Using an Intervention Mapping Approach to Develop a Program for Preventing High Blood Pressure in a Marginalized Afro-Colombian Population: A Community-Based Participatory Research

The prevention of high blood pressure (HBP) is an important public health initiative worldwide, since HBP is the main risk factor for cardiovascular diseases and increases the damage caused by coronavirus disease 2019 (COVID-19). We designed, implemented, and evaluated a program to identify effective and sustainable interventions for preventing HBP in a marginalized black population. Our study was conducted in Quibdó, a city in Colombia with the highest poverty rate and located in the Pacific coast, a subregion in Colombia with the highest prevalence of HBP. We followed an intervention mapping framework using a community-based participatory research approach. Focus groups, photovoice, literature reviews, and cross-sectional quantitative surveys were used for data collection. The community chose the time, place, and type of physical activity; led the physical activities; and strengthened their skills in seeking resources in their community to sustain the program. The evaluation was aimed at determining whether the interventions were able to achieve the program’s primary aim. We used a before (September 2016) and after (December 2017) design for the evaluation. To decrease the selection bias and allow comparisons between homogeneous groups, we used a propensity score matching technique. The steps required to create a self-sustaining physical activity program were provided in detail. The pre-post test showed a decrease of the HBP (systolic, 13.4% points; p = 0.018; diastolic, 6.5% points; p = 0.002). The program may be an effective and self-sustaining intervention, and it can be replicated by policymakers and implemented in other population groups.

Discussing lifestyle behaviors: perspectives and experiences of general practitioners

Background: Initiatives aimed at increasing participation in preventive health behaviors has been identified as a priority for addressing the increasing incidence of non-communicable chronic disease. General practice is an existing network that can be leveraged to intervene and promote messages for health behavior change. We aimed to explore the extent to which ‘lifestyle’ behaviors are discussed by general practitioners (GPs) with their patients in their practices, and the context and content of these discussions.

Methods: GPs (N = 26) practising in Australian clinics participated in semi-structured interviews. Data were analyzed using an inductive thematic analysis.

Results: Results showed discussions of lifestyle behaviors were brief, but relatively frequent and often initiated by the GP. GPs generally provided basic advice and education that was often ad-hoc and in reaction to prompts from the patient. GPs recognized the importance of addressing lifestyle behaviors in practice, but also highlighted substantive barriers that limit the initiation of these discussions. These included patient readiness for change, patient acceptance and openness, patient accountability and responsibility, patient background factors, GPs’ role and knowledge, GP financial implications, GP-patient relationship, and lack of time.

Conclusions: Current findings provide important preliminary knowledge on the extent to which Australian GPs discuss lifestyle behavior change with patients during routine consultations, the context and content of these discussions, and barriers to initiating these discussions. Further research should seek to gain a better understanding of barriers and identify strategies to mitigate their impact. This might maximize the potential for GPs to promote adaptive lifestyle behavior change for improving patient health.

A review of healthy weight behavior maintenance in Hispanic women

Healthy weight behavior maintenance is key to prevent overweight and obesity in Hispanic/Latino women, particularly for those who are more likely to be sedentary. In this paper, I review the intervention components used by various researchers for successful healthy weight behavior maintenance for Hispanic women. Randomized and experimental studies were located (N = 9) through computer and manual searches in identified articles dated between 1992 and 2015. The methodological characteristics and components of the intervention studies were analyzed systematically. Maintenance of behavior was determined by the statistical significant behavior change and by the effective magnitude of the intervention effect report, favoring the experimental groups in the follow-up periods. Intervention components supporting Hispanic women's weight-related behavior changes and maintenance included interpersonal contact, intervention duration, and the use of cultural motivation and social support strategies. Seven studies were found to be successful in maintaining behavior change, although their retention rates at follow-up completion had either wide-ranging variations or were not specified. The findings are discussed, and recommendations are made so future efforts may successfully employ weight-related intervention strategies for behavior maintenance in Hispanic women.