A Neighborhood-Centered Clinical Project: Improving Diabetes and Cardiovascular Outcomes in Hispanic Women

Abstract

Neighborhood-centered disease prevention programs have become a growing means of introducing baccalaureate nursing students to health care systems. This article reports diabetes and cardiovascular clinical outcomes and health behavior changes made following a 2-year baccalaureate community/public health clinical project and partnership with an urban Hispanic neighborhood. This pilot study used a pretest-posttest design without comparators. The healthy lifestyle consisted of health coaching, physical activity, and lifestyle modification. Thirty-eight women completed the 12-week program. Results revealed significant reductions in diabetes and cardiovascular total risk scores, glycated hemoglobin, body mass index, and physical activity (α = 0.05). Students gained learning opportunities in research and public health competencies, while providing clinical practice, research, and scholarship opportunities for nurse educators. Insights from these programs can help faculty, students, and communities identify new approaches that are consistent with the National Prevention Strategy and the Patient Protection and Affordable Care Act to improve diabetes and cardiovascular outcomes among Hispanic women.

Integrative Review of Nurse-delivered Community-Based Physical Activity Promotion

“…Interventions were conducted in community centers, senior centers, churches, a community fitness center, and a community nursing service setting. Seven studies solely used face-to-face intervention delivery (Baldwin, 2015;Banks-Wallace & Conn, 2005;Choi & Rush, 2012;Harris et al, 2013;Huang et al, 2002;Peterson, 2005;Smith, 2012), one study used telephone delivery only (Chiang & Sun, 2009), and the remaining five used more than one delivery mode (Holland et al, 2005;Lee et al, 2007;Leveille et al, 1998;Speck et al, 2007;Wallace et al, 1998). Four studies used individual-based intervention delivery only (Chiang & Sun, 2009;Harris et al, 2013;Lee et al, 2007;Peterson, 2005), four studies used group-based intervention only (Banks- Wallace & Conn, 2005;Choi & Rush, 2012;Huang et al, 2002;Smith, 2012), and the remaining five studies used a combination of individual-and groupbased strategies.…”

“…Three of the 13 studies involved PA education only (Harris et al, 2013;Huang et al, 2002;Smith, 2012), eight studies involved some combination of PA education/counseling and cognitive-behavioral strategies (Baldwin, 2015;Banks-Wallace & Conn, 2005;Chiang & Sun, 2009;Choi & Rush, 2012;Holland et al, 2005;Lee et al, 2007;Leveille et al, 1998;Peterson, 2005), and the remaining two involved the combination of behavioral (i.e., exercise classes and supervised walking) and cognitive-behavioral strategies (Speck et al, 2007;Wallace et al, 1998). Most (10/13, 77%) of the studies had an intervention duration of 6 months or less.…”

“…Two of the 13 studies provided exercise training sessions organized by nurses and lead by exercise instructors (Huang et al, 2002;Wallace et al, 1998). In five of the 13 studies, nurses helped participants develop exercise plans (Baldwin, 2015;Holland et al, 2005;Leveille et al, 1998;Peterson, 2005;Wallace et al, 1998). In seven of the 13 studies nurses delivered motivational and/or supportive contacts as the main PA intervention.…”

“…Overall, seven of the 13 studies demonstrated efficacy in PA behavior change (Baldwin, 2015;Banks-Wallace & Conn, 2005;Holland et al, 2005;Huang et al, 2002;Lee et al, 2007;Leveille et al, 1998;Smith, 2012).…”

“…Three of the 5 uncontrolled pretest-posttest studies reported significant increases in selfreported PA behaviors post-interventions (Baldwin, 2015;Huang et al, 2002) or at 1 month following a one-time exercise education (Smith, 2012). Baldwin (2015) and Huang (2002) received an effectiveness rating of "promising direction" while Smith (2012) received a rating of "well-supported".…”