Impact evaluation of a healthy lifestyle intervention to reduce cardiovascular disease risk in health centers in San José, Costa Rica and Chiapas, Mexico

Abstract

BackgroundPrevious healthy lifestyle interventions based on the Salud para Su Corazón curriculum for Latinos in the United States, and a pilot study in Guatemala, demonstrated improvements in patient knowledge, behavior, and clinical outcomes for adults with hypertension. This article describes the implementation of a healthy lifestyle group education intervention at the primary care health center level in the capital cities of Costa Rica and Chiapas, Mexico for patients with hypertension and/or type 2 diabetes and presents impact evaluation results.MethodsSix group education sessions were offered to participants at intervention health centers from November 2011 to December 2012 and participants were followed up for 8 months. The study used a prospective, longitudinal, nonequivalent pretest-posttest comparison group design, and was conducted in parallel in the two countries. Cognitive and behavioral outcome measures were knowledge, self-efficacy, stage-of-change, dietary behavior and physical activity. Clinical outcomes were: body mass index, systolic and diastolic blood pressure, and fasting blood glucose. Group by time differences were assessed using generalized estimating equation models, and a dose–response analysis was conducted for the intervention group.ResultsThe average number of group education sessions attended in Chiapas was 4 (SD: 2.2) and in Costa Rica, 1.8 (SD: 2.0). In both settings, participation in the study declined by 8-month follow-up. In Costa Rica, intervention group participants showed significant improvements in systolic and diastolic blood pressure and borderline significant improvement for fasting glucose, and significant improvement in the stages-of-change measure vs. the comparison group. In Chiapas, the intervention group showed significant improvement in the stages-of-change measure in relation to the comparison group. Significant improvements were not observed for knowledge, self-efficacy, dietary behavior or physical activity. In Chiapas only, a significant dose–response relationship was observed for systolic and diastolic blood pressure.ConclusionGroup education interventions at health centers have the potential to improve stage-of-change activation, and may also improve clinical outcomes. In the future, it will be essential to dedicate resources to understand ways to reach a representative group of the patient population, tailor the intervention so that patients are engaged to participate, and consider the broader family and community context that influences patients’ capacity to manage their condition.

Effect of Theory-Based Training Intervention on Physical Activity and Blood Pressure in Hypertensive Patients: A Randomized Control Trial

“…In a study by Lee, based on the theory of SE and one by Gong, based on deployment of TTM in HTN patients, similar results were reported (9,14). In the aforementioned study by Fort, consisting of a healthy lifestyle intervention based on stages of change and SE in HTN patients, no significant changes were observed in participation in PA (28). One of the reasons why PA increased in our study, compared with that of Fort, may be that in our study four sources of ESE were used, whereas in that study it was not clear how ESE was applied in education.…”

A Home-Based Type 2 Diabetes Self-Management Intervention in Rural Guatemala

“…We addressed this issue by selecting instruments previously validated in Spanish, professionally translating them into Mayan, and then iterating them during the pilot period. Third, as in our underlying clinical diabetes program ( 14 ) and other community-based chronic disease interventions ( 23 , 25 , 26 ), we enrolled a disproportional number of women in our intervention. Such female predominance reflects a failure of chronic disease programs globally, including our own, to identify and overcome the barriers men confront in receiving care ( 27 ).…”

“Consumo De Alimentos Restringidos” en Pacientes Hipertensos Mexicanos: Un Análisis De Trayectoria

“…Finalmente, Font y cols. (9), en un estudio binacional en su modalidad de intervención que se llevó al cabo en Costa Rica y México, en el caso de este se menciona que no se encontraron cambios significativos en el antes y el después en los grupos intervención y comparación en los siguientes factores: conocimientos sobre la enfermedad y los tratamientos, autoeficacia para controlar las condiciones que pudieran interferir con las conductas de adhesión, así como en el índice de dieta, cuya puntuación de la media (M) para el grupo de intervención fue 11,5 y 10,5 para el grupo de comparación. La única diferencia estadísticamente significativa se reportó en realizar ejercicio físico el tiempo recomendado por el personal de salud.…”