Strong Hearts, Healthy Communities: A Community‐Based Randomized Trial for Rural Women

Abstract

Objective To evaluate a multilevel cardiovascular disease (CVD) prevention program for rural women. Methods This six-month community-based randomized trial enrolled 194 sedentary rural women aged 40 or older, with a BMI ≥ 25 kg/m2. Intervention participants attended six months of twice-weekly exercise, nutrition, and heart health classes (48 total) that included individual-, social-, and environment-level components. An education-only control program included didactic healthy lifestyle classes once a month (6 total). The primary outcome measures were change in BMI and weight. Results Within group and between group multivariate analyses revealed that only intervention participants decreased BMI (−0.85 units; 95% CI 1.32, −0.39; p=0.001) and weight (−2.24 kg; −3.49, −0.99; p=0.002); compared to controls, intervention participants decreased BMI and weight (difference: −0.71 units; −1.35, −0.08; p=0.03 and 1.85 kg; −3.55, −0.16; p=0.03, respectively) and improved C-reactive protein (difference: −1.15; −2.16, −0.15; p=0.03) and Simple 7, a composite CVD risk score (difference=0.67; 0.14, 1.21; p=0.01). Cholesterol decreased in controls but increased among intervention (−7.85 versus 3.92; difference=11.77; 0.57, 22.96; p=0.04). Conclusions The multilevel intervention demonstrated modest but superior and meaningful improvements in BMI and other CVD risk factors compared to the control program.

Strengthening community-clinical linkages to reduce cardiovascular disease risk in rural NC: feasibility phase of the CHANGE study

“…change in weight, − 3.8 mmHg change in systolic and − 2.3 in diastolic pressure, which are all comparable our findings. For 10-year Atherosclerotic Vascular Disease (ASCVD) risk score, the study by Seguin and colleagues in rural populations (among mostly non-Hispanic whites) showed lowering of risk scores by − 0.96 [19]. Although we do not report ASCVD risk scores (because of the small clinical sample size), the blood pressure lowering observed in CHANGE would result in a relative risk reduction of 0.73 to a 10-year ASCVD risk score [31].…”

“…However, little is known about the feasibility of implementing CHW-delivered interventions in rural settings, especially among rural minority populations. While there is some CVD risk reduction intervention research in rural settings, [17][18][19] evidence gaps remain for studies with CHWs among rural African Americans. Moreover, in clinical-community linkages research with CHWs, [20] more evidence is needed on the effectiveness of CHWs working "interchangeably in both community and healthcare settings" to determine whether they can build and enhance these linkages [15].…”

Web-Based Dissemination of a Civic Engagement Curriculum to Promote Healthy Eating and Active Living in Rural Towns: The eHEART Study

“…Creating environmental change through civic engagement is one promising strategy for improving access to food and physical activity resources. Existing studies suggest that engaging local residents can lead to meaningful built environment and policy changes in urban and rural settings [5][6][7][8][9][10].…”

“…The HEART of 8 Club program (also known as the Change Club) was first developed, implemented, and evaluated in the period 2010-2011 [7]. Several follow-up studies refining the materials and process have been conducted since then, with successful achievement of goal setting and attainment [8,9].…”

Strengthening Community-Clinical Linkages to Reduce Cardiovascular Disease Risk in Rural NC: Feasibility Phase of the CHANGE Study

“…However, little is known about the feasibility of implementing CHW-delivered interventions in rural settings, especially among rural minority populations. While there is some CVD risk reduction intervention research in rural settings, (17)(18)(19) evidence gaps remain for studies with CHWs among rural African Americans. Moreover, in clinical-community linkages research with CHWs,(20) more evidence is needed on the effectiveness of CHWs working "interchangeably in both community and healthcare settings" to determine whether they can build and enhance these linkages.…”