Abstract

Keywords

۱٫ Introduction

۲٫ Materials and methods

۳٫ Results

۴٫ Discussion

CRediT authorship contribution statement

Acknowledgement

References

Abstract

Community health worker-led interventions may be an optimal approach to promote behavior change among populations with low incomes due to the community health workers’ unique insights into participants’ social and environmental contexts and potential ability to deliver interventions widely. The objective was to determine the feasibility (implementation, acceptability, preliminary efficacy) of a weight management intervention for adults living in public housing developments. In 2016–۲۰۱۸, in Boston Massachusetts, we conducted a 3-month, two-group randomized trial comparing participants who received a tailored feedback report (control group) to participants who received the same report plus behavioral counseling. Community health workers provided up to 12 motivational interviewing-based counseling sessions in English or Spanish for diet and physical activity behaviors using a website designed to guide standardized content delivery. 102 participants enrolled; 8 (7.8%) were lost at 3-month follow up. Mean age was 46.5 (SD = 11.9) years; the majority were women (88%), Hispanic (67%), with ≤ high school degree (62%). For implementation, among intervention group participants (n = 50), 5 completed 0 sessions and 45 completed a mean of 4.6 (SD = 3.1) sessions. For acceptability, most indicated they would be very likely (79%) to participate again. For preliminary efficacy, adjusted linear regression models showed mean changes in weight (-0.94 kg, p = 0.31), moderate-to-vigorous physical activity (+11.7 min/day, p = 0.14), and fruit/vegetable intake (+2.30 servings/day, p < 0.0001) in the intervention vs. control group. Findings indicate a low-income public housing population was reached through a community health worker-led intervention with sufficient implementation and acceptability and promising beneficial changes in weight, nutrition, and physical activity outcomes.

۱٫ Introduction

Cardiovascular diseases account for a substantial amount of preventable death which can be at least partially mitigated by changing modifiable behaviors and factors, including diet quality, physical activity, and weight (Benjamin et al., 2019). In the U.S., racial/ethnic minority and populations with low socio-economic status (i.e., health disparity facing populations) have higher prevalence of cardiovascular diseases compared to white and higher SES populations. From 2013 to 2016, prevalence of cardiovascular diseases (including hypertension) among adults 20 years or older is 60.1% for non-Hispanic Black males, 50.6% for non-Hispanic white males, and 49.0% for Hispanic males; and among females, 57.1% for non-Hispanic Black females, 43.4% for non-Hispanic white females, and 42.6% for Hispanic females (Benjamin et al., 2019). Furthermore, health disparity facing populations have lower adherence to national guidelines for cardiovascular disease-related health behaviors and contributing factors such as obesity (Hales et al., 2018), likely owing to inequalities in economic, educational, environmental resources and racial/ethnic discrimination. Weight management interventions have been less effective among racial/ethnic minority compared to white individuals (West et al., 2008). Residents of public housing tend to have a higher proportion of individuals with low income, belonging to racial/ethnic minority groups, and with obesity and cardiovascular disease-related health conditions compared to other city residents (Digenis-Bury et al., 2008, Chambers and Rosenbaum, 2014).