Outcomes of National Community Organization Cardiovascular Prevention Programs for High-Risk Women

Abstract

The purpose of this study was to reduce cardiovascular disease (CVD) risk in women by implementing a cardiovascular prevention health promotion program in faith-and community-based sites. The primary outcomes were reducing obesity and increasing physical activity. A longitudinal cohort of high-risk (age>40, ethnic minority) women (n=1,052) was enrolled at 32 sites across the USA. The pre-or post-educational intervention consisted of eight biweekly counseling sessions conducted over 4 months each addressing one of six of the major CVD risk factors (smoking, diabetes, hypertension, cholesterol, obesity, and physical inactivity) as well as signs and symptoms of a heart attack and stroke; plus 4-6 maintenance sessions over three additional months. A multifaceted approach delivered by lay and medically trained personnel involving medical screenings, health behavior counseling, risk behavior modification, and stage of change were determined at baseline and end of counseling or maintenance. Following list-wise deletion, data were analyzed on 423 women who completed all follow-up time-points. Overall, significant improvement was attained in most of 28 secondary outcomes but not in the primary outcomes. Knowledge and awareness of heart disease as the leading killer or women, all of the signs and symptoms of a heart attack, calling 911, and CVD risk factors increased significantly (p<0.05) by 8.8%, 13.6%, 5.8%, and 10%, respectively. There was a 10% (p<0.05) increase in participants attaining control for hypertension (blood pressure<140/90) coupled with a significant reduction in mean blood pressure in the entire cohort. Knowledge of effective CVD risk modification strategies for all CVD risk factors increased significantly (p<0.05), except for obesity. In addition, there were significant (p<0.05) increases in forward movement in stage of change for each CVD risk factor (range +10% to +39%). Thus, a heart disease prevention intervention built around a model of community engagement, advocacy, self-efficacy, resource knowledge, and health promotion in faith-and community-based organizations is successful at improving cardiovascular knowledge and awareness outcomes in high-risk women. Limitations of our study include the high dropout rate, significant time demands on site coordinators, limited resources for program implementation, lack of morbidity and mortality endpoints, and failure to attain the primary outcomes of weight loss and physical activity. Future studies should not only assess the effect of community education interventions on lifestyle change and

Hypertension Knowledge, Awareness, and Self-Management Behaviors Affect Hypertension Control: A Community-Based Study in Xuhui District, Shanghai, China

“…A study on the outcome of a Know Your Numbers program on BP indicated that the knowledge for all health conditions assessed was closely associated with improved hypertension [10]. Outcomes of a cardiovascular prevention health promotion program targeting women indicated that increasing women's knowledge and awareness of heart disease increased their hypertension control and significantly reduced the mean BP in the entire cohort [11]. However, this may not be true for overall knowledge of hypertension in our study population.…”

Outcomes of a Clinic-Based Educational Intervention for Cardiovascular Disease Prevention by Race, Ethnicity, and Urban/Rural Status

“…However, we have previously published that similar educational programs sustained over a period of 4-6 months do, in fact, result in sustained improvements in heart disease risk profiles, a reduction in inflammatory burden, and cardiometabolic risk in racial/ethnic minority women. 6,20,42 In addition, others have demonstrated that awareness translates to action and poor health behaviors translate to physical health disorders, 44 pointing to the importance of awareness and knowledge as an important factor in the path to improved physical health. It is unclear as to what extent baseline knowledge predicted change in knowledge in our study, and whether the gains observed were, in part, attributable to lower baseline knowledge.…”

“…The survey questions are summarized in Table 1 and were provided to the study sites by the UC Davis Women's Cardiovascular Medicine Program to maintain uniformity for all sites. The instrument was available to women in English or Spanish, and it was adapted from one validated by the U.S. Department of Health and Human Services Office of Women's Health 6,20 and linked with the assessment of specific Healthy People 2020 heart disease outcomes (Heart Disease and Stroke objectives): http://www .healthypeople.gov/2020/topics-objectives/topic/heart-diseaseand-stroke/objectives Women were individually educated on the survey questions by a health professional at each of the five clinical sites …”

“…Racio/ethnic minority women and women living in nonurban settings face specific health challenges that are directly related to risk factor knowledge, personal behavior, access to healthcare, and other factors. [13][14][15] In addition, ischemic heart disease in women aged 20 and older has been shown to be the highest in small rural counties. 16 Direct correlations exist between race/ ethnicity and morbidity/mortality due to heart disease.…”

Relationship of Self-Determination Theory Constructs and Physical Activity and Diet in a Mexican American Population in Nueces County, Texas

“…21 Similarly, a 7-month MI intervention resulted in no significant changes in physical activity among a large sample of African American women. 22 One identified study that used MI and SDT constructs to tailor health messages for diet and physical activity among African American adults showed no overall significant differences between treatment and control groups. 8 However, the SDT construct of autonomy support was shown to be a significant moderator of fruit and vegetable consumption and was also related to the correlations between autonomous and controlled motivation and fruit and vegetable intake.…”