (U.S.) and have an increased risk of atherosclerotic cardiovascular disease (ASCVD). This pilot study evaluated a culturally-salient, community-based healthy lifestyle intervention to reduce ASCVD risk among South Asians. Methods Through an academic-community partnership, medically underserved South Asian immigrants at risk for ASCVD were randomized into the South Asian Heart Lifestyle Intervention (SAHELI) study. The intervention group attended 6 interactive group classes focused on increasing physical activity, healthful diet, weight, and stress management. They also received follow-up telephone support calls. The control group received translated print education materials about ASCVD and healthy behaviors. Primary outcomes were feasibility and initial efficacy, measured as change in moderate/vigorous physical activity and dietary saturated fat intake at 3- and 6-months. Secondary clinical and psychosocial outcomes were also measured. Results Participants’ (n = 63) average age was 50 (SD = 8) years, 63 % were female, 27 % had less than or equal to a high school education, one-third were limited English proficient, and mean BMI was 30 kg/m2 (SD ± 5). There were no significant differences in change in physical activity or saturated fat intake between the intervention and control group. Compared to the control group, the intervention group showed significant weight loss (−1.5 kg, p-value = 0.04) and had a greater sex-adjusted decrease in hemoglobin A1C (−0.43 %, p-value <0.01) at 6 months. Study retention was 100 %. Conclusions This pilot study suggests that a culturally-salient, community-based lifestyle intervention was feasible for engaging medically underserved South Asian immigrants and more effective at addressing ASCVD risk factors than print health education materials. Trial registration NCT01647438, Date of Trial Registration: July 19, 2012 Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2401-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA. .,Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Swapna Dave
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Peter John De Chavez
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Himali Bharucha
- Metropolitan Asian Family Services, 7541 N Western Avenue, Chicago, IL, 60645, USA.
| | - Yasin Patel
- National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Paola Seguil
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Santosh Kumar
- Metropolitan Asian Family Services, 7541 N Western Avenue, Chicago, IL, 60645, USA.
| | - David W Baker
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, USA.
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
| | - Juned Siddique
- Department of Preventive Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA.
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Saeidi M, Soroush A, Komasi S, Moemeni K, Heydarpour B. Attitudes Toward Cardiovascular Disease Risk Factors Among Patients Referred to a Cardiac Rehabilitation Center: Importance of Psychological Attitudes. ACTA ACUST UNITED AC 2015. [DOI: 10.17795/semj22281] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Holden RJ, Schubert CC, Eiland EC, Storrow AB, Miller KF, Collins SP. Self-care Barriers Reported by Emergency Department Patients With Acute Heart Failure: A Sociotechnical Systems-Based Approach. Ann Emerg Med 2015; 66:1-12, 12e.1-2. [PMID: 25616317 PMCID: PMC4478102 DOI: 10.1016/j.annemergmed.2014.12.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/11/2014] [Accepted: 12/18/2014] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVE We pilot tested a sociotechnical systems-based instrument that assesses the prevalence and nature of self-care barriers among patients presenting to the emergency department (ED) with acute heart failure. METHODS A semistructured instrument for measuring self-reported self-care barriers was developed and administered by ED clinicians and nonclinician researchers to 31 ED patients receiving a diagnosis of acute heart failure. Responses were analyzed with descriptive statistics and qualitative content analysis. Feasibility was assessed by examining participant cooperation rates, instrument completion times, item nonresponse, and data yield. RESULTS Of 47 distinct self-care barriers assessed, a median of 15 per patient were indicated as "sometimes" or "often" present. Thirty-four specific barriers were reported by more than 25% of patients and 9 were reported by more than 50%. The sources of barriers included the person, self-care tasks, tools and technologies, and organizational, social, and physical contexts. Seven of the top 10 most prevalent barriers were related to patient characteristics; the next 3, to the organizational context (eg, life disruptions). A preliminary feasibility assessment found few item nonresponses or comprehension difficulties, good cooperation, and high data yield from both closed- and open-ended items, but also found opportunities to reduce median administration time and variability. CONCLUSION An instrument assessing self-care barriers from multiple system sources can be feasibly implemented in the ED. Further research is required to modify the instrument for widespread use and evaluate its implementation across institutions and cultural contexts. Self-care barriers measurement can be one component of broader inquiry into the distributed health-related "work" activity of patients, caregivers, and clinicians.
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Affiliation(s)
- Richard J Holden
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, and the Center for Health Informatics Research and Innovation, Indianapolis, IN.
| | - Christiane C Schubert
- Department of Medical Education, Loma Linda University School of Medicine, Loma Linda, CA
| | - Eugene C Eiland
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Karen F Miller
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN
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Shah A, Clayman ML, Glass S, Kandula NR. Protect your heart: a culture-specific multimedia cardiovascular health education program. JOURNAL OF HEALTH COMMUNICATION 2015; 20:424-430. [PMID: 25647363 PMCID: PMC4834216 DOI: 10.1080/10810730.2014.965366] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
South Asians, the second fastest growing racial/ethnic minority in the United States, have high rates of coronary heart disease. Few coronary heart disease prevention efforts target this population. The authors developed and tested a culture-specific, multimedia coronary heart disease prevention education program in English and Hindi for South Asians. Participants were recruited from community organizations in Chicago, Illinois, between June and October of 2011. Bilingual interviewers used questionnaires to assess participants' knowledge and perceptions before and after the patient education program. The change from pretest score to posttest score was calculated using a paired t test. Linear regression was used to determine the association between posttest scores and education and language. Participants' (N = 112) average age was 41 years, 67% had more than a high school education, and 50% spoke Hindi. Participants' mean pretest score was 15 (SD = 4). After the patient education program, posttest scores increased significantly among all participants (posttest score = 24, SD = 4), including those with limited English proficiency. Lower education was associated with a lower posttest score (β = -2.2, 95% CI [-0.68, -3.83]) in adjusted regression. A culture-specific, multimedia patient education program significantly improved knowledge and perceptions about coronary heart disease prevention among South Asian immigrants. Culturally salient multimedia education may be an effective and engaging way to deliver health information to diverse patient populations.
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Affiliation(s)
- Amy Shah
- a Department of Community Health Sciences, School of Public Health , University of Illinois , Chicago , Illinois , USA
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"Every disease…man can get can start in this cab": focus groups to identify south Asian taxi drivers' knowledge, attitudes and beliefs about cardiovascular disease and its risks. J Immigr Minor Health 2014; 15:986-92. [PMID: 22843321 DOI: 10.1007/s10903-012-9682-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
South Asian (SA) taxi drivers potentially possess a double epidemiologic risk for cardiovascular disease (CVD) due to their ethnicity and occupation. This study investigates SA taxi drivers' knowledge, attitudes, beliefs about general health, CVD and approaches to reduce CVD risk. Five focus groups were conducted with 31 SA taxi drivers in the participants' primary language (Bengali, Hindi, Urdu or Punjabi). Audio-recordings of the sessions were transcribed, translated and entered into ATLAS.ti 6.2 for coding and analysis. SA drivers in an urban setting perceive themselves to be at high risk for CVD because of high work-related stress, physical inactivity, poor diet and poor health care access. Participants attributed their occupation to increasing risk for heart disease; none believed that being SA increased their risk. Interventions to lower CVD risk among SA taxi drivers should be multi-level and involve the individual drivers and the taxi industry.
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Bragazzi NL. Commentary On: Self-Care Self-Efficacy, Religious Participation and Depression as Predictors of Post-Stroke Self-Care Among Underserved Ethnic Minorities. Health Psychol Res 2014; 2:1641. [PMID: 26973940 PMCID: PMC4768553 DOI: 10.4081/hpr.2014.1641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/06/2014] [Indexed: 12/02/2022] Open
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Kandula NR, Patel Y, Dave S, Seguil P, Kumar S, Baker DW, Spring B, Siddique J. The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: design and methods. Contemp Clin Trials 2013; 36:479-87. [PMID: 24060673 DOI: 10.1016/j.cct.2013.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 01/13/2023]
Abstract
Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian Heart Lifestyle Intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6weeks of group classes, followed by 12weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population.
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Affiliation(s)
- Namratha R Kandula
- Department of General Internal Medicine, Northwestern University Feinberg School of Medicine, 750 N Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA.
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Mukherjea A, Modayil MV. Culturally Specific Tobacco Use and South Asians in the United States. Health Promot Pract 2013; 14:48S-60S. [DOI: 10.1177/1524839913485585] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over the past two decades, the United States has attracted large South Asian populations, who have imported tobacco products previously unique to the native subcontinent. South Asian cigarette use prevalence is consistently lower than other U.S. Asian subgroups; however, most surveys fail to capture smokeless products accurately. In part because of the pervasive use of popular smokeless cultural products resulting in greater population attributable risk of oral malignancies, many countries outside the United States have developed surveillance systems to capture these products and implemented effective population-level or community-based intervention strategies. This minority population in the United States continues to be “at risk” of suffering from a disproportionate burden of diseases, which are plausibly linked to the use of these products. The primary focus of this article is to provide an exhaustive literature review of tobacco use patterns and existing tobacco control strategies among South Asians in the United States. Framed within the social ecological model, the article suggests that there needs to be more detailed assessment of cultural tobacco products, a concurrent increase in cultural competencies of health care providers and provision of cessation resources outside the clinical setting. At the policy level, future efforts should adequately regulate these products and oversight must include such products in efforts to reduce rates of use. Concurrently, community-based efforts are needed to change social norms related to perceived health benefit and lack of stigma. This will help ensure that appropriately framed messages around use rates and burden of disease are addressed through culturally valued institutions and leaders.
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Affiliation(s)
| | - Mary V. Modayil
- California Tobacco Control Program, California Department of Public Health, Sacramento, CA, USA
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18
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George M. Health beliefs, treatment preferences and complementary and alternative medicine for asthma, smoking and lung cancer self-management in diverse Black communities. PATIENT EDUCATION AND COUNSELING 2012; 89:489-500. [PMID: 22683293 PMCID: PMC3463761 DOI: 10.1016/j.pec.2012.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 05/01/2012] [Accepted: 05/05/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The purpose of this literature review is to characterize unconventional health beliefs and complementary and alternative medicine (CAM) for asthma, smoking and lung cancer as those that are likely safe and those that likely increase risk in diverse Black communities. These findings should provide the impetus for enhanced patient-provider communication that elicits patients' beliefs and self-management preferences so that they may be accommodated, or when necessary, reconciled through discussion and partnership. METHODS Original research articles relevant to this topic were obtained by conducting a literature search of the PubMed Plus, PsychINFO and SCOPUS databases using combinations of the following search terms: asthma, lung cancer, emphysema, chronic obstructive pulmonary disease (COPD), smoking, beliefs, complementary medicine, alternative medicine, complementary and alternative medicine (CAM), explanatory models, African American, and Black. RESULTS Using predetermined inclusion and exclusion criteria, 51 original research papers were retained. Taken together, they provide evidence that patients hold unconventional beliefs about the origins of asthma and lung cancer and the health risks of smoking, have negative opinions of standard medical and surgical treatments, and have favorable attitudes about using CAM. All but a small number of CAM and health behaviors were considered safe. CONCLUSION When patients' unconventional beliefs and preferences are not identified and discussed, there is an increased risk that standard approaches to self-management of lung disease will be sub-optimal, that potentially dangerous CAM practices might be used and that timely medical interventions may be delayed. PRACTICE IMPLICATIONS Providers need effective communication skills as the medical dialog forms the basis of patients' understanding of disease and self-management options. The preferred endpoint of such discussions should be agreement around an integrated treatment plan that is effective, safe and acceptable to both.
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Affiliation(s)
- Maureen George
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104-4217, USA.
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A community and culture-centered approach to developing effective cardiovascular health messages. J Gen Intern Med 2012; 27:1308-16. [PMID: 22584728 PMCID: PMC3445691 DOI: 10.1007/s11606-012-2102-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 04/10/2012] [Accepted: 04/23/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Little is known about how best to target cardiovascular health promotion messages to minorities. This study describes key lessons that emerged from a community and culture-centered approach to developing a multimedia, coronary heart disease (CHD) patient education program (PEP) for medically underserved South Asian immigrants. METHODS The prototype PEP integrated the surface structures (e.g. language) and deeper structures (e.g. explanatory models (EMs), values) of South Asians' socio-cultural context. Seven focus groups and 13 individual interviews were used to investigate South Asians' reactions and obtain qualitative feedback after viewing the culturally targeted PEP. Qualitative data were organized into emergent thematic constructs. RESULTS Participants (n=56) mean age was 51 years and 48 % were Hindi speakers. Community members had a strong, negative reaction to some of the targeted messages, "This statement is a bold attack. You are pin-pointing one community." Other important themes emerged from focus groups and interviews about the PEP: 1) it did not capture the community's heterogeneity; 2) did not sufficiently incorporate South Asians' EMs of CHD; and 3) did not address economic barriers to CHD prevention. Feedback was used to revise the PEP. CONCLUSION A community and culture-centered approach to developing cardiovascular health promotion messages revealed tensions between the researcher's vantage point of "cultural targeting" and the community's perceptions and reactions to these messages. Engaging communities in every phase of message design, incorporating their EMs, recognizing community heterogeneity, and addressing economic and structural barriers, are critical steps to ensuring that health promotion messages reach their intended audience and achieve true cultural appropriateness.
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Sharma S, Bhui K, Chilcot J, Wellsted D, Farrington K. Identifying depression in South asian patients with end-stage renal disease: considerations for practice. NEPHRON EXTRA 2011; 1:262-71. [PMID: 22470400 PMCID: PMC3290835 DOI: 10.1159/000331446] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Depression is a prevalent burden for patients with end-stage renal disease (ESRD) and one that is under-recognized and consequently under-treated. Although several studies have explored the association between depression symptoms, treatment adherence and outcomes in Euro-American patient groups, quantitative and qualitative exploration of these issues in patients from different cultural and ethnic backgrounds has been lacking. This review discusses the methodological issues associated with measuring depression in patients of South Asian origin who have a 3- to 5-fold greater risk of developing ESRD. There is a need to advance research into the development of accurate screening practices for this patient group, with an emphasis on studies utilizing rigorous approaches to evaluating the use of both emic (culture-specific) and etic (universal or culture-general) screening instruments.
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Affiliation(s)
- Shivani Sharma
- School of Psychology, University of Hertfordshire, Hatfield, UK
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