Scaling a Community-Wide Campaign Intervention to Manage Hypertension and Weight Loss

Abstract

Public health impacts can be achieved when evidence-based interventions are implemented to those most in need. Too often implementation never or slowly occurs. The community-wide campaign intervention Tu Salud ¡Si Cuenta! has evidence of improving health outcomes related to chronic disease among low-income, Latinos. Using the RE-AIM Framework, this study examined if the scaled-up version of the intervention is associated with improvements in hypertension and obesity in 12 locations. Each element of the RE-AIM framework was examined. For “Effectiveness,” we examined outcomes overall and by implementing location. We used linear and logistic regression to assess if exposure in the intervention was associated with improvement in hypertension and weight loss. Participants were stratified into “low exposure” (2–3 outreach visits) vs. “high exposure” (4–5 outreach visits). Based on the RE-AIM Framework, the intervention “reached” its intended population of low-income Latinos, demonstrated “effectiveness” in improving hypertension and obesity, was “adopted” at a high level in all but one site, was “implemented” with fidelity to the intervention model with moderate success across locations, and showed high “maintenance” over time. For effectiveness specifically, we found that out of 5,019 participants, 2,508 (50%) had a baseline hypertensive blood pressure (BP) reading. Of the 2,508, 1,245 (49.9%) recovered to normal blood pressure or pre-hypertension stage by last follow-up. After adjusting for baseline BP and potential confounders in multivariable linear regression models, the high exposure group had significantly more reduction in systolic BP (adjusted mean difference in % change = −0.96; p = 0.002) and diastolic BP (adjusted mean difference in % change = −1.61; p < 0.0001) compared to the low exposure group. After controlling for baseline weight and other confounders, the high exposure group had significantly greater decrease in weight compared to the low exposure group (adjusted mean difference in % change = −1.28; p < 0.0001). Results from the multivariable logistic regression models indicated that compared to the low exposure group the high exposure group was more likely to achieve a clinically significant minimum 5% weight loss [adjusted odds ratio (OR) = 2.97; p < 0.0001). This study contributes evidence that a Community-Wide Campaign model holds promise for addressing hypertension and obesity among low-income Latinos.

Participant engagement in a community health worker-delivered intervention and type 2 diabetes clinical outcomes: a quasiexperimental study in MexicanAmericans

“…The results of this intervention contribute to the growing literature demonstrating the effectiveness of CHWs delivering community-based interventions in addressing chronic diseases 20 32–36. More specifically, the SyV programme contributes to the growing body of evidence that participation in CHW interventions is associated with improved HbA1c outcomes 22 37–41.…”

Lay advisor interventions for hypertension outcomes: A Systematic Review, Meta-analysis and a RE-AIM evaluation

“…See Table 4 and Supplementary Table S1 . One study specifically reported study results in RE-AIM format ( 45 ) and one recent study specifically reported reach and adoption of peer coaching intervention in primary care practices ( 33 , 57 ).…”

“…Six of the nine studies with sample sizes >1000 were conducted in developing countries ( 18–20 , 23 , 25 , 34 ) and three were done in the United States ( 27 , 31 , 45 ). Participation rate varied from 2 to 98% with clinic-based recruitment showing higher participation rates compared to population-level recruitment.…”

“…Seven studies indicate the continued feasibility of maintaining intervention using already available infrastructure or public funding ( 25 , 28 , 32 , 39 , 44 , 45 , 60 ).…”

Influence of “Hospital-Community-Family” Integrated Management on Blood Pressure, Quality of Life, Anxiety and Depression in Hypertensive Patients

“…The results of epidemiological investigation indicate that the number of people suffering from hypertension in the world is more than 1 billion, and it is expected that the number of cases will reach 1.55 billion in 10 years' time. According to the latest hypertension guidelines in China, the prevalence of hypertension among adult residents in China is 27.9%, that is, one-third of adults suffer from hypertension, and the prevalence of hypertension in large and medium-sized cities is relatively high [ 2 ]. Cardiovascular and cerebrovascular diseases are caused, and the resulting medical expenses are also increasing year by year [ 3 ].…”