Translating a Heart Disease Lifestyle Intervention into the Community

描述（由申请人提供）：亚洲印度人和巴基斯坦人（南亚人）患冠心病（CHD）的风险不成比例，并且与所有其他种族/族裔群体相比，CHD的死亡风险更高。美国有近300万南亚裔;在过去十年中，他们是美国增长第二快的种族群体，仅次于西班牙裔。相对于白人、黑人、拉丁美洲人、日本人和加州的中国人，南亚人的冠心病死亡率最高。行为因素对在南亚人中观察到的CHD风险增加有显着贡献;在所有美国人中，南亚人超重/肥胖率最高，并且报告体力活动最少。公布的数据显示， 支持健康生活方式干预的益处，作为减少CHD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可能会对南亚人的冠心病风险产生重大影响;但关于如何最好地在医疗服务不足的社区和南亚人中提供生活方式干预的知识有限。虽然基于诊所的筛查、生活方式建议和药物治疗是降低个体患者CHD风险因素的关键，但传统的医疗保健系统方法不太可能覆盖服务不足的南亚人。我们之前的研究是在一个社会经济地位低、英语水平有限的南亚社区进行的，确定了几个社会、文化和环境因素，这些因素可能会限制基于诊所的干预措施在这一群体中的影响。鉴于以临床为基础的冠心病预防在解决这些因素方面的局限性，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 签署人：[1]将行为干预的实际应用扩展到服务不足的社区;[2]填补基于诊所的冠心病风险因素管理的空白，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，以及缺乏访问之间的支持。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文化针对性、基于群体的冠心病预防生活方式干预。这种干预结合了南亚文化的深层结构（例如，冠心病的解释模型）作为机制，使南亚人参与冠心病预防和健康的生活方式。本研究的目的是通过随机设计对SAHELI进行试点测试，并研究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疗效。我们还将进行过程评估，以了解参与者对干预措施的看法。这项研究将为计划未来的大规模比较有效性试验提供必要的数据，该试验旨在加强难以达到的南亚裔美国人人群的冠心病预防。

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.