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Quesada O, Crousillat D, Rodriguez F, Bravo-Jaimes K, Briller J, Ogunniyi MO, Mattina DJ, Aggarwal NR, Rodriguez CJ, De Oliveira GMM, Velarde G. Cardiovascular Disease in Hispanic Women: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:1702-1712. [PMID: 38658109 DOI: 10.1016/j.jacc.2024.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Abstract
Cardiovascular disease affects 37% of Hispanic women and is the leading cause of death among Hispanic women in the United States. Hispanic women have a higher burden of cardiovascular risk factors, are disproportionally affected by social determinants of health, and face additional barriers related to immigration, such as discrimination, language proficiency, and acculturation. Despite this, Hispanic women show lower rates of cardiovascular disease and mortality compared with non-Hispanic White women. However, this "Hispanic paradox" is challenged by recent studies that account for the diversity in culture, race, genetic background, country of origin, and social determinants of health within Hispanic subpopulations. This review provides a comprehensive overview of the cardiovascular risk factors in Hispanic women, emphasizing the role of social determinants, and proposes a multipronged approach for equitable care.
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Affiliation(s)
- Odayme Quesada
- Women's Heart Center, The Christ Hospital Heart and Vascular Institute, Cincinnati, Ohio, USA; The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, Ohio, USA.
| | - Daniela Crousillat
- Division of Cardiovascular Sciences, Department of Medicine, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and the Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Katia Bravo-Jaimes
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Joan Briller
- Division of Cardiology, Department of Medicine, University of Illinois Chicago, Chicago, Illinois, USA; Department of Obstetrics and Gynecology, University of Illinois Chicago, Chicago, Illinois, USA
| | - Modele O Ogunniyi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Grady Health System, Atlanta, Georgia, USA
| | - Deirdre J Mattina
- Department of Cardiovascular Medicine, Cleveland Clinic, Beachwood, Ohio, USA
| | - Niti R Aggarwal
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Gladys Velarde
- Division of Cardiology, Department of Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
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Montalvo AM, Wallace JS, Nedimyer AK, Chandran A, Kossman MK, Gildner P, Register-Mihalik JK, Kerr ZY. Does the Association Between Concussion Measures and Social Context Factors Differ in Black and White Parents? J Athl Train 2024; 59:363-372. [PMID: 37681666 PMCID: PMC11064114 DOI: 10.4085/1062-6050-0193.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
CONTEXT Middle school (MS) parents may benefit from education supporting timely concussion identification and care-seeking in their young children (aged approximately 10 to 15 years). However, such education may not consider individual needs and different social context factors, including lower socioeconomic status, disadvantaged social determinants of health, and different racial and ethnic backgrounds. OBJECTIVES To examine the relationship between social context factors and concussion knowledge, attitudes, and communication in MS parents and to explore the possible role of race and ethnicity (Black or White) as an effect measure modifier. DESIGN Cross-sectional study. SETTING Online survey. PATIENTS OR OTHER PARTICIPANTS A nationally representative sample of MS parents who completed an online survey (n = 1248). MAIN OUTCOME MEASURE(S) Parent outcomes were a history of concussion education, concussion symptom knowledge and attitudes, and communication with children about concussion. Main exposures were parental race and ethnicity (Black or White) and social context factors. Uni- and multivariable statistical analyses were performed to achieve the study aims. RESULTS Black parents were more likely than White parents to have received concussion education (69.5% versus 60.5%, P = .009), although median concussion knowledge scores were higher for White parents than for Black parents (40 versus 37, P < .001). Few associations were found for social context factors with concussion knowledge, attitudes, and communication in Black and White parents separately. CONCLUSIONS Among MS parents, race and ethnicity may not influence the association between social context factors and concussion-related knowledge, attitudes, or communication. However, differences were present by race and ethnicity regarding previous concussion education and other parental outcomes, concussion symptom knowledge in particular.
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Affiliation(s)
- Alicia M Montalvo
- College of Health Solutions, Arizona State University, Phoenix
- Emory Sports Performance and Research Center, Flowery Branch, GA
- Sports Medicine and Community Health Research Lab, University of Southern Mississippi, Hattiesburg
| | | | - Aliza K Nedimyer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Datalys Center for Sports Injury Research and Prevention, Indianapolis, IN
| | - Melissa K Kossman
- School of Health Professions, University of Southern Mississippi, Hattiesburg
- Sports Medicine and Community Health Research Lab, University of Southern Mississippi, Hattiesburg
| | - Paula Gildner
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Johna K Register-Mihalik
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
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Haș IM, Teleky BE, Vodnar DC, Ștefănescu BE, Tit DM, Nițescu M. Polyphenols and Cardiometabolic Health: Knowledge and Concern among Romanian People. Nutrients 2023; 15:nu15102281. [PMID: 37242164 DOI: 10.3390/nu15102281] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023] Open
Abstract
The cardiometabolic health of the population is a crucial indicator of public health, considering the significant impact of cardiovascular disease (CVD) and diabetes on global mortality. Determining the population's knowledge and the predictors of these pathologies is essential in developing effective educational and clinical strategies for the prevention and management of cardiometabolic risk (CMR). Polyphenols are natural compounds with a multitude of beneficial effects on cardiometabolic health. This study explored the current knowledge, understanding, and awareness of CMR, the benefits of polyphenols among Romanians, and how sociodemographic and clinical characteristics influence this aspect. Five hundred forty-six subjects responded anonymously to an online questionnaire designed to assess their knowledge. The data were collected and analyzed based on gender, age, education level, and BMI status. Most respondents expressed concern to a great or very great extent about their health (78%) and food (60%), with significant differences (p < 0.05) depending on age, educational level, and BMI status. Of the respondents, 64.8% declared that they were familiar with the CMR term. Still, the results showed a weak correlation between the stated risk factors and the self-assessment of increased risk (r = 0.027) for CVD or diabetes. Only 35% of the respondents reported a good or very good knowledge of the term "polyphenols", 86% recognized the antioxidant effect, and significantly fewer (26%) recognized the prebiotic effect. Developing and implementing targeted educational strategies to enhance learning and individual behaviors related to CMR factors and the benefits of polyphenols is necessary.
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Affiliation(s)
- Ioana Mariana Haș
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania
| | - Bernadette-Emőke Teleky
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Dan-Cristian Vodnar
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
- Department of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Bianca Eugenia Ștefănescu
- Institute of Life Sciences, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania
| | - Delia Mirela Tit
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 29 N. Jiga St., 410028 Oradea, Romania
| | - Maria Nițescu
- Department of Preclinical-Complementary Sciences, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
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Acevedo M, Varleta P, Casas-Cordero C, Berríos A, Navarrete C, Valentino G, Lopez R, Smith SC. Mobile-phone text messaging to promote ideal cardiovascular health in women. Open Heart 2023; 10:e002214. [PMID: 36759011 PMCID: PMC9923351 DOI: 10.1136/openhrt-2022-002214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVE Ideal cardiovascular health (CVH) was developed to promote CVH as a key component of primordial prevention. Mobile short message service (SMS) is useful for improving health behaviours. We aim to test the effectiveness of SMS intervention in women to improve CVH. METHODS In a single-blinded, randomised, controlled study, 620 women, aged 35-70 years, without cardiovascular disease, were enrolled in SMS intervention versus no SMS. CVH metrics by self-report, and biochemical laboratory, anthropometric and blood pressure measurements were collected during home visits at baseline and 9 months. Women were categorised as having poor (0-2), intermediate (3-4) or ideal (5-7) CVH according to the number of ideal CVH metrics. Participants were randomised 1:1 to SMS intervention versus control. SMS was sent every 5-6 days for 9 months. The primary outcome was the difference in the proportion of women with ideal CVH between SMS and control groups at 9 months. Rates of intermediate CVH, poor CVH and each of the seven ideal CV health metrics at 9 months were key secondary endpoints. RESULTS At 9 months, there was no significant difference between groups for the primary outcome (16.3% at baseline and 13.3% at 9 months, and 10.1% and 11.1%, in SMS and control groups, respectively, adjusted RR 1.0; 95% CI 0.6 to 1.6). Similarly, there were no significant differences between groups for the key secondary endpoints. SMS had an acceptance rate of 94.9%. CONCLUSIONS Behavioural SMS intervention did not improve rates of ideal CVH in women, despite being feasible and well received. TRIAL REGISTRATION NUMBER 6377.
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Affiliation(s)
- Monica Acevedo
- Fundación SOCHICAR (Sociedad Chilena de Cardiología y Cirugía Cardiovascular), Santiago, Chile
- División de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Paola Varleta
- Fundación SOCHICAR (Sociedad Chilena de Cardiología y Cirugía Cardiovascular), Santiago, Chile
- Centro Cardiovascular, Hospital DIPRECA, Las Condes, Chile
| | - Carolina Casas-Cordero
- Instituto de Sociología, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Sociología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Amalia Berríos
- Fundación SOCHICAR (Sociedad Chilena de Cardiología y Cirugía Cardiovascular), Santiago, Chile
| | - Carlos Navarrete
- Departamento de Matemáticas, Universidad de La Serena, La Serena, Chile
| | - Giovanna Valentino
- Carrera de Nutrición y Dietética, Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rosario Lopez
- Carrera de Kinesiología, Facultad de Ciencias de la Salud, Universidad San Sebastián - Campus Bellavista, Santiago de Chile, Chile
| | - Sidney C Smith
- Cardiovascular Department, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Yeong SW, Kon ZH, Ong SC, Babar ZUD. Engaging students in experiential learning through a public health campaign: a pre–post survey on hypertension and diabetes mellitus. HEALTH EDUCATION 2021. [DOI: 10.1108/he-05-2021-0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis study looked at the impact of a community-based public health campaign on hypertension and diabetes mellitus awareness and prevention, as well as student experiential learning in a campaign conducted by pharmacy students.Design/methodology/approachA convenience sampling cross-sectional pre–post survey was done to assess disease awareness and knowledge among those who attended the health campaign. The data analysis includes a total of 230 participants with complete data. After the campaign, the pharmacy students used self-assessment to reflect their learning experience.FindingsMost participants were unaware of their blood pressure and blood glucose readings, but they reported improved awareness of diseases and prevention of hypertension and diabetes after the health campaign. Although most participants correctly identified the common signs and symptoms of hypertension, few could associate it with overweight. Most participants were unaware of the 5 g per day salt intake limit for controlling hypertension before the campaign. Most participants were less aware that diabetes is associated with impaired vision, peripheral neuropathy, renal and heart diseases. Students expressed increased confidence in leadership, teamwork and communication abilities after the campaign based on self-assessment.Practical implicationsA health campaign enhances the disease knowledge of the general public. It has been suggested that experiential learning be encouraged in the pharmacy curriculum.Originality/valueThis study adds to the knowledge on the roles of community-based health campaigns and the value of pharmacy students’ involvement in experiential learning.
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Clinical outcomes of a community clinic-based lifestyle change program for prevention and management of metabolic syndrome: Results of the 'Vida Sana/Healthy Life' program. PLoS One 2021; 16:e0248473. [PMID: 33793595 PMCID: PMC8016241 DOI: 10.1371/journal.pone.0248473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction As US Hispanic populations are at higher risk than non-Hispanics for cardiovascular disease and Type 2 diabetes targeted interventions are clearly needed. This paper presents the four years results of the Vida Sana Program (VSP), which was developed and is implemented by a small clinic serving mostly Spanish-speaking, limited literacy population. Methods The eight-week course of interactive two-hour sessions taught by Navegantes, bilingual/cultural community health workers, was delivered to participants with hypertension, or high lipids, BMI, waist circumference, glucose or hemoglobin A1C (A1C). Measures, collected by Navegantes and clinic nurses, included blood chemistries, blood pressure, anthropometry, and an assessment of healthy food knowledge. Results Most participants (67%) were female, Hispanic (95%), and all were 18 to 70 years of age. At baseline, close to half of participants were obese (48%), had high waist circumference (53%), or elevated A1C (52%), or fasting blood glucose (57%). About one third had high blood pressure (29%) or serum cholesterol (35%), and 22% scored low on the knowledge assessment. After the intervention, participants decreased in weight (-1.0 lb), BMI (-0.2 kg/m2), WC (-0.4 inches), and cholesterol (-3.5 mg/dl, all p<0.001). Systolic blood pressure decreased (-1.7 mm Hg, p<0.001), and the knowledge score increased (6.8 percent, p<0.001). Discussion VSP shows promising improvements in metabolic outcomes, similar to other programs with longer duration or higher intensity interventions. VSP demonstrates an important model for successful community-connected interventions.
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Cushman M, Shay CM, Howard VJ, Jiménez MC, Lewey J, McSweeney JC, Newby LK, Poudel R, Reynolds HR, Rexrode KM, Sims M, Mosca LJ. Ten-Year Differences in Women's Awareness Related to Coronary Heart Disease: Results of the 2019 American Heart Association National Survey: A Special Report From the American Heart Association. Circulation 2021; 143:e239-e248. [PMID: 32954796 PMCID: PMC11181805 DOI: 10.1161/cir.0000000000000907] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND High awareness that cardiovascular disease is the leading cause of death (LCOD) among women is critical to prevention. This study evaluated longitudinal trends in this awareness among women. METHODS AND RESULTS Online surveys of US women (≥25 years of age) were conducted in January 2009 and January 2019. Data were weighted to the US population distribution of sociodemographic characteristics. Multivariable logistic regression was used to evaluate knowledge of the LCOD. In 2009, awareness of heart disease as the LCOD was 65%, decreasing to 44% in 2019. In 2019, awareness was greater with older age and increasing education and lower among non-White women and women with hypertension. The 10-year awareness decline was observed in all races/ethnicities and ages except women ≥65 years of age. The greatest declines were among Hispanic women (odds ratio of awareness comparing 2019 to 2009, 0.14 [95% CI, 0.07-0.28]), non-Hispanic Black women (odds ratio, 0.31 [95% CI, 0.19-0.49]), and 25- to 34-year-olds (odds ratio, 0.19 [95% CI, 0.10-0.34]). In 2019, women were more likely than in 2009 to incorrectly identify breast cancer as the LCOD (odds ratio, 2.59 [95% CI, 1.86-3.67]), an association that was greater in younger women. Awareness of heart attack symptoms also declined. CONCLUSIONS Awareness that heart disease is the LCOD among women declined from 2009 to 2019, particularly among Hispanic and non-Hispanic Black women and in younger women (in whom primordial/primary prevention may be most effective). An urgent redoubling of efforts by organizations interested in women's health is required to reverse these trends.
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Dağıstan Akgöz A, Ozer Z, Gözüm S. The effect of lifestyle physical activity in reducing cardiovascular disease risk factors (blood pressure and cholesterol) in women: A systematic review. Health Care Women Int 2020; 42:4-27. [PMID: 33175658 DOI: 10.1080/07399332.2020.1828422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cardiovascular diseases (CVD) are the most important cause of death in older women. Although there is strong evidence in the literature that moderate lifestyle physical activity (PA) is effective in modifiable CVD risk factors, there is limited evidence demonstrating which activities are effective in women. This systematic review was conducted to evaluate the effect of lifestyle PA interventions on CVD risk factors in women. Various databases were searched for English articles from 2000 to 2019. Eight articles met the selection criteria. It is recommended to use different combinations of interventions including moderate PA, to reduce CVD risk factors in women.
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Affiliation(s)
| | - Zeynep Ozer
- Department of Internal Medicine Nursing, Akdeniz Universitesi, Antalya, Turkey
| | - Sebahat Gözüm
- Department of Public Health Nursing, Akdeniz Universitesi, Antalya, Turkey
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de Almeida AP, Rocha DMUP, Moreira AVB, Moraes E Lima HCF, Hermsdorff HHM. Personalized Nutrition Using PROCARDIO to Reduce Cardiometabolic Risk in the Academic Community: A Study Protocol with Preliminary Results. J Am Coll Nutr 2020; 39:591-600. [PMID: 32101086 DOI: 10.1080/07315724.2019.1706663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Background: Strategies of promotion, prevention and health care of individuals with cardiometabolic risk are necessary to control cardiovascular diseases.Objective: To describe a study design and present partial results of nutritional counseling in the Cardiovascular Health Care Program (PROCARDIO).Methods: PROCARDIO is a nutritional intervention program for students and workers or dependents of the Brazilian university academic community who are at risk of or have a cardiovascular disease (Brazilian Registry of Clinical Trials n° RBR-5n4y2g). Patients are submitted to nutritional clinical assessments involving anthropometry, biochemical analysis, sociodemographic and clinical, lifestyle and dietary data. Patients are provided with nutritional counseling, dietetic workshops and educational materials. In addition, nutritional following-ups are performed monthly.Results: The sample consisted of 296 patients (171 F/125 M, 27-56 years). The prevalence of individuals with excess body weight, dyslipidemia, diabetes and hypertension in the sample were 74.7% (n = 222), 79.1% (n = 235), 18.2% (n = 54) and 25.3% (n = 75), respectively. After three months of nutritional counseling, PROCARDIO users had decreased body fat, waist circumference, fasting blood glucose, total cholesterol and LDL-C (p < 0.05). Specifically, patients with diabetes exhibited reduced glycated hemoglobin concentrations (p < 0.05); those with dyslipidemia showed a reduction in total cholesterol, LDL-C and LDL/HDL (p < 0.05) concentrations; and those with excess body weight reduced waist circumference, waist-to-hip ratio, body fat, uric acid and total cholesterol/HDL-C ratios (p < 0.05).Conclusion: PROCARDIO patients concluded with a clinical-metabolic improvement regardless of chronic diseases after receiving nutritional counseling, thus highlighting the importance of individual actions and strategies to be based on personalized nutrition for achieving proposed therapeutic targets.
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Interventions to Reduce Ethnic and Racial Disparities in Dyslipidemia Management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:24. [DOI: 10.1007/s11936-019-0725-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Sriram U, Sandreuter K, Graham M, Folta S, Pullyblank K, Paul L, Seguin R. Process Evaluation of Strong Hearts, Healthy Communities: A Rural Community-Based Cardiovascular Disease Prevention Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:138-149. [PMID: 30738562 PMCID: PMC6422156 DOI: 10.1016/j.jneb.2018.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/13/2018] [Accepted: 10/21/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the implementation of a community-based cardiovascular disease prevention program for rural women: Strong Hearts, Healthy Communities (SHHC). DESIGN Mixed-methods process evaluation. SETTING/PARTICIPANTS A total of 101 women from 8 rural towns were enrolled in the SHHC program; 93 were enrolled as controls. Eligible participants were aged ≥40 years, sedentary, and overweight or obese. Local health educators (n = 15) served as program leaders within each town. OUTCOME MEASURES Reach, fidelity, dose delivered, dose received, and program satisfaction were assessed using after-class surveys, participant satisfaction surveys, interviews with program leaders, and participant focus groups. ANALYSIS Descriptive statistics, chi-square tests of independence, and thematic analysis were employed. RESULTS Intervention sites reported high levels of fidelity (82%) and dose delivered (84%). Overall reach was 2.6% and program classes were rated as effective (3.9/5). Participants were satisfied with their experience and reported benefits such as camaraderie and awareness of healthy eating and exercise strategies. Common recommendations included increasing class time and enhancing group discussion. CONCLUSIONS AND IMPLICATIONS Implementation was good in terms of fidelity, dose delivered, and satisfaction, although low reach. Findings from this research have informed a second round of implementation and evaluation of the SHHC program in rural communities.
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Affiliation(s)
- Urshila Sriram
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | | | - Meredith Graham
- Division of Nutritional Sciences, Cornell University, Ithaca, NY
| | - Sara Folta
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA
| | | | - Lynn Paul
- College of Education, Health and Development, Montana State University, Bozeman, MT
| | - Rebecca Seguin
- Division of Nutritional Sciences, Cornell University, Ithaca, NY.
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Systematic Review of the Effect of Lifestyle Interventions on the Components of the Metabolic Syndrome in South Asian Migrants. J Immigr Minor Health 2019; 20:231-244. [PMID: 27766507 DOI: 10.1007/s10903-016-0515-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A systematic review was undertaken to identify lifestyle intervention studies in South Asian migrant populations to determine the effect on the components of the metabolic syndrome. A total of seven studies were identified, of which six focused on educational advice and the seventh on intensive exercise intervention. Four studies were Randomised Controlled Trials of which two studies reported significant reductions in waist circumference. One of these studies focused on home based education with cooperation of the home cook (adjusted waist reduction of 1.9 cm, 95 % CI 0.52-3.3 cm; p = 0.007) and the other entailed an intensive physical activity program (adjusted waist reduction 3.4 cm, 95 % CI 2.0-4.7 cm). The evidence whether lifestyle intervention studies in South Asians can improve components of the metabolic system is not clear. Further lifestyle interventions for South Asians should be culturally adapted, involve friends and family, especially those with cooking responsibilities.
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Risica PM, McCarthy M, Barry K, Oliverio SP, De Groot AS. Community clinic-based lifestyle change for prevention of metabolic syndrome: Rationale, design and methods of the 'Vida Sana/healthy life' program. Contemp Clin Trials Commun 2018; 12:123-128. [PMID: 30417157 PMCID: PMC6218840 DOI: 10.1016/j.conctc.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/09/2018] [Accepted: 10/17/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose and Objectives: The risk of diseases associated with Metabolic Syndrome (MetS) is higher for Hispanics living in the northeastern United States than for other racial and ethnic groups. Higher risk of diabetes, high blood lipids, obesity and limited access to continuity of care are all factors that also contribute to disproportionately poorer chronic disease outcomes for Hispanics. Intervention approach This article describes the planning and implementation of, and evaluation plans for the Vida Sana Program (VSP), a community-based group intervention created to address the identified MetS risks by encouraging healthier diet and physical activity behaviors among a low-income, largely Spanish speaking, and literacy limited uninsured population. Developed in response to recent calls for culturally-tailored interventions, VSP is conducted by trained bicultural/bilingual Navegantes, who deliver a culturally sensitive, fun and engaging eight-week, in-person educational series through group meetings. The intervention also includes a 40-page colorful, picture and graphic enhanced booklet to be used in the group setting and at home. The intervention focused on screening for MetS-associated disease risk factors, understanding chronic disease management, encouraging medication adherence, increasing physical activity, and healthful dietary changes such as limiting alcohol, sodium, unhealthy fats and excess carbohydrate intake, while emphasizing portion control, whole grains and healthy fats. Conclusions This creative, community-based approach fills an important gap in the community and in the public health literature, is well liked by health literacy limited patients, and will provide an important model of successfully engaging the Hispanic community on these important health issues.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Box G-S121, Providence, RI, 02912, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121, Providence, RI, 02912, USA.,Department of Epidemiology Brown School of Public Health, Providence, RI, 02912, USA
| | | | | | - Susan P Oliverio
- Department of Internal Medicine, Warren Alpert School of Medicine, Brown University, Providence, RI, 02903, USA
| | - Anne S De Groot
- Institute for Immunology and Informatics, University of Rhode Island, 02903, USA.,Clínica Esperanza/Hope Clinic, Providence, RI, 02909, USA
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Trejo R, Cross W, Stephenson J, Edward KL. Young adults' knowledge and attitudes towards cardiovascular disease: A systematic review and meta-analysis. J Clin Nurs 2018; 27:4245-4256. [DOI: 10.1111/jocn.14517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/18/2018] [Accepted: 05/07/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Ronald Trejo
- School of Nursing, Midwifery and Paramedicine (Melbourne Campus); Faculty of Health Sciences; Australian Catholic University; Fitzroy Vic. Australia
| | - Wendy Cross
- National Mental Health Commission; Laureate International Universities; Melbourne Vic. Australia
| | - John Stephenson
- School of Human and Health Sciences; University of Huddersfield; Huddersfield UK
| | - Karen-leigh Edward
- Faculty of Health, Arts and Design; Swinburne University of Technology; Melbourne Vic. Australia
- St Vincent's Private Hospital; Melbourne Vic. Australia
- University of Huddersfield; Huddersfield UK
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Soto Mas F, Schmitt CL, Jacobson HE, Myers OB. A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum. J Community Health 2018; 43:717-724. [PMID: 29428986 DOI: 10.1007/s10900-018-0475-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.
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Affiliation(s)
- Francisco Soto Mas
- College of Population Health MSC09 5070, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA.
| | - Cheryl L Schmitt
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Holly E Jacobson
- Department of Linguistics, University of New Mexico, Albuquerque, NM, USA
| | - Orrin B Myers
- School of Medicine, Family & Community Medicine, University of New Mexico, Albuquerque, NM, USA
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Raeisi-Giglou P, Volgman AS, Patel H, Campbell S, Villablanca A, Hsich E. Advances in Cardiovascular Health in Women over the Past Decade: Guideline Recommendations for Practice. J Womens Health (Larchmt) 2018; 27:128-139. [PMID: 28714810 PMCID: PMC5815443 DOI: 10.1089/jwh.2016.6316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the number one cause of death in women. It is estimated that 44 million women in the United States are either living with or at risk for heart disease. This article highlights the recent significant progress made in improving care, clinical decision-making, and policy implications for women with CVD. We provide our perspective supported by evidence-based advances in cardiovascular research and clinical care guidelines in seven areas: (1) primary CVD prevention and community heart care, (2) secondary prevention of CVD, (3) stroke, (4) heart failure and cardiomyopathies, (5) ischemia with nonobstructive coronary artery disease, (6) spontaneous coronary artery dissection, and (7) arrhythmias and device therapies. Advances in these fields have improved the lives of women living with and at risk for heart disease. With increase awareness, partnership with national organizations, sex-specific research, and changes in policy, the morbidity and mortality of CVD in women can be further reduced.
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Affiliation(s)
| | - Annabelle Santos Volgman
- Rush Heart Center for Women Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Hena Patel
- Rush Heart Center for Women Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | | | - Amparo Villablanca
- Women's Cardiovascular Medicine Program, Division of Cardiovascular Medicine, University of California, Davis, Davis, California
| | - Eileen Hsich
- Heart and Vascular Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Lai YJ, Hu HY, Lee YL, Ku PW, Yen YF, Chu D. A retrospective cohort study on the risk of stroke in relation to a priori health knowledge level among people with type 2 diabetes mellitus in Taiwan. BMC Cardiovasc Disord 2017; 17:130. [PMID: 28532430 PMCID: PMC5440939 DOI: 10.1186/s12872-017-0568-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/14/2017] [Indexed: 12/15/2022] Open
Abstract
Background Intervention of diabetes care education with regular laboratory check-up in outpatient visits showed long-term benefits to reduce the risk of macrovascular complications among people with type 2 diabetes. However, research on the level of a priori health knowledge to the prevention of diabetic complications in community settings has been scarce. We therefore aimed to investigate the association of health knowledge and stroke incidence in patients with type 2 diabetes in Taiwan. Methods A nationally representative sample of general Taiwanese population was selected using a multistage systematic sampling process from Taiwan National Health Interview Survey (NHIS) in 2005. Subjects were interviewed by a standardized face-to-face questionnaire in the survey, obtaining information of demographics, socioeconomic status, family medical history, obesity, health behaviors, and 15-item health knowledge assessment. The NHIS dataset was linked to Taiwan National Health Insurance claims data to retrieve the diagnosis of type 2 diabetes in NHIS participants at baseline and identify follow-up incidence of stroke from 2005 to 2013. Univariate and multivariate Cox regressions were used to estimate the effect of baseline health knowledge level to the risk of stroke incidence among this group of people with type 2 diabetes. Results A total of 597 diabetic patients with a mean age of 51.28 years old and nearly half of males were analyzed. During the 9-year follow-up period, 65 new stroke cases were identified among them. Kaplan–Meier curves comparing the three groups of low/moderate/high knowledge levels revealed a statistical significance (p-value of log-rank test <0.01). After controlling for potential confounders, comparing to the group of low health knowledge level, the relative risk of stroke was significantly lower for those with moderate (adjusted hazard ratio [AHR] = 0.63; 95% CI, 0.33–1.19; p-value = 0.15) and high level of health knowledge (AHR = 0.43; 95% CI, 0.22–0.86; p-value = 0.02), with a significant linear trend (p-value = 0.02). Conclusions An exposure-response gradient of moderate to high health knowledge levels to the prevention of stroke incidence among people with type 2 diabetes in community was found with 9 years of follow-up in Taiwan. Development and delivery of health education on stroke prevention to people with type 2 diabetes are warranted.
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Affiliation(s)
- Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Hsiao-Yun Hu
- Department of Education and Research, Taipei City Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Ling Lee
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Dentistry, Taipei City Hospital, Taipei, Taiwan.,Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
| | - Po-Wen Ku
- Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan
| | - Yung-Feng Yen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, No.145, Zhengzhou Rd., Datong Dist., Taipei, 10341, Taiwan. .,Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan. .,Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Dachen Chu
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan. .,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. .,Department of Neurosurgery, Taipei City Hospital, Taiwan, No.145, Zhengzhou Rd., Datong Dist., Taipei, 10341, Taiwan. .,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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18
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Lucke-Wold B, Shawley S, Ingels JS, Stewart J, Misra R. A Critical Examination of the Use of Trained Health Coaches to Decrease the Metabolic Syndrome for Participants of a Community-Based Diabetes Prevention and Management Program. JOURNAL OF HEALTHCARE COMMUNICATIONS 2016; 1. [PMID: 27857997 PMCID: PMC5110146 DOI: 10.4172/2472-1654.100038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The epidemic of obesity and diabetes in the United States poses major challenge to the prevention and management of chronic diseases. Furthermore, when this is viewed in other components of the metabolic syndrome (i.e., the burden of high cholesterol and hypertension), the prevalence of the metabolic syndrome continues to rise in the USA continued challenge is how to deal with this epidemic from a medical and public health standpoint. Community Based Participatory Research (CBPR) is a unique approach and offers a novel perspective for answering this challenge. A critical set of goals for CBPR is to address health disparities and social inequalities while getting community members engaged in all aspects of the research process. Utilizing the West Virginia Diabetes Prevention and Management Program and trained Health Coaches as a model, we discuss topics of consideration related to CBPR, involving trained health coaches, optimizing early adoption of healthy lifestyle behaviors, and enhancing participation. Through careful project planning and design, questions regarding disparities increasing susceptibility and preventive efforts within the community can be addressed successfully. These topics are part of a broader integration of theories such as participatory research, community engagement, and outcomes measurement. The understanding of the pathophysiology and epidemiology of the metabolic syndrome can help frame an appropriate strategy for establishing long-term community-wide changes that promote health. In order to continue to improve investigations for preventing the metabolic syndrome, it will be necessary to have aggressive efforts at the individual and population level for developing culturally sensitive programs that start early and are sustainable in practical environments such as the workplace. In this comprehensive review, we will discuss practical considerations related to project design, implementation, and how to measure effectiveness in regards to reducing the burden of the metabolic syndrome.
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Affiliation(s)
| | | | | | | | - Ranjita Misra
- West Virginia University, Morgantown, West Virginia, USA
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19
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Yang SO, Kim SJ, Lee SH. Effects of a South Korean Community-Based Cardiovascular Disease Prevention Program for Low-Income Elderly with Hypertension. J Community Health Nurs 2016; 33:154-67. [DOI: 10.1080/07370016.2016.1191872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Villablanca AC, Slee C, Lianov L, Tancredi D. Outcomes of a Clinic-Based Educational Intervention for Cardiovascular Disease Prevention by Race, Ethnicity, and Urban/Rural Status. J Womens Health (Larchmt) 2016; 25:1174-1186. [PMID: 27356155 DOI: 10.1089/jwh.2015.5387] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Heart disease is the leading killer of women and remains poorly recognized in high-risk groups. We assessed baseline knowledge gaps and efficacy of a survey-based educational intervention. METHODS Four hundred seventy-two women in clinical settings completed pre-/post-surveys for knowledge of: heart disease as the leading killer, risk factors (general and personal levels), heart attack/stroke symptoms, and taking appropriate emergency action. They received a clinic-based educational intervention delivered by healthcare professionals in the course of their clinical care. Change score analyses tested pre-/post-differences in knowledge after the educational intervention, comparing proportions by race, ethnicity, and urban/nonurban status. RESULTS Knowledge and awareness was low in all groups, especially for American Indian women (p < 0.05). Awareness was overall highest for heart disease as the leading killer, but it was the lowest for taking appropriate action (13% of Hispanic, 13% of American Indian, 29% of African American, and 18% of nonurban women; p < 0.05). For all women, knowledge of the major risk factors was low (58%) as was knowledge of their personal levels for risk factors (73% awareness for hypertension, 54% for cholesterol, and 50% for diabetes). The intervention was effective (% knowledge gain) in all groups of women, particularly for raising awareness of: (1) heart disease as the leading killer in American Indian (25%), Hispanic (18%), and nonurban (15%) women; (2) taking appropriate action for American Indian (80%), African American (64%), non-Hispanic (55%), and urban (56%) women; (3) heart disease risk factors for Hispanic (56%) and American Indian (47%) women; and (4) heart disease and stroke symptoms in American Indian women (54% and 25%, respectively). CONCLUSIONS Significant knowledge gaps persist for heart disease in high-risk women, suggesting that these gaps and groups should be targeted by educational programs. We specify areas of need, and we demonstrate efficacy of a clinic-based educational intervention that can be of utility to busy healthcare professionals.
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Affiliation(s)
- Amparo C Villablanca
- 1 Division of Cardiovascular Medicine, University of California , Davis, Davis, California
| | - Christina Slee
- 2 Clinical Affairs Division, University of California , Davis Medical Center, Davis, California
| | - Liana Lianov
- 3 Department of Internal Medicine, American College of Lifestyle Medicine, University of California , Davis, Davis, California
| | - Daniel Tancredi
- 4 Department of Pediatrics, Center for Healthcare Policy and Research, University of California , Davis, Davis, California
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21
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Mattei J, Mendez J, Falcon LM, Tucker KL. Perceptions and Motivations to Prevent Heart Disease among Puerto Ricans. Am J Health Behav 2016; 40:322-31. [PMID: 27103411 DOI: 10.5993/ajhb.40.3.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVES We performed a qualitative assessment of Puerto Ricans' knowledge and perceptions of cardiovascular disease (CVD), and motivations/barriers and preferences to participate in community/ clinical programs for CVD-prevention. METHODS Four guided focus group discussions were conducted on a total of 24 Puerto Ricans, aged 40-60 years in Boston, MA. RESULTS Participants were aware of CVD, but less knowledgeable about its prevention. They perceived it as serious, and either had CVD or knew someone who had it. They favored education and activities on nutrition, exercise, clinical advice, and social interaction, in weekly/ biweekly small-group sessions with other Latinos, led in Spanish by a familiar health professional, in a convenient community location. Age- and culture-specific program content and educational materials were preferred. A theme emerged on 'personal or family motivations' such as to become healthier and live longer so they would feel better and support their families, or to learn about CVD-prevention. Main barriers included family obligations, weather, safety concerns, transportation, and depressive mood. CONCLUSIONS Culturally-tailored CVD-prevention programs for Puerto Ricans should include multiple behavioral and social approaches, and draw on intrinsic motivators while reducing barriers to help enhance efficacy and sustainability.
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Affiliation(s)
- Josiemer Mattei
- Harvard T.H. Chan School of Public Health, Department of Nutrition, Boston MA, USA.
| | | | - Luis M Falcon
- College of Fine Arts, Humanities and Social Services, University of Massachusetts, Lowell, MA, USA
| | - Katherine L Tucker
- Department of Clinical Laboratory and Nutritional Sciences, University of Massachusetts, Lowell, MA, USA
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Vivir Con Un Corazón Saludable: a Community-Based Educational Program Aimed at Increasing Cardiovascular Health Knowledge in High-Risk Hispanic Women. J Racial Ethn Health Disparities 2016; 3:99-107. [PMID: 26896109 DOI: 10.1007/s40615-015-0119-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 03/22/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hispanic women suffer from high rates of cardiometabolic risk factors and an increasingly disproportionate burden of cardiovascular disease (CVD). Particularly, Hispanic women with limited English proficiency suffer from low levels of CVD knowledge associated with adverse CVD health outcomes. METHODS Thirty-two predominantly Spanish-speaking Hispanic women completed, Vivir Con un Corazón Saludable (VCUCS), a culturally tailored Spanish language-based 6-week intensive community program targeting CVD health knowledge through weekly interactive health sessions. A 30-question CVD knowledge questionnaire was used to assess mean changes in CVD knowledge at baseline and postintervention across five major knowledge domains including CVD epidemiology, dietary knowledge, medical information, risk factors, and heart attack symptoms. RESULTS Completion of the program was associated with a statistically significant (p < 0.001) increase in total mean CVD knowledge scores from 39 % (mean 11.7/30.0) to 66 % (mean 19.8/30.0) postintervention consistent with a 68 % increase in overall mean CVD scores. There was a statistically significant (p < 0.001) increase in mean knowledge scores across all five CVD domains. CONCLUSION A culturally tailored Spanish language-based health program is effective in increasing CVD awareness among high CVD risk Hispanic women with low English proficiency and low baseline CVD knowledge.
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23
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Folta SC, Seguin RA, Chui KKH, Clark V, Corbin MA, Goldberg JP, Heidkamp-Young E, Lichtenstein AH, Wiker N, Nelson ME. National Dissemination of StrongWomen-Healthy Hearts: A Community-Based Program to Reduce Risk of Cardiovascular Disease Among Midlife and Older Women. Am J Public Health 2015; 105:2578-85. [PMID: 26469644 PMCID: PMC4638239 DOI: 10.2105/ajph.2015.302866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We describe the national dissemination of an evidence-based community cardiovascular disease prevention program for midlife and older women using the RE-AIM (reach effectiveness adoption implementation maintenance) framework and share key lessons learned during translation. METHODS In a 2010 to 2014 collaboration between the StrongWomen program and the National Extension Association of Family and Consumer Sciences, we assessed reach, adoption, implementation, and maintenance using survey methods, and we assessed effectiveness using a pretest-posttest within-participants design, with weight change as the primary outcome. RESULTS Overall reach into the population was 15 per 10,000. Of 85 trained leaders, 41 (48%) adopted the program. During the 12-week intervention, weight decreased by 0.5 kilograms, fruit and vegetable intake increased by 2.1 servings per day, and physical activity increased by 1238 metabolic equivalent (MET)-minutes per week (all P < .001). Average fidelity score was 4.7 (out of possible 5). Eleven of 41 adopting leaders (27%) maintained the program. CONCLUSIONS The StrongWomen-Healthy Hearts program can be implemented with high fidelity in a variety of settings while remaining effective. These data provide direction for program modification to improve impact as dissemination continues.
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Affiliation(s)
- Sara C Folta
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Rebecca A Seguin
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Kenneth K H Chui
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Valerie Clark
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Marilyn A Corbin
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Jeanne P Goldberg
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Eleanor Heidkamp-Young
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Alice H Lichtenstein
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Nancy Wiker
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
| | - Miriam E Nelson
- At the time of the study, Sara C. Folta, Valerie Clark, Jeanne P. Goldberg, Eleanor Heidkamp-Young, and Miriam E. Nelson were with the Friedman School of Nutrition Science and Policy; Kenneth K. H. Chui was with the Department of Public Health and Community Medicine, School of Medicine; and Alice H. Lichtenstein was with the Human Nutrition Research Center on Aging, Tufts University, Boston, MA. Rebecca A. Seguin was with the Division of Nutritional Sciences, Cornell University, Ithaca, NY. Marilyn A. Corbin was with the Penn State Extension, University Park, PA. Nancy Wiker was with the Penn State Cooperative Extension, Lancaster, PA
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Cainzos-Achirica M, Blaha MJ. Cardiovascular risk perception in women: true unawareness or risk miscalculation? BMC Med 2015; 13:112. [PMID: 25963396 PMCID: PMC4428116 DOI: 10.1186/s12916-015-0351-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/21/2015] [Indexed: 12/18/2022] Open
Abstract
Assessing the 'accuracy' of cardiovascular risk perception is a worthy scientific goal that may lead to targeted interventions aimed at improving risk communication and health outcomes. Current cardiovascular risk scores, however, have shown poor calibration when used in populations that differ temporally and/or geographically from the derivation sample, limiting their reliability as the reference standard for absolute risk. In addition, accurately assessing risk awareness is challenging, with few available validated tools for effectively accounting for the outcomes assessed (coronary heart disease vs. cardiovascular disease), the time span of prediction (10-year vs. lifetime risk), and concepts of absolute versus relative risk. In this context, assessing patient awareness of the role of age as the key, non-modifiable driver of absolute risk can be particularly challenging. This commentary will examine each of these issues, providing context for the interpretation of studies on 'discordance' between calculated and perceived cardiovascular risk, such as the one recently published by Oertelt-Prigione et al. Moreover, we explore alternative approaches aimed at overcoming those limitations, enhancing understanding of the factors and true magnitude associated with such discordance.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Michael J Blaha
- Department of Epidemiology and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD, USA. .,Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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