Abstract:Compared with UCG women, women in the EIG were more likely to improve their health behaviors. The CVD risk profile, as measured by the 10-year CHD risk, improved in women with the highest baseline risk.
“…The resulting seven studies were included in this review. Two papers were based on data from the same study population [18,19]. We evaluated the content of these papers as two separate studies because of the difference in their study objectives.Figure 1
Flow diagram.…”
BackgroundThe health status of older adults belonging to ethnic minorities in Western countries is an important public issue because their health is often less favourable than that of older adults from the majority population. In addition, the number of older adults belonging to ethnic minorities is increasing rapidly in Western countries. The introduction of community health workers (CHWs) has proven to be successful in addressing health disparities among ethnic minorities; however, an overview of CHW’s benefits for older adults is absent in the literature. We reviewed the literature to explore whether CHWs are also effective in improving the health and the delivery of health care services to ethnic minority older adults in Western countries.MethodsWe searched the PubMed database (2002-Present) for RCTs published on the use of CHWs in Western countries.ResultsOut of the 729 studies identified, seven studies met our inclusion criteria. The effectiveness of the implementation of CHW programmes in older adults belonging to ethnic minorities is not univocal. In two studies, we found no significant differences. In five studies, we found some positive effects. We did not find negative effects in any of the studies. For better interpretation of the results, effect ratios (ERs) were calculated as the number of positive findings divided by the total number of measured findings. Substantial effects on the access to care (mean ER = 0.58) and on health behaviour (mean ER = 0.45) were found. The mean ER for health outcomes was considerably lower (mean ER = 0.17).ConclusionWe found indications that CHWs serve as a means of improving health care use and health behaviour and, to a lesser extent, health outcomes among ethnic minority older adults. Further research is required to draw more solid conclusions on the effectiveness of CHW interventions in this target group. This is particularly important for Western countries in which the number of ethnic minority older adults has increased significantly because their health status is mostly unfavourable and their access to health care services is often limited.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0497-1) contains supplementary material, which is available to authorized users.
“…The resulting seven studies were included in this review. Two papers were based on data from the same study population [18,19]. We evaluated the content of these papers as two separate studies because of the difference in their study objectives.Figure 1
Flow diagram.…”
BackgroundThe health status of older adults belonging to ethnic minorities in Western countries is an important public issue because their health is often less favourable than that of older adults from the majority population. In addition, the number of older adults belonging to ethnic minorities is increasing rapidly in Western countries. The introduction of community health workers (CHWs) has proven to be successful in addressing health disparities among ethnic minorities; however, an overview of CHW’s benefits for older adults is absent in the literature. We reviewed the literature to explore whether CHWs are also effective in improving the health and the delivery of health care services to ethnic minority older adults in Western countries.MethodsWe searched the PubMed database (2002-Present) for RCTs published on the use of CHWs in Western countries.ResultsOut of the 729 studies identified, seven studies met our inclusion criteria. The effectiveness of the implementation of CHW programmes in older adults belonging to ethnic minorities is not univocal. In two studies, we found no significant differences. In five studies, we found some positive effects. We did not find negative effects in any of the studies. For better interpretation of the results, effect ratios (ERs) were calculated as the number of positive findings divided by the total number of measured findings. Substantial effects on the access to care (mean ER = 0.58) and on health behaviour (mean ER = 0.45) were found. The mean ER for health outcomes was considerably lower (mean ER = 0.17).ConclusionWe found indications that CHWs serve as a means of improving health care use and health behaviour and, to a lesser extent, health outcomes among ethnic minority older adults. Further research is required to draw more solid conclusions on the effectiveness of CHW interventions in this target group. This is particularly important for Western countries in which the number of ethnic minority older adults has increased significantly because their health status is mostly unfavourable and their access to health care services is often limited.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0497-1) contains supplementary material, which is available to authorized users.
“…This suggests that a healthy lifestyle is beneficial for protection against HF over and above its benefits in lowering risk for these clinical intermediates. Evidence from randomized trials suggest that multi-component lifestyle interventions, where several healthy lifestyle habits are simultaneously promoted, are successful in increasing healthful habits and decreasing cardiovascular disease risk (52-55)—in some cases, even more so than clinical treatment (56). Therefore, prevention strategies that place a higher emphasis on the combination and integration of healthy lifestyle habits may be of most benefit.…”
Background
The impact of a healthy lifestyle on risk of heart failure (HF) is not well known.
Objective
To evaluate the effect of a combination of lifestyle factors on incident HF, and further investigate whether weighting each lifestyle factor has additional impact.
Methods
Participants were 84,537 post-menopausal women from the Women's Health Initiative Observational Study, free of self-reported HF at baseline. A healthy lifestyle score (HL-score) was created, where women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL-score) was also created where each lifestyle factor was weighted according to its independent magnitude of effect on HF. Incident hospitalized HF was determined by trained adjudicators using standardized methodology.
Results
There were 1,826 HF cases over a mean follow-up of 11 years. HL-score was strongly associated with risk of HF (multivariable-adjusted HR [95% CI] = 0.49 [0.38,0.62], 0.36 [0.28,0.46], 0.24 [0.19,0.31], and 0.23 [0.17,0.30] for HL-score of 1,2,3,4 vs 0, respectively]. The HL-score and wHL-score were similarly associated with HF risk (HR [95% CI] = 0.46 [0.41,0.52] for HL-score and 0.48 [0.42,0.55] for wHL-score, comparing the highest tertile to the lowest). The HL-Score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension.
Conclusions
An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact.
“…An example of this model of care is the clinic-based WISEWOMAN program in California, which involved community health workers alongside health professionals in lifestyle health promotion with low-income Latinas at risk for cardiovascular disease. Women receiving the intervention showed improvements in eating habits and physical activity, systolic blood pressure, and 10-year cardiovascular disease risk assessment, but no significant change in body mass index or cholesterol levels (Hayashi et al, 2010). Other clinic-affiliated studies based on the WISEWOMAN program similarly support positive dietary and physical activity outcomes (Khare et al, 2012; Staten et al, 2004,).…”
Section: Introductionmentioning
confidence: 99%
“…In several studies community health workers are part of medical teams working in community or hospital clinics with identified at-risk populations, rather than delivering interventions independently in nonclinical settings (Hayashi et al, 2010; Khare et al, 2012; Ockene et al, 2012; Staten et al, 2004). The design of studies, differences in intervention components, and the exclusion of control groups often make it difficult to draw conclusions about the overall effectiveness of community-based interventions by promotoras.…”
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