Effectiveness of a Faith-placed Cardiovascular Health Promotion Intervention for Rural Adults

95 Effectiveness of a Faith-placed Cardiovascular Health Promotion Intervention for Rural Adults Zimmermann, et al. Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019, pp. 95-111 © 2011 Center for Health Disparities Research School of Community Health Sciences University of Nevada, Las Vegas Effectiveness of a Faith-placed Cardiovascular Health Promotion Intervention for Rural Adults Kristine Zimmermann, PhD, MPH, University of Illinois at Chicago Leslie R. Carnahan, MPH, University of Illinois at Chicago Manorama M. Khare, PhD, University of Illinois College of Medicine Rockford Apurba Chakraborty, PhD, University of Illinois at Chicago Heather Risser, PhD, Northwestern University Yamile Molina, PhD, MPH, University of Illinois at Chicago Stacie Geller, PhD, University of Illinois at Chicago Corresponding Author: Kristine Zimmermann, PhD, MPH, ABSTRACT Introduction: Cardiovascular disease (CVD) is the leading cause of mortality in the US. Further, rural US adults experience disproportionately high CVD prevalence and mortality compared to non-rural. Cardiovascular risk-reduction interventions for rural adults have shown short-term effectiveness, but long-term maintenance of outcomes remains a challenge. Faith organizations offer promise as collaborative partners for translating evidence-based interventions to reduce CVD. Methods: We adapted and implemented a collaborative, faith-placed, CVD risk-reduction intervention in rural Illinois. We used a quasi-experimental, pre-post design to compare changes in dietary and physical activity among participants. Intervention components included Heart Smart for Women (HSFW), an evidence-based program implemented weekly for 12 weeks followed by Heart Smart Maintenance (HSM), implemented monthly for two years. Participants engaged in HSFW only, HSM only, or both. We used regression and generalized estimating equations models to examine changes in outcomes after one year. Results: Among participants who completed both baseline and one-year surveys (n = 131), HSFW+HSM participants had significantly higher vegetable consumption (p = .007) and combined fruit/vegetable consumption (p = .01) compared to the HSM-only group at one year. We found no differences in physical activity. Conclusion: Improving and maintaining CVD-risk behaviors is a persistent challenge in rural populations. Advancing research to improve our understanding of effective translation of CVD risk-reduction interventions in rural populations is critical. Keywords: Rural, faith-based organizations, physical activity, nutrition, health promotion, cardiovascular disease Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ Follow on Facebook: Health.Disparities.Journal Follow on Twitter: @jhdrp 96 Effectiveness of a Faith-placed Cardiovascular Health Promotion Intervention for Rural Adults Zimmermann, et al. INTRODUCTION Approximately one out of every three deaths in the US is caused by cardiovascular disease (CVD), making it the leading cause of death (Mozaffarian et al., 2016). Residents of the rural US experience disproportionately high CVD mortality rates compared to non-rural, with age-adjusted rates of 280.2 and 248.3 deaths per 100,000, respectively (Singh & Siahpush, 2014). Further, CVD is the leading contributor to excess rural mortality, accounting for 24% of this rural-urban lifeexpectancy gap (Singh & Siahpush, 2014). These disparities can be attributed in part to modifiable lifestyle factors, such as poor nutrition habits and inadequate physical activity (PA) (Meit et al., 2014; Singh & Siahpush, 2014). Like other US states, Illinois shows considerable health disparities between rural and nonrural residents. The rural southernmost seven (S7) counties of Illinois experience particularly high rates of CVD risk factors compared to Illinois overall. This region, home to 67,190 residents over 2,003 square miles (U.S. Census Bureau, 2016), comprises Alexander, Hardin, Johnson, Massac, Pope, Pulaski, and Union counties and is considered primarily non-metropolitan based on the 2010 Rural-Urban Commuting Area Codes (U.S. Department of Agriculture, 2016). According to the 2010 Behavioral Risk Factor Surveillance System (BRFSS), among S7 adults, 47% have been told they have high blood cholesterol (38% in Illinois), 34% have been told they have high blood pressure (27% in Illinois), 12% have been told they have diabetes (9% in Illinois), and 71% are overweight or obese (62% in Illinois) (Illinois Department of Public Health, 2017). Best practices for CVD risk reduction interventions in rural communities include ensuring accessibility and promoting sustainability, which can be facilitated by collaboratively implementing programs in community-based settings and building on community strengths and the existing community infrastructure (Melvin et al., 2013; Rodrigues, Ball, Ski, Stewart, & Carrington, 2016). Collaborative implementation research is also beneficial for enhancing intervention relevance, efficacy, and tailoring (Minkler & Salvatore, 2012). In addition, evidencebased interventions (EBIs) that incorporate behavior-change theory such as goal setting, selfmonitoring, and increasing self-efficacy, have demonstrated effectiveness in improving nutrition and PA behaviors related to CVD risk and CVD outcomes (Artinian et al., 2010; Greaves et al., 2011; Rodrigues et al., 2016). Tailoring EBIs for specific population groups, including rural communities, is essential for effective research translation (Artinian et al., 2010; Rodrigues et al., 2016). However, maintaining long-term health outcomes remains a barrier in CVD risk reduction (Rodrigues et al., 2016). In rural communities, non-traditional partners such as churches may be ideal for CVD risk reduction interventions because they are often acceptable and accessible to residents, interventions may be endorsed by church leaders, and interventions can build community capacity to address health needs (Schoenberg & Swanson, 2017; Yeary et al., 2011). Rural, faith-placed interventions have also shown promise in improving behavioral and health outcomes in rural populations in the short term (Thomson, Goodman, & Tussing-Humphreys, 2015); however, evidence around longterm effectiveness of faith-placed interventions is limited. In practice, intervention tailoring for implementation within churches requires a balance between fidelity to ensure effectiveness and flexibility to meet community needs (Allen, Linnan, & Emmons, 2012). As an evidence-based example using a tailored implementation approach, we assessed a rural, faith-placed CVD risk reduction intervention tailored to improve outcomes among women in the S7 counties of Illinois through a collaboration among the local health department, a Journal of Health Disparities Research and Practice Volume 12, Issue 6, Winter 2019 http://digitalscholarship.unlv.edu/jhdrp/ F (...truncated)