Translating a Heart Disease Lifestyle Intervention into the Community

描述(申请人提供)：与所有其他种族/民族相比，亚裔印度人和巴基斯坦人(南亚人)患冠心病(CHD)的风险更高，死于CHD的风险更大。有近300万南亚裔美国人；在过去的十年里，他们一直是增长第二快的美国种族，仅次于西班牙裔。相对于加州的白人、黑人、拉丁裔、日本人和中国人，南亚人的冠心病死亡率最高。行为因素显著增加了南亚人的冠心病风险；在所有美国亚洲人中，南亚人的超重/肥胖率最高，报告的体力活动最少。发布的数据强劲 支持健康生活方式干预的益处，将其作为降低冠心病风险因素的一种手段。促进和促进对这一不断增长的人口的生活方式干预措施可能会对南亚人的冠心病风险产生重大影响；然而，关于如何最好地在医疗服务不足的社区提供生活方式干预措施的知识有限，特别是对南亚人。虽然基于诊所的筛查、生活方式建议和药物治疗是降低个别患者冠心病风险因素的关键，但传统的医疗保健系统方法不太可能接触到服务不足的南亚人。我们之前的研究是在一个社会经济地位较低、英语水平有限的南亚社区进行的，发现了几个社会、文化和环境因素，这些因素可能会限制基于临床的干预措施对这一群体的影响。考虑到以临床为基础的预防冠心病以解决这些因素的局限性，在患者社区提供文化突出的生活方式干预可以增强临床护理的影响 通过：[1]将行为干预的实际应用推广到服务不足的社区；以及[2]填补以诊所为基础的冠心病危险因素管理方面的空白，例如缺乏时间进行生活方式咨询，对不同文化群体的了解有限，对社区资源的认识有限，以及缺乏就诊间隔支持。研究小组与社区合作，利用形成性数据、健康行为和学习理论开发了南亚心脏生活方式干预(Saheli)，这是一种针对医疗服务不足的南亚人的具有文化针对性的、以群体为基础的预防冠心病的生活方式干预。干预措施结合了南亚文化的深层结构(例如，冠心病的解释性模型)，作为让南亚人参与预防冠心病和健康生活方式的机制。这项研究的目标是通过随机设计对Saheli进行试点测试，并检验其在社区环境中改变医疗服务不足的南亚人的身体活动和饮食行为的可行性和初步效果。我们还将进行过程评估，以了解参与者对干预的看法。这项研究将为规划未来在难以接触到南亚裔美国人人群中加强CHD预防的不同方法的大规模比较有效性试验提供必要的数据。

DESCRIPTION (provided by applicant): Asian Indians and Pakistanis (South Asians) have a disproportionate risk of coronary heart disease (CHD) and are at greater risk for death from CHD compared to all other racial/ethnic groups. There are almost 3 million South Asians Americans; over the past decade they have been the second fastest growing U.S. ethnic group after Hispanics. Relative to Whites, Blacks, Latinos, Japanese, and Chinese in California, South Asians have the highest CHD mortality rates. Behavioral factors contribute significantly to the increased CHD risk observed in South Asians; among all U.S. Asians, South Asians have the highest rates of overweight/obesity and report the least physical activity. Published data strongly support the benefits of healthy lifestyle interventions as a means to decrease CHD risk factors. Facilitating and promoting lifestyle interventions for this growing population could lead to a substantial impact on South Asians' CHD risk; yet knowledge is limited on how best to deliver lifestyle interventions in medically underserved communities and to South Asians, specifically. While clinic-based screening, lifestyle advice, and medication are key to reducing CHD risk factors in individual patients, traditional health care system approaches are unlikely to reach underserved South Asians. Our prior research, conducted in a South Asian community with low socioeconomic status and limited English proficiency, identified several social, cultural, and environmental factors that could limit the impact of clinic- based interventions in this group. Given the limits of clinic-based CHD prevention to address these factors, a culturally-salient lifestyle intervention delivered in the patient's community can enhance the impact of clinical care by: [1] Extending the practical applications of behavioral interventions into underserved neighborhoods; and [2] Filling gaps in clinic-based CHD risk factor management, such as lack of time to engage in lifestyle counseling, limited knowledge about different cultural groups, limited awareness of neighborhood resources, and lack of between-visit support. In partnership with the community, the research team used formative data and health behavior and learning theory to develop the South Asian Heart Lifestyle Intervention (SAHELI), a culturally targeted, group-based, CHD prevention lifestyle intervention for medically underserved South Asians. The intervention incorporates the deep structures of South Asian culture (e.g., explanatory models of CHD) as the mechanism to engage South Asians in CHD prevention and a healthy lifestyle. The goal of this study is to pilot-test SAHELI, via a randomized design, and examine its feasibility and initially efficacy to change physical activity and diet behaviors among medically underserved South Asians in a community-based setting. We will also conduct a process evaluation to understand participants' perceptions of the intervention. This study will provide essential data for the planning of a future large-scale comparative effectiveness trial of differen approaches to enhance CHD prevention in hard to reach South Asian American populations.