Developing and Testing a New Model

to Reduce Risk for Heart Disease

and StrokeProject Update

- May 24, 2016 -

PI: Ruth Lindquist, PhD, RN, FAAN, Professor

University of Minnesota, School of Nursing

Partner: National USA Foundation, Inc. (NUFI)

Rev./Dr. LB West, Mount Airy Baptist Church, Washington, D.C.

Conceptual Model

↑Awareness

Education

↑Activation

Ready to

change

Demonstrated

commitment

(run-in)

↑Awareness

Effort to

change

Outcomes

↑Knowledge

Improved health behaviors

“Simple 7” goals achieved

Reduced CVD risk

↓Community

CVD risk of

AA men

Goal

setting

Education Inspiration Ongoing

Feedback

“tracking”

Peer

support

Advice

Community

CVD risk

of AA men

Peer Group

vs. Education

Group

Accountability

Peer Group

Processes

Feasibility

Safety

Pot. Efficacy

Protocol &

Design

Refinements

Next Grant

Personal risk

(screening)

Follow-up

Study Aim

Aim 1. Determine the feasibility of a six-month psycho-educational peer

group intervention to reduce risk factors for CVD and stroke. Feasibility

will be assessed by the degree of completion of the four phases of the

intervention and the protocol-relevant activities including: screening for

risks; run-in of one month of weekly blood pressure checks; recruitment

of two groups of 6 men for the 6-month program at each church; delivery

of a program of counseling and behavior change; distribution and use of

activity monitors and smart phones to monitor and share activity, sleep,

and nutritional intake; engagement in mutual peer support; completion of

study measures; and achievement of short-term goals set within peer

groups for behavior change.

Intervention Model Phases

Phase I

Education

Video Presentation

Phase II

Health Screening

Health activation will be assessed

Consent and Measures

Phase III

Blood Pressure Run-In

3-week Blood pressure check

Recruit to enroll in the 6-month program

Phase IV

6-month small group support, education, and behavioral change

Weekly -> Bi-weekly -> Monthly

Phase V

Follow-up

2 month after the end of Phase IV

Approach

Subjects and Setting – Performance sites

Research Design

Research Progress

2Participants Enrollment (n)

Minneapolis Washington DC Total

Phase I

(Education)5 19 24

Phase II

(Screening)20 15 35

Phase III

(Run-In)13 12 25

Phase IV

(Peer Group)13 12 25

Update

• Sample (N=52): New Salem (n=24) and Mount Airy (n=28);

(1 withdrawl).

• Peer Group (N=16): (n=9) and (n=8). Individuals (N=7):

(n=3) and (n=4).

• Phase IV: Week 8 and Week 12 (136 pages of group

process transcripts to date).

Study Aim

Aim 2: To implement and revise the peer group

intervention protocol.

Study Aim

Aim 3. Determine the effect size of the peer

group intervention on outcomes of risk

reduction.

Measures

I. Primary Outcome Measures

(Life’s Simple 7)

Total Cholesterol

Blood Pressure

Blood Glucose

Physical Activity

Health diet score

Obesity Smoking

Productivity

Primary Outcome for a Pilot Study to Reduce Risk Factors for Heart Disease and

Stroke for African American Men: American Heart Association’s Life’s Simple 7.

Using wearable fitness and mobile technologies to augment behavior change and

reduce cardiovascular (CVD) risk among African American (AA) men.

Developing, a New Model to Prevent Heart Disease and Stroke:

Challenges and Lessons Learned.

Discrepancy between Self-Report and Objective Assessments of Cardiovascular

Risk in a Pilot Study to Reduce Risks for Heart Disease and Stroke

of African American Men.

Evaluation: Church Leadership

• I think it’s going great, to see the men getting

excited about their health…to the extent their

diet is changing and they’re exercising.

• The men continue to be mega-excited. We’re

seeing physical results and they continue

supporting one another. I believe their pledge

is to continue their journey even beyond the

study.

Evaluation: Facilitator

• “My only comment at this time would be that

when we get an individual’s attention on

risks and ultimate consequences of negative

lifestyles, they pay attention and are willing

to change. In other words, the myth that

individuals are so set in their ways that they

don’t desire to change, particularly AA men,

is proving not to be true.”

Evaluation: Investigator

“It’s working!”

“There is a notable shift of engagement of

participants in the group and daily decisions

impacting their health. There is

accountability, self-responsibility, and self-

regulation. Men are examining and

discussing what they do, shouldn’t do,

should do and what they could do better”..

Preliminary Qualitative Analysis

Peer group transcripts: Men are taking personal responsibility

and integrating new information that they are discovering on

their own. They are making judgments and tailoring

information to their own needs/lifestyle/response. They are

helping each other, spreading their wisdom regarding salutary

lifestyle choices to their families and members of the church,

and making plans for long-term continuance. They are

shopping differently, packing food, and eating out less, cutting

“hidden” calories, salt, preservatives, and speaking about

“choices,” goals and “balance.” There is tremendous growth in

understanding lifestyle impact on health in the group.

Audio Recording, Transcription and Qualitative Text:

The Long Road

• “When I first started losing weight I enjoyed it. Now

all things coming down. Blood pressure is down.

Blood sugars lower.”

• “Walking is my main goal. My blood pressure looks

better. Not where I want to be. 120/80 is where I

want it to be. I know I can do better. I know that we

are closer to that 7 thing.”

Transcript text (cont.)

• “What goes in affects our entire

body…again…when we know better…we do

better.”

• “I started eating more multigrain…so that was one

thing…and because of the FitBit…I am more

conscious of that [physical activity].”

• “I ate spinach for the first time”…

Transcript text (cont.)

• “I lost 8 to 10 pounds”… “pants getting loose”…

• “When I think that I am all balanced, I eat a

salad…Thursday, I just walked away … that fried

chicken”…

• …”he was here to preserve his body... To do what

he was put on earth to do.”

• “Cuz it all works together. The way I got my mind

set up now. What I put into my body, I figure how

long it takes me to burn it off.”

Transcript text (cont.)

• … “We will be losing…getting that pressure

right…we gotta eat different”…

• “I might try that. I like chicken…I gotta try more

fish”…

• “Since we come here, I been cookin’ …I’m starting

to cook”…

• … “remove that skin first…I like the shake’n bake;

I’m trying not to eat that fried chicken.”

Transcript text (cont.)

• “Peach Cobbler…I didn’t get any of that…I asked

them not to give you any of that…some people ate

peach cobbler and the cake…I had a small portion.”

• … “My blood pressure is better when I sleep”…

• “We plan our meals…now we are planning healthy

meals…you can get a container…you can get a

portion…you can measure your meals…some

people do it…cut up their chicken for the rest of the

week”…

Transcript text (cont.): Facilitators

• “So I will give you a challenge…at least two

salads…without any type of dressing on it…2 this

week. In terms of beverages…water only” …

[coffee, black, permitted].

• “One cupcake…it usually takes me 20-30 minutes

to burn it off. I become more conscious. You want

to start monitoring. The guys are journaling…and

hopefully, next week I’m gonna cook for you all.

And it will be probably no more than 300 calories.”

Project Summary Highlights

• Screening results

• Congregational interest

• Wives/friends are helping

• Thinking about & finding new ways to be active (choosing more activity)

• Food interest/knowledge exploding (actively choosing to eat better: Cut

sodas; Cut sweets; Cut salt)

• Experimenting; making connections

• Learning from each other; active observing/modeling

• Planning ahead (eating and activity)

• 2 men needed to purchase new pants; more reporting weight loss.

• “Transportable”

Discussion & Next Steps (cont.)

Contemplated Manuscripts and Presentations

1. Primary Outcomes (feasibility and effect size)

2. The Long Road to Behavior Change (qualitative)---AHA

3. Literature review Life’s Simple 7 for AA men

4. Literature review technology use for AA men

5. Lessons Learned

6. Developing a New Model to Reduce Heart Disease and

Stroke in AA Men

Contemplated Grants

1. AHA Innovative Research Grant

2. PA-13-331 Health Promotion among Racial and Ethnic

Minority Males (R21)

Discussion/Next Steps (cont.)

• Challenges

• Facilitators

• No-cost extension

• Follow-up

• Design

• Population