Impact evaluation of a healthy lifestyle intervention to reduce cardiovascular disease risk in health centers in San José, Costa Rica and Chiapas, Mexico

• Published in: BMC health services research 2015-12, Vol.15 (579), p.577-577, Article 577
• Main Authors: Fort, Meredith P, Murillo, Sandra, López, Erika, Dengo, Ana Laura, Alvarado-Molina, Nadia, de Beausset, Indira, Castro, Maricruz, Peña, Liz, Ramírez-Zea, Manuel, Martínez, Homero
• Format: Article
• Language: English
• Subjects: Adult; Aged; Blood Pressure; Body Mass Index; Cardiovascular disease; Cardiovascular Diseases - prevention & control; Care and treatment; Chronic illnesses; Costa Rica; Diabetes; Diabetes Mellitus, Type 2; Disease Management; Female; Guatemala; Health care; Health education; Health facilities; Health Promotion; Humans; Hypertension; Hypertension - psychology; Life Style; Male; Maternal & child health; Medical personnel; Mexico; Middle Aged; Patient education; Patients; Pilot Projects; Primary care; Primary Health Care; Prospective Studies; Type 2 diabetes; United States
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-015-1248-7

Previous healthy lifestyle interventions based on the Salud para Su Corazón curriculum for Latinos in the United States, and a pilot study in Guatemala, demonstrated improvements in patient knowledge, behavior, and clinical outcomes for adults with hypertension. This article describes the implementation of a healthy lifestyle group education intervention at the primary care health center level in the capital cities of Costa Rica and Chiapas, Mexico for patients with hypertension and/or type 2 diabetes and presents impact evaluation results. Six group education sessions were offered to participants at intervention health centers from November 2011 to December 2012 and participants were followed up for 8 months. The study used a prospective, longitudinal, nonequivalent pretest-posttest comparison group design, and was conducted in parallel in the two countries. Cognitive and behavioral outcome measures were knowledge, self-efficacy, stage-of-change, dietary behavior and physical activity. Clinical outcomes were: body mass index, systolic and diastolic blood pressure, and fasting blood glucose. Group by time differences were assessed using generalized estimating equation models, and a dose-response analysis was conducted for the intervention group. The average number of group education sessions attended in Chiapas was 4 (SD: 2.2) and in Costa Rica, 1.8 (SD: 2.0). In both settings, participation in the study declined by 8-month follow-up. In Costa Rica, intervention group participants showed significant improvements in systolic and diastolic blood pressure and borderline significant improvement for fasting glucose, and significant improvement in the stages-of-change measure vs. the comparison group. In Chiapas, the intervention group showed significant improvement in the stages-of-change measure in relation to the comparison group. Significant improvements were not observed for knowledge, self-efficacy, dietary behavior or physical activity. In Chiapas only, a significant dose-response relationship was observed for systolic and diastolic blood pressure. Group education interventions at health centers have the potential to improve stage-of-change activation, and may also improve clinical outcomes. In the future, it will be essential to dedicate resources to understand ways to reach a representative group of the patient population, tailor the intervention so that patients are engaged to participate, and consider the broader family and community context that infl