Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP)

Abstract

BackgroundSouth Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population.MethodsSouth Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures).ResultsBaseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff.ConclusionsSA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer–led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.

Acceptability of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda: a qualitative study

“…For community members, they looked at the intervention programme as an opportunity to obtain knowledge about CVDs and their prevention, and access extended screening and treatment services within their communities or health facility. Similar aspirations and benefits have been reported in other community programmes [33,34].…”

Facilitators of and barriers to accessing clinical prevention services for the South Asian population in Surrey, British Columbia: a qualitative study

“…The literature on access to primary care services, including prevention services, by South Asian people in North America highlights the impact of culturally related 9 and pragmatic 10 barriers to uptake such as transportation and hours of service. It also describes the central role of culture and health literacy in preventive service uptake and chronic disease management for people from South Asia [21][22][23] and other immigrant and older populations.…”

“…6,10,11,16 We sought to develop a more in-depth understanding of the facilitators of and barriers to uptake of clinical prevention services for the South Asian population.…”

A community faith centre based screening and educational intervention to reduce the risk of type 2 diabetes: A feasibility study

“…There is a small but growing body of literature reporting on such activities aimed at screening in these settings for cardiovascular risk factors such as blood pressure and cholesterol [16,17]. The key factors that have been identified in promoting uptake are linguistic and cultural competence in the context of effective communication of health advice [18] within these initiatives.…”

“…Success in previous faith based screening interventions has also been attributed to the involvement of community volunteers and peer educators [17] [19]. Involving members of the community in the design and delivery of interventions is important in overcoming barriers and meeting the needs of the community in relation to engagement in clinical trials [20][21][22].…”