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Schwertfeger JL, Miller SA, Jordan M, Jordan D, Schneider KL. A 3-day 'stroke camp' addressed chronic disease self-management elements and perceived stress of survivors of stroke and their caregivers reduced: Survey results from the 14 US camps. Top Stroke Rehabil 2024; 31:1-10. [PMID: 37004716 DOI: 10.1080/10749357.2023.2196468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/24/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Stroke is a leading cause of disability for persons with stroke (PWS). Difficulty coping with long-term stress for PWS and their caregivers (CG) contributes to their poor health. Variations of chronic-disease self-management programs (CDSMPs) have reduced long-term stress in PWS and CGs. CDSMPs include training for decision-making, problem-solving, resource utilization, peer support, developing a patient-provider relationship, and environmental support. OBJECTIVE This study examined whether a user-designed stroke camp addressed CDSMP domains, used consistent activities, and decreased stress in PWS and CG. METHODS This open cohort survey study followed STROBE guidelines and assessed stress at four timepoints: 1 week before camp, immediately before camp, immediately after camp, and 1 month after camp. Mixed-model analysis examined changes in stress from the two baseline time points to the two post-camp time points. The research team reviewed documents and survey responses to assess activities described in camp documents and CDSMP domains across camps. POPULATION PWS and CG who attended a camp in 2019. The PWS sample (n = 40) included50% males, aged 1-41-years post stroke, 60% with ischemic, one-third with aphasia, and 37.5% with moderate-severe impairment. CG sample (n = 24) was 60.8% female, aged 65.5 years, and had 7.4 years CG experience. RESULTS Stress decreased significantly in PWS (Cohen's d = -0.61) and CGs (Cohen's d = -0.87) from pre- to post-camp. Activities addressing all but one CDSMP domains were evident across camps. CONCLUSIONS Stroke camp is a novel model that addresses CDSMP domains, which may reduce stress in PWS and CG. Larger, controlled studies are warranted.
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Affiliation(s)
- Julie Lynn Schwertfeger
- Chicago Medical School, Rosalind Franklin University of Medicine & Science, North Chicago, IL, USA
| | - Steven A Miller
- Psychology, Rosalind Franklin University of Medicine and Science College of Health Professions, North Chicago, IL, USA
| | | | - Dean Jordan
- Spring Grove Fire Protection District. BattalionChief, Spring Grove, IL, USA
| | - Kristin L Schneider
- Rosalind Franklin University of Medicine& Science, College of Health Professions, North Chicago, IL, USA
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Kessler D, McCutcheon T, Rajachandrakumar R, Lees J, Deyell T, Levy M, Liddy C. Understanding barriers to participation in group chronic disease self-management (CDSM) programs: A scoping review. Patient Educ Couns 2023; 115:107885. [PMID: 37473604 DOI: 10.1016/j.pec.2023.107885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To identify factors that influence enrollment in and attendance of chronic disease self-management (CDSM) group programs. METHODS A scoping review of peer-reviewed publications that reported on factors of enrollment or attendance in group CDSM programs for adults with any type of chronic condition. Screening was completed by two reviewers and data extraction was checked for accuracy. Data were summarized and key themes were identified in collaboration with the study team. RESULTS Following screening, 52 of 2774 articles were included. Attendance rates that varied from 10.4-98.5% (mean =72.5%). There is considerable overlap between enrollment and attendance factors. These included Competing Commitments, Logistics, Personal characteristics, Perception of illness/health status, Health service provision, and Group dynamics. CONCLUSIONS Varied and individualized factors can facilitate or impede enrollment or attendance in group CDSM programs. Consideration of these factors and tailoring of programs is needed to facilitate patient ability to take part. Participatory co-design is a growing approach to ensure programs meet individual and community needs. More research is needed to identify the specific impact of using codesign on enrollment and attendance in group CDSM programs. PRACTICE IMPLICATIONS Including community members and service users in design and implementation may enhance CDSM program access.
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Affiliation(s)
- Dorothy Kessler
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada.
| | - Tess McCutcheon
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | | | - Jodie Lees
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Tracy Deyell
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada
| | - Marisa Levy
- School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Canada
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Boden-Albala B, Rebello V, Drum E, Gutierrez D, Smith WR, Whitmer RA, Griffith DM. Use of Community-Engaged Research Approaches in Clinical Interventions for Neurologic Disorders in the United States: A Scoping Review and Future Directions for Improving Health Equity Research. Neurology 2023; 101:S27-S46. [PMID: 37580148 DOI: 10.1212/wnl.0000000000207563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/09/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence suggests a significant prevalence of race and ethnic disparities in the United States among people with neurologic conditions including stroke, Alzheimer disease and related dementia (ADRD), Parkinson disease (PD), epilepsy, spinal cord injury (SCI), and traumatic brain injury (TBI). Recent neurologic research has begun the paradigm shift from observational health disparities research to intervention research in an effort to narrow the disparities gap. There is an evidence base that suggests that community engagement is a necessary component of health equity. While the increase in disparities focused neurologic interventions is encouraging, it remains unclear whether and how community-engaged practices are integrated into intervention design and implementation. The purpose of this scoping review was to identify and synthesize intervention studies that have actively engaged with the community in the design and implementation of interventions to reduce disparities in neurologic conditions and to describe the common community engagement processes used. METHODS Two databases, PubMed and CINAHL, were searched to identify eligible empirical studies within the United States whose focus was on neurologic interventions addressing disparities and using community engagement practices. RESULTS We identified 392 disparity-focused interventions in stroke, ADRD, PD, epilepsy, SCI, and TBI, of which 53 studies incorporated community engagement practices: 32 stroke studies, 15 ADRD, 2 epilepsy studies, 2 PD studies, 1 SCI study, and 1 TBI study. Most of the interventions were designed as randomized controlled trials and were programmatic in nature. The interventions used a variety of community engagement practices: community partners (42%), culturally tailored materials and mobile health (40%), community health workers (32%), faith-based organizations and local businesses (28%), focus groups/health need assessments (25%), community advisory boards (19%), personnel recruited from the community/champions (19%), and caregiver/social support (15%). DISCUSSION Our scoping review reports that the proportion of neurologic intervention studies incorporating community engagement practices is limited and that the practices used within those studies are varied. The major practices used included collaboration with community partners and utilization of culturally tailored materials. We also found inconsistent reporting and dissemination of results from studies that implemented community engagement measures in their interventions. Future directions include involving the community in research early and continuously, building curricula that address challenges to community engagement, prioritizing the inclusion of community engagement reporting in peer-reviewed journals, and prioritizing and incentivizing research of subpopulations that experience disparities in neurologic conditions.
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Affiliation(s)
- Bernadette Boden-Albala
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC.
| | - Vida Rebello
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Emily Drum
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Desiree Gutierrez
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Wally R Smith
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Rachel A Whitmer
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
| | - Derek M Griffith
- From the Department of Health, Society and Behavior (B.B.-A., V.R., E.D., D.G.), Department of Epidemiology and Biostatistics (B.B.-A.), Program in Public Health, and Department of Neurology (B.B.-A.), School of Medicine, Susan and Henry Samueli College of Health Sciences, University of California, Irvine; Division of General Internal Medicine (W.R.S.), Department of Medicine, Virginia Commonwealth University, Richmond; Departments of Public Health Sciences (R.A.W.), and Neurology (R.A.W.), and Division of Epidemiology (R.A.W.), University of California, Davis; Center for Men's Health Equity (D.M.G.), Racial Justice Institute (D.M.G.), and Department of Health Systems Administration (D.M.G.), School of Nursing and Health Sciences, Georgetown University, Washington, DC
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Falasinnu T, Bao G, Brady TJ, Lim SS, Drenkard C. Factors Associated With the Initiation and Retention of Patients With Lupus in the Chronic Disease Self-Management Program. Arthritis Care Res (Hoboken) 2023; 75:519-528. [PMID: 34738339 PMCID: PMC9065209 DOI: 10.1002/acr.24811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 10/05/2021] [Accepted: 10/21/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The Chronic Disease Self-Management Program (CDSMP) is designed to enhance patients' self-efficacy and skills to manage their chronic illness. There is compelling evidence for the benefits of the CDSMP among patients with systemic lupus erythematosus (SLE); however, little is known about predictors of participation among Black women with SLE. We examined factors associated with CDSMP initiation and completion in this population. METHODS We studied 228 Black women with SLE who consented to attend a CDSMP workshop. We used logistic regression to calculate unadjusted and adjusted odds ratios (ORs) for being a CDSMP initiator (a participant registered into the CDSMP who attended at least 1 of the first 2 weekly classes) and a CDSMP completer (a participant who completed at least 4 of 6 weekly classes). RESULTS The majority of participants were CDSMP initiators (74% [n = 168]). Of those, 126 (75%) were CDSMP completers. Older age (adjusted OR [ORadj ] 1.03 [95% confidence interval (95% CI) 1.00-1.06]) and unemployment/disability (ORadj 2.05 [95% CI 1.05-4.14]) increased the odds of being a CDSMP initiator. The odds of initiating the CDSMP decreased by 22% for each additional child in the household (OR 0.78 [95% CI 0.62-0.98]), but this association became nonsignificant in the adjusted model (ORadj 0.89 [95% CI 0.68-1.18]). The only factor that differed significantly between CDSMP completers and noncompleters was age, with 4% higher odds of being a completer for each additional year of age (ORadj 1.04 [95% CI 1.00-1.07]). CONCLUSION Our findings suggest that young Black women with SLE face barriers to attend and complete in-person CDSMP workshops, possibly in relation to work and child care demands.
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Affiliation(s)
| | | | | | - S Sam Lim
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Cristina Drenkard
- Emory University and Rollins School of Public Health, Emory University, Atlanta, Georgia
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Abstract
BACKGROUND Stroke survivors are often physically inactive as well as sedentary,and may sit for long periods of time each day. This increases cardiometabolic risk and has impacts on physical and other functions. Interventions to reduce or interrupt periods of sedentary time, as well as to increase physical activity after stroke, could reduce the risk of secondary cardiovascular events and mortality during life after stroke. OBJECTIVES To determine whether interventions designed to reduce sedentary behaviour after stroke, or interventions with the potential to do so, can reduce the risk of death or secondary vascular events, modify cardiovascular risk, and reduce sedentary behaviour. SEARCH METHODS In December 2019, we searched the Cochrane Stroke Trials Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, Conference Proceedings Citation Index, and PEDro. We also searched registers of ongoing trials, screened reference lists, and contacted experts in the field. SELECTION CRITERIA Randomised trials comparing interventions to reduce sedentary time with usual care, no intervention, or waiting-list control, attention control, sham intervention or adjunct intervention. We also included interventions intended to fragment or interrupt periods of sedentary behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and performed 'Risk of bias' assessments. We analyzed data using random-effects meta-analyses and assessed the certainty of the evidence with the GRADE approach. MAIN RESULTS We included 10 studies with 753 people with stroke. Five studies used physical activity interventions, four studies used a multicomponent lifestyle intervention, and one study used an intervention to reduce and interrupt sedentary behaviour. In all studies, the risk of bias was high or unclear in two or more domains. Nine studies had high risk of bias in at least one domain. The interventions did not increase or reduce deaths (risk difference (RD) 0.00, 95% confidence interval (CI) -0.02 to 0.03; 10 studies, 753 participants; low-certainty evidence), the incidence of recurrent cardiovascular or cerebrovascular events (RD -0.01, 95% CI -0.04 to 0.01; 10 studies, 753 participants; low-certainty evidence), the incidence of falls (and injuries) (RD 0.00, 95% CI -0.02 to 0.02; 10 studies, 753 participants; low-certainty evidence), or incidence of other adverse events (moderate-certainty evidence). Interventions did not increase or reduce the amount of sedentary behaviour time (mean difference (MD) +0.13 hours/day, 95% CI -0.42 to 0.68; 7 studies, 300 participants; very low-certainty evidence). There were too few data to examine effects on patterns of sedentary behaviour. The effect of interventions on cardiometabolic risk factors allowed very limited meta-analysis. AUTHORS' CONCLUSIONS Sedentary behaviour research in stroke seems important, yet the evidence is currently incomplete, and we found no evidence for beneficial effects. Current World Health Organization (WHO) guidelines recommend reducing the amount of sedentary time in people with disabilities, in general. The evidence is currently not strong enough to guide practice on how best to reduce sedentariness specifically in people with stroke. More high-quality randomised trials are needed, particularly involving participants with mobility limitations. Trials should include longer-term interventions specifically targeted at reducing time spent sedentary, risk factor outcomes, objective measures of sedentary behaviour (and physical activity), and long-term follow-up.
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Affiliation(s)
- David H Saunders
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Gillian E Mead
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Claire Fitzsimons
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Paul Kelly
- Physical Activity for Health Research Centre (PAHRC), University of Edinburgh, Edinburgh, UK
| | - Frederike van Wijck
- Institute for Applied Health Research and the School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | - Karianne Backx
- Institute for Sport, Physical Education and Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Coralie English
- Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, Florey Institute of Neuroscience and Mental Health & Hunter Medical Research Institute, Melbourne and Newcastle, Australia
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Towfighi A, Cheng EM, Ayala-Rivera M, Barry F, McCreath H, Ganz DA, Lee ML, Sanossian N, Mehta B, Dutta T, Razmara A, Bryg R, Song SS, Willis P, Wu S, Ramirez M, Richards A, Jackson N, Wacksman J, Mittman B, Tran J, Johnson RR, Ediss C, Sivers-Teixeira T, Shaby B, Montoya AL, Corrales M, Mojarro-Huang E, Castro M, Gomez P, Muñoz C, Garcia D, Moreno L, Fernandez M, Lopez E, Valdez S, Haber HR, Hill VA, Rao NM, Martinez B, Hudson L, Valle NP, Vickrey BG. Effect of a Coordinated Community and Chronic Care Model Team Intervention vs Usual Care on Systolic Blood Pressure in Patients With Stroke or Transient Ischemic Attack: The SUCCEED Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2036227. [PMID: 33587132 PMCID: PMC7885035 DOI: 10.1001/jamanetworkopen.2020.36227] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
IMPORTANCE Few stroke survivors meet recommended cardiovascular goals, particularly among racial/ethnic minority populations, such as Black or Hispanic individuals, or socioeconomically disadvantaged populations. OBJECTIVE To determine if a chronic care model-based, community health worker (CHW), advanced practice clinician (APC; including nurse practitioners or physician assistants), and physician team intervention improves risk factor control after stroke in a safety-net setting (ie, health care setting where all individuals receive care, regardless of health insurance status or ability to pay). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included participants recruited from 5 hospitals serving low-income populations in Los Angeles County, California, as part of the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) clinical trial. Inclusion criteria were age 40 years or older; experience of ischemic or hemorrhagic stroke or transient ischemic attack (TIA) no more than 90 days prior; systolic blood pressure (BP) of 130 mm Hg or greater or 120 to 130 mm Hg with history of hypertension or using hypertensive medications; and English or Spanish language proficiency. The exclusion criterion was inability to consent. Among 887 individuals screened for eligibility, 542 individuals were eligible, and 487 individuals were enrolled and randomized, stratified by stroke type (ischemic or TIA vs hemorrhagic), language (English vs Spanish), and site to usual care vs intervention in a 1:1 fashion. The study was conducted from February 2014 to September 2018, and data were analyzed from October 2018 to November 2020. INTERVENTIONS Participants randomized to intervention were offered a multimodal coordinated care intervention, including hypothesized core components (ie, ≥3 APC clinic visits, ≥3 CHW home visits, and Chronic Disease Self-Management Program workshops), and additional telephone visits, protocol-driven risk factor management, culturally and linguistically tailored education materials, and self-management tools. Participants randomized to the control group received usual care, which varied by site but frequently included a free BP monitor, self-management tools, and linguistically tailored information materials. MAIN OUTCOMES AND MEASURES The primary outcome was change in systolic BP at 12 months. Secondary outcomes were non-high density lipoprotein cholesterol, hemoglobin A1c, and C-reactive protein (CRP) levels, body mass index, antithrombotic adherence, physical activity level, diet, and smoking status at 12 months. Potential mediators assessed included access to care, health and stroke literacy, self-efficacy, perceptions of care, and BP monitor use. RESULTS Among 487 participants included, the mean (SD) age was 57.1 (8.9) years; 317 (65.1%) were men, and 347 participants (71.3%) were Hispanic, 87 participants (18.3%) were Black, and 30 participants (6.3%) were Asian. A total of 246 participants were randomized to usual care, and 241 participants were randomized to the intervention. Mean (SD) systolic BP improved from 143 (17) mm Hg at baseline to 133 (20) mm Hg at 12 months in the intervention group and from 146 (19) mm Hg at baseline to 137 (22) mm Hg at 12 months in the usual care group, with no significant differences in the change between groups. Compared with the control group, participants in the intervention group had greater improvements in self-reported salt intake (difference, 15.4 [95% CI, 4.4 to 26.0]; P = .004) and serum CRP level (difference in log CRP, -0.4 [95% CI, -0.7 to -0.1] mg/dL; P = .003); there were no differences in other secondary outcomes. Although 216 participants (89.6%) in the intervention group received some of the 3 core components, only 35 participants (14.5%) received the intended full dose. CONCLUSIONS AND RELEVANCE This randomized clinical trial of a complex multilevel, multimodal intervention did not find vascular risk factor improvements beyond that of usual care; however, further studies may consider testing the SUCCEED intervention with modifications to enhance implementation and participant engagement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01763203.
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Affiliation(s)
- Amytis Towfighi
- University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | | | - Monica Ayala-Rivera
- University of Southern California, Los Angeles
- Los Angeles County Department of Health Services, Los Angeles, California
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | | | | | - David A. Ganz
- University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Martin L. Lee
- University of California, Los Angeles
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Nerses Sanossian
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Bijal Mehta
- University of California, Los Angeles
- Harbor-UCLA Medical Center, Torrance, California
| | - Tara Dutta
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- University of Maryland, Baltimore
| | - Ali Razmara
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Kaiser Permanente, Irvine, California
| | - Robert Bryg
- University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Shlee S. Song
- Cedars Sinai Medical Center, Los Angeles, California
| | - Phyllis Willis
- Watts Labor Community Action Committee, Los Angeles, California
| | - Shinyi Wu
- University of Southern California, Los Angeles
| | - Magaly Ramirez
- University of Washington School of Public Health, Seattle
| | - Adam Richards
- Community Partners International, San Francisco, California
| | | | | | - Brian Mittman
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Kaiser Permanente, Los Angeles, California
| | - Jamie Tran
- Harbor-UCLA Medical Center, Torrance, California
| | - Renee R. Johnson
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- California State University, Los Angeles
| | - Chris Ediss
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Theresa Sivers-Teixeira
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
| | - Betty Shaby
- Olive View-UCLA Medical Center, Sylmar, California
| | - Ana L. Montoya
- Harbor-UCLA Medical Center, Torrance, California
- Olive View-UCLA Medical Center, Sylmar, California
| | - Marilyn Corrales
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- University of California, Riverside
| | - Elizabeth Mojarro-Huang
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Marissa Castro
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Cedars Sinai Medical Center, Los Angeles, California
| | - Patricia Gomez
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Cynthia Muñoz
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Diamond Garcia
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- Harbor-UCLA Medical Center, Torrance, California
| | - Lilian Moreno
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Maura Fernandez
- University of Southern California, Los Angeles
- LAC+USC Medical Center, Los Angeles, California
| | - Enrique Lopez
- Rancho Los Amigos National Rehabilitation Center, Downey, California
| | - Sarah Valdez
- Harbor-UCLA Medical Center, Torrance, California
| | - Hilary R. Haber
- Dimagi, Cambridge, Massachusetts
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Neal M. Rao
- University of California, Los Angeles
- Olive View-UCLA Medical Center, Sylmar, California
| | - Beatrice Martinez
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
- LAC+USC Medical Center, Los Angeles, California
- Harbor-UCLA Medical Center, Torrance, California
| | - Lillie Hudson
- University of Southern California, Los Angeles
- Rancho Los Amigos National Rehabilitation Center, Downey, California
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