Preventing Chronic Disease | Improving Heart Healthy Lifestyles Among Participants in a Salud Para Su Corazón Promotores Model: The Mexican Pilot Study, 2009–2012 - CDC

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Preventing Chronic Disease | Improving Heart Healthy Lifestyles Among Participants in a Salud Para Su Corazón Promotores Model: The Mexican Pilot Study, 2009–2012 - CDC

Improving Heart Healthy Lifestyles Among Participants in a Salud Para Su Corazón Promotores Model: The Mexican Pilot Study, 2009–2012

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• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Héctor Balcázar, PhD; Ana Cecilia Fernández-Gaxiola, MSc; Ana Bertha Pérez-Lizaur, MSc; Rosa Adriana Peyron; Carma Ayala, RN, MPH, PhD

Suggested citation for this article: Balcázar H, Fernández-Gaxiola AC, Pérez-Lizaur AB, Peyron RA, Ayala C. Improving Heart Healthy Lifestyles Among Participants in a Salud Para Su Corazón Promotores Model: The Mexican Pilot Study, 2009–2012. Prev Chronic Dis 2015;12:140292. DOI: http://dx.doi.org/10.5888/pcd12.140292.

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Abstract

Introduction
In Mexico, cardiovascular disease and its risk factors are growing problems and major public health concerns. The objective of this study was to implement cardiovascular health promotion and disease prevention activities of the Salud para su Corazónmodel in a high-risk, impoverished, urban community in Mexico City.

Methods
We used a pretest–posttest (baseline to 12-week follow-up) design without a control group. Material from Salud para su Corazónwas validated and delivered by promotores (community health workers) to community members from 6 geographic areas. Two validated, self-administered questionnaires that assessed participants’ knowledge and behaviors relating to heart health were administered. We used t tests and χ2 tests to evaluate pretest and posttest differences, by age group (≤60 and >60 years), for participants’ 3 heart-healthy habits, 3 types of physical activity, performance skills, and anthropometric and clinical measurements.

Results
A total of 452 (82%) adult participants completed the program. Heart-healthy habits from pretest to posttest varied by age group. “Taking action” to modify lifestyle behaviors increased among adults aged 60 or younger from 31.5% to 63.0% (P < .001) and among adults older than 60 from 30.0% to 45.0% (P < .001). Positive responses for cholesterol and fat consumption reduction were seen among participants 60 or younger (P = .03). Among those older than 60, salt reduction and weight control increased (P = .008). Mean blood glucose concentration among adults older than 60 decreased postintervention (P = .03).

Conclusion
Significant improvements in some heart-healthy habits were seen among adult participants. The model has potential to improve heart-healthy habits and facilitate behavioral change among high-risk adults.

Acknowledgments

We thank all the promotores and partners of the Santa Fe community for their work on and support for this project. The project was financed by the Sistema Universitario Jesuita, Fundación SERTULL AC, and the Department of Health of the Universidad Iberoamericana Mexico City.

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Author Information

Corresponding Author: Héctor Balcázar, PhD, University of Texas, Health Science Center at Houston. School of Public Health, El Paso Regional Campus, 1101 N Campbell, CH 400, El Paso, TX 79902. Telephone: 915-747-8507. E-mail: Hector.G.Balcazar@uth.tmc.edu.

Author Affiliations: Ana Cecilia Fernández-Gaxiola, Ana Bertha Pérez-Lizaur, Rosa Adriana Peyron, Universidad Iberoamericana Ciudad de México, México City, México; Carma Ayala, Centers for Disease Control and Prevention, Atlanta, Georgia.

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References

1. Acosta-Cázares B, Escobedo-de la Peña J. High burden of cardiovascular disease risk factors in Mexico: an epidemic of ischemic heart disease that may be on its way? Am Heart J 2010;160(2):230–6. CrossRef PubMed
2. World Health Statistics 2013. Geneva (CH): World Health Organization; 2013. http://apps.who.int/healthinfo/statistics/mortality/whodpms. Accessed February 12, 2014.
3. Secretaria de Salud. Sistema Nacional de Información en Salud (SINAIS) 2000–2008. http://sinais.salud.gob.mx/mortalidad/index.html. Accessed February 12, 2014.
4. Pan American Health Organization, World Health Organization, Health Information and Analysis Project (HSD/HA). Health situation in the Americas: basic indicators 2012. http://ais.paho.org/chi/brochures/2012/BI_2012_ENG.pdf. Accessed February 12, 2014.
5. Rtveladze K, Marsh T, Barquera S, Sanchez Romero LM, Levy D, Melendez G, et al. Obesity prevalence in Mexico: impact on health and economic burden. Public Health Nutr 2014;17(1):233–9. CrossRef PubMed
6. Global Burden of Disease. 2004 Update. Geneva (CH): World Health Organization; 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Accessed February 12, 2014.
7. Closing the gap in a generation — health equity through action and the social determinants of health. Geneva (CH): World Health Organization; 2008. http://whqlibdoc.who.int/publications/2008/9789241563703_eng.pdf. Accessed February 12, 2014.
8. Zedleweski SR, Giannarelli L, Morton J, Wheaton L. Extreme poverty rising, existing government programs could do more. The Urban Institute; 2002. Series B, no. B-45. http://www.urban.org/uploadedpdf/310455.pdf. Accessed February 12, 2014.
9. Pleasant A. Health literacy around the world: part 1: health literacy efforts outside of the United States. Commissioned paper by Institute of Medicine; Roundtable on Health Literacy; National Academy of Sciences; 2012. http://www.iom.edu/Activities/PublicHealth/~/media/Files/Activity%20Files/PublicHealth/HealthLiteracy/2012-SEP-24/WorldHealthLit.pdf. Accessed February 12, 2014.
10. Waisel DB. Vulnerable populations in healthcare. Curr Opin Anaesthesiol 2013;26(2):186–92. CrossRef PubMed
11. Tay L, Tan K, Diener E, Gonzalez E. Social relations, health behaviors, and health outcomes: a survey and synthesis. Appl Psychol Health Well Being 2013;5(1):28–78. CrossRef PubMed
12. Retelny VS, Neuendorf A, Roth JL. Nutrition protocols for the prevention of cardiovascular disease. Nutr Clin Pract 2008;23(5):468–76. CrossRef PubMed
13. Van Horn L, McCoin M, Kris-Etherton PM, Burke F, Carson JA, Champagne CM, et al. The evidence for dietary prevention and treatment of cardiovascular disease. J Am Diet Assoc 2008;108(2):287–331. CrossRef PubMed
14. Alcalay R, Alvarado M, Balcazar H, Newman E, Huerta E. Salud para su Corazón: a community-based Latino cardiovascular disease prevention and outreach model. J Community Health 1999;24(5):359–79. CrossRef PubMed
15. Anders RI, Balcazar H, Paez L. Hispanic community-based participatory research using a Promotores de Salud model. Hisp Health Care Int 2006;4(2):71–8.CrossRef
16. Balcázar H, Wise S, Rosenthal EL, Ochoa C, Rodriguez J, Hastings D, et al. An ecological model using promotores de salud to prevent cardiovascular disease on the US–Mexico border: the HEART project. Prev Chronic Dis 2012;9:E35 [Accessed February 12, 2014].http://www.cdc.gov/pcd/issues/2012/pdf/11_0100.pdf PubMed
17. Balcazar H, Alvarado M, Ortiz G. Salud Para Su Corazón (Health for Your Heart) community health worker model: community and clinical approaches for addressing CVD risk reduction in Hispanic/Latinos. J Ambul Care Manage 2011;34(4):362–72. CrossRef PubMed
18. Balcazar HG, Byrd TL, Ortiz M, Tondapu SR, Chavez M. A randomized community intervention to improve hypertension control among Mexican Americans: using the promotoras de salud community outreach model. J Health Care Poor Underserved 2009;20(4):1079–94. CrossRef PubMed
19. Balcázar H, Alvarado M, Cantu F, Pedregon V, Fulwood R. A promotora de salud model for addressing cardiovascular disease risk factors in the US–Mexico border region. Prev Chronic Dis 2009;6(1):A02. PubMed
20. Balcázar HG, de Heer H, Rosenthal L, Aguirre M, Flores L, Puentes FA, et al. A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005–2008. Prev Chronic Dis 2010;7(2):A28. PubMed
21. Perez-Lizaur A, Peyron R, Balcazar-Quintero M, Fernandez-Gaxiola A, Balcazar H, Ayala C. Promotores de salud trabajando para la salud cardiovascular: Program Salud Para Su Corazon Santa Fe. Cuad Nutr 2012;35(5):191–7.
22. Balcázar H, Alvarado M, Hollen ML, Gonzalez-Cruz Y, Pedregón V. Evaluation of Salud para su Corazón (health for your heart) — National Council of La Raza promotora outreach program. Prev Chronic Dis 2005;2(3):A09. PubMed
23. Oficial Mexicana N. NOM-043-SSA2-2005. Servicios Básicos de Salud. Promoción y Educación para la Salud en Materia Alimentaria. Criterios para brindar orientación. Mexico (DF): Diario Oficial; 2006. http://wholegrainscouncil.org/files/MexicoNOM043.pdf. Accessed February 12, 2014.
24. World Health Organization. Physical status: the use and interpretation of anthropometry. WHO Technical Report Series 854. Geneva (CH): World Health Organization; 1995.
25. Joint National Committee on Prevention. The Seventh Report of the Joint National Committee on Prevention. Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Washington (DC): National Heart, Lung, and Blood Institute; 2004. http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.htm. Accessed July 17, 2014.
26. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2006;29(Suppl 1):S43–8. PubMed
27. van de Vijver S, Oti S, Addo J, de Graft-Aikins A, Agyemang C. Review of community-based interventions for prevention of cardiovascular diseases in low- and middle-income countries. Ethn Health 2012;17(6):651–76. CrossRef PubMed
28. Lehmann U, Sanders D. Community health workers: what do we know about them? The state of the evidence on programmes, activities, costs, and impact on health outcomes of using community health workers. Geneva (CH): World Health Organization; 2007.
29. Merrill RM, Aldana SG. Cardiovascular risk reduction and factors influencing loss to follow-up in the coronary health improvement project. Med Sci Monit 2008;14(4):PH17–25. PubMed
30. Schuit AJ, Wendel-Vos GC, Verschuren WM, Ronckers ET, Ament A, Van Assema P, et al. Effect of 5-year community intervention Hartslag Limburg on cardiovascular risk factors. Am J Prev Med 2006;30(3):237–42. CrossRef PubMed