Impact of Technology-Based Intervention for Improving Self-Management Behaviors in Black Adults with Poor Cardiovascular Health: A Randomized Control Trial

Abstract

Cardiovascular disease (CVD) is the number one killer of adults in the U.S., with marked ethnic/racial disparities in prevalence, risk factors, associated health behaviors, and death rates. In this study, we recruited and randomized Blacks with poor cardiovascular health in the Atlanta Metro area to receive an intervention comparing two approaches to engagement with a behavioral intervention technology for CVD. Generalized Linear Mixed Models results from a 6-month intervention indicate that 53% of all participants experienced a statistical improvement in Life’s Simple 7 (LS7), 54% in BMI, 61% in blood glucose, and 53% in systolic blood pressure. Females demonstrated a statistically significant improvement in BMI and diastolic blood pressure and a reduction in self-reported physical activity. We found no significant differences in changes in LS7 or their constituent parts but found strong evidence that health coaches can help improve overall LS7 in participants living in at-risk neighborhoods. In terms of clinical significance, our result indicates that improvements in LS7 correspond to a 7% lifetime reduction of incident CVD. Our findings suggest that technology-enabled self-management can be effective for managing selected CVD risk factors among Blacks.

A Systematic Review of Internet-Based Interventions for the Prevention and Self-Management of Cardiovascular Diseases among People of African Descent

“…All the studies were conducted in the United States of America (USA). Two studies were predominantly concerned with CVD prevention [ 43 , 44 ]. The remaining 11 studies were mostly concerned with preventing or self-management of CVD risk factors, including hypertension, diabetes, overweight and obesity, physical inactivity, and smoking [ 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ].…”

“…Socioeconomic status, regional information, and prior internet usage were not reported universally. Eleven of the studies were RCTs [ 43 , 44 , 46 , 47 , 48 , 50 , 51 , 52 , 53 , 54 , 55 ] and two were pre-test and post-test quasi-experiments [ 45 , 49 ]. The duration of follow-up in randomised controlled trials and quasi-experimental studies varied between 30 days and 12 months.…”

“…Most studies were published during the last decade (85.7%). Participants were recruited from metropolitan areas [ 44 , 45 , 46 , 48 , 51 , 55 ], big academic medical facilities [ 49 ], primary care and outpatient clinics [ 52 , 54 ], churches [ 43 , 47 ], and an online community [ 50 , 53 ].…”

“…Migneault et al [ 50 ] utilised social cognitive theory, motivational interviewing, and transtheoretical models to design their intervention. The mobile health modalities used in the studies are social media [ 45 , 48 ], smartphone applications [ 43 , 44 , 52 , 55 ], voice technologies [ 50 , 54 ], online videos [ 47 ], and websites [ 46 , 49 , 51 , 53 , 55 ]. The intervention in one of the studies was in the form of website and smartphone applications [ 55 ].…”

“…Two studies compared the outcomes of pre- and post-intervention [ 42 , 46 ]. One three-arm study compared the outcomes of interventions delivered via tailored Internet, tailored print, and standard Internet [ 51 ]; another study compared two approaches to engagement with a behavioural intervention technology for CVDs [ 44 ]. Finally, one study contrasted a tailored website with standard text message intervention [ 55 ].…”