Does a program that focuses on lifestyle changes reduce heart disease risk factors in a rural community in Appalachian Kentucky? / Debra K. Moser.

Format:

Book

Author/Creator:

Moser, Debra K., author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Final research report

Language:

English

Subjects (All):

Health promotion.

Health surveys.

Physical Description:

1 online resource.

Place of Publication:

Washington, DC : Patient-Centered Outcomes Research Institute (PCORI), 2019.

Summary:

BACKGROUND: People who live in rural Appalachian Kentucky represent the top 1% for cardiovascular disease (CVD) risk, morbidity, and mortality in the United States. Despite the marked CVD disparities seen in this geographic area, efforts directed toward CVD risk reduction and prevention are limited. OBJECTIVES: To determine the effect of an individualized, culturally appropriate, self-care CVD risk reduction intervention (HeartHealth) compared with referral of patients to a primary care provider for usual care on the following CVD risk factors: tobacco use, blood pressure, lipid profile, body mass index, depressive symptoms, physical activity levels, and overall Framingham risk score. METHODS: We developed the study protocol and intervention in conjunction with a community advisory board that consisted of lay community members who were part of the targeted population, business owners, local government officials, church leaders, and health care providers. In this randomized trial, we enrolled 355 individuals living in Appalachia who were at high risk for CVD by virtue of having 2 or more CVD risk factors. The intervention was delivered in person to groups of 10 or fewer individuals over 12 weeks. We designed the HeartHealth intervention to provide participants with successful self-care skills appropriate to CVD risk reduction and to reduce barriers to risk reduction found in austere rural environments. We measured the targeted CVD risk factors at baseline, 4 months, and 12 months postintervention. RESULTS: More individuals in the intervention group compared with the control group met their lifestyle change goal (50% vs 16%; P < .001). HeartHealth produced a positive impact on systolic blood pressure, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, body mass index, smoking status, and depressive symptoms; we saw improvement at 4 months in these risk factors, and positive changes were maintained through 12 months. We saw no differences across time by group in low-density lipoprotein cholesterol or triglyceride levels, nor did we observe differences in either the mental health or the physical health component of the Short Form-12 Health Survey quality-of-life measure. CONCLUSIONS: Interventions like HeartHealth--that focus on self-care of CVD risk factors and that are driven by collaboration with the community of interest--are effective in medically underserved, socioeconomically distressed rural areas. LIMITATIONS AND SUBPOPULATION CONSIDERATIONS: A potential limitation is lack of widespread generalizability, given that we conducted this study in southeastern Appalachian Kentucky; it may not be generalizable to the rest of Appalachia or to other rural areas. In heterogeneity of treatment effect analyses, HeartHealth proved equally effective in men and women, in depressed and nondepressed individuals, and in those with high and low health literacy.

Notes:

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