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The Heart Healthy and Ethnically Relevant (HHER) Lifestyle Program Kick-Off Event

The Heart Healthy and Ethnically Relevant (HHER) Lifestyle Program Kick-Off Event. Welcome & Agenda. Introductions Genova McFadden, MSW Overview of the HHER Study Deborah Parra-Medina, PhD, MPH Benefits of Provider Lifestyle Counseling Mary Beth Poston, MD

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The Heart Healthy and Ethnically Relevant (HHER) Lifestyle Program Kick-Off Event

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  1. The Heart Healthy and Ethnically Relevant (HHER) Lifestyle ProgramKick-Off Event

  2. Welcome & Agenda • Introductions • Genova McFadden, MSW • Overview of the HHER Study • Deborah Parra-Medina, PhD, MPH • Benefits of Provider Lifestyle Counseling • Mary Beth Poston, MD • Stage-Matched Counseling & Study Logistics • Sara Wilcox, PhD • Next Steps for Delivering Lifestyle Counseling • Genova McFadden, MSW

  3. Introductions Genova McFadden, MSW

  4. Overview of the HHER Lifestyle Program Deborah Parra-Medina, MPH, PhD

  5. Background - Need • HHER Lifestyle Program envisioned as a partnership to work toward reducing disparities in cardiovascular health • CVD mortality rates: • 273.6 for White women • 376.6 for Black women • Hypertension-related complications: • Risk of fatal stroke 1.8 times greater in Blacks • Risk of CHD mortality 1.5 times greater in Blacks • End-stage kidney disease 4.2 times greater in Blacks • SC ranks highest in stroke mortality • SC ranks 42 (of 52) in overall CVD mortality Data Source: American Heart Association, 2003

  6. 1990 1995 2001 No Data <4% 4%-6% 6%-8% 8%-10% >10% Diabetes Trends

  7. 1991 Obesity Trends 1996 2003 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  8. Obesity Epidemic • Physical inactivity and a poor diet are the major contributors to obesity Data Source: Flegel et al., 2002; 1999-2000 NHIS

  9. Study Background • Four-year study funded by the National Institutes of Health • Builds on partnership between the Eau Claire Cooperative Health Center and USC that began in 1999 • Partnership between USC Arnold School of Public Health and • Family Health Centers, Inc. • Eau Claire Cooperative Health Center

  10. Study Design • Randomized 312 patients to: • Standard care only (provider counseling + nurse goal setting) • Standard care plus telephone counseling and newsletters for one year • (312 patients will come from EC and FHC combined) • Conduct baseline, 6 months, and 12 months assessments and measure: • Physical activity (self-report & objective) • Dietary fat and cholesterol • Lipids • Body mass index

  11. Benefits of Provider Lifestyle Counseling Mary Beth Poston, MD

  12. Why Focus on Provider Counseling? • Routine physical activity and nutrition counseling in primary care settings is recommended by numerous professional organizations

  13. Official recommendations: counseling for lifestyle change • Healthy People 2010 • US Preventive Services Task Force • American Heart Association • American College of Preventive Medicine • American College of Obstetrics and Gynecology • American Academy of Family Physicians

  14. AAFP – Americans in Motion • The AIM initiative is conceptualized to be a readily available resource to family physicians who wish to promote "fitness" as a path to health for all members of the American family. • Mission • The mission of AIM is to improve the health of all Americans by implementing a multifaceted fitness program addressing physical activity, nutrition, and emotional well-being in the individual, family and community. • Goals of the initiative include: • Encourage family physicians to be fitness role models. • Improve family physicians' ability to positively affect the fitness of their patients. • Enhance the awareness of family physicians' unique ability to promote fitness within their communities.

  15. Why the HHER Lifestyle Program? • The HHER Lifestyle Program will help you deliver this recommended counseling in a more efficient and perhaps more effective manner by: • Integrating current evidence-based guidelines on: • Physical Activity • Nutrition • Counseling techniques • Using a multi-faceted approach that involves: • Providers • Nurses • Community resources • HHER staff

  16. Why the HHER Lifestyle Program? • Health care clinics are excellent settings to counsel people on lifestyle factors • Health care providers are trusted sources of health information • Behavioral interventions in this setting have shown promising results • Few studies have been done health care settings with financially disadvantaged African American women Adults are counseled about physical activity and diet at suboptimal levels due to many barriers providers face • Lack of time • Lack of formal training in behavior counseling techniques • Reimbursement issues

  17. Physical Activity Examples • Project PACE • Intervention: • Assess physical activity • Deliver brief (3-5 min) stage-matched counseling & goal setting • Follow-up booster telephone call (2 wks) • Results (mins/wk walked) • Intervention: 39 min/wk • Control: 10 min/wk Source: Calfas et al., 1996, Prev Med

  18. Physical Activity Example: The Activity Counseling Trial (ACT) • Examined the effect of PA counseling (2 intensities) relative to usual care • Advice – Physician recommendation to meet CDC/ACSM recommendations (usual care) • Assistance – Advice + 1 behavioral counseling session + behaviorally oriented, tailored mailings • Counseling – Assistance + telephone-based behavioral counseling (monthly) • Outcome – Improved physical activity in all groups. Increased fitness with Assistance and Counseling (but not with Advice) Source: The Activity Counseling Trial Writing Group, JAMA, 2001

  19. Dietary Example: WATCH • Randomized primary care providers to one of three groups: • Usual care (control group) • Physician nutrition counseling training • Physician nutrition counseling training + office support program • Physician training included patient-centered counseling for nutrition • Office support included in-office prompts, algorithms, and simple dietary assessment tools Source: Ockene et al., 1999, Arch Intern Med

  20. WATCH Findings • Significant improvements were seen in all primary outcome measures, but only in Group 3 (training + office support): • 10% reduction in saturated fat • 2.3 kg reduction in weight • 0.10 mmol/L (3.8 mg/dL) decrease in LDL cholesterol

  21. Evidence Supporting the HHER Lifestyle Goals Physical Activity & Low Fat Eating

  22. Why Physical Activity? • Long-Term Goal: 30+ minutes, 5+ days per week, moderate-intensity • Physical inactivity is an independent risk factor for coronary heart disease • Plus numerous other health benefits • Regular physical activity participation is low in African Americans

  23. Regular Physical Activity Data Source: CDC, 2003 BRFSS

  24. Why Diet? • Goal: Reduce intake of saturated fat and trans fats • i.e., fat from animals (meat, high fat dairy, etc.) or foods made with hydrogenated fat (chips, crackers, baked goods, etc.) • Saturated fat and trans fats, but not total fat, are strongly related to CHD mortality • CHD risk can be reduced by substituting healthy fats for saturated and trans fats

  25. Dietary Guidelines for Americans 2005 – Key Recommendations • ADEQUATE NUTRIENTS WITHIN CALORIE NEEDS • Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol. • Meet recommended intakes within energy needs by adopting a balanced eating pattern, such as the U.S. Department of Agriculture (USDA) Food Guide or the Dietary Approaches to Stop Hypertension (DASH) Eating Plan.

  26. HHER Lifestyle Program Benefits To Your Practice • System to assist you deliver counseling more efficiently and with support • Potential to help your patients become more adherent and have better health outcomes (potential cost savings) • Other benefits to you or your patients?

  27. Stage-Matched Counseling & Study Logistics Sara Wilcox, PhD

  28. Recruitment Flow Chart

  29. Counseling Flow Chart

  30. Tools – Providers & Nurses Walking – Stage 3 Walking – Stage 2 Diet – Stage 3 Diet – Stage 2 Walking – Stage 1a Walking – Stage 1b Diet – Stage 1b Diet – Stage 1a Stickers Goal Sheets CD ROM Training Manual Provider Pocket Tool

  31. Tools - Patients Tracking Calendar Pedometer Educational Materials Monthly Newsletter Community Resource Guide

  32. Transtheoretical Model (aka Stages of Change) • Assumptions • Decision to change = patient’s • Change is difficult & ambivalence is normal • Change is not linear • Interventions matched to a person’s readiness for change are more effective • Clinically useful • Helps you match your intervention to patient needs • Allows for tailoring (meeting people where they are at) • Helps you use your resources (time) wisely

  33. Intends to take action in the immediate future. Has a plan of action & is taking small steps. Maintained healthy life style change for over 6 mo. No intention to take action in the near future Maintenance “I have” Precontemplation “I won’t/I can’t Preparation “I will / I’m starting” Contemplation “I might” Action “I am” Thinking about changing behavior within the next 6 mo. Has made specific overt change in life style within the past six mo. Is meeting recommendations Stages of Change

  34. Stages for HHER: Counseling Focus • Stage 1: “Not Ready for Change” • Increase awareness of need to change and motivation for change (thoughts) • Stage 2: “Beginning to Change” • Help make change more regular (thoughts & behavior) • Stage 3: “Making Changes” • Support maintenance of behavior and help prevent relapse (behavior)

  35. Steps for Counseling • Step 1: Ask permission to audio record • Step 2: Praise patient for joining HHER Lifestyle Program & briefly summarize program goals • Regular physical activity like walking (30 m/d, 5 d/wk) • Reduce saturated and trans fats in diet (e.g., fatty meats, high fat dairy, baked goods, chips, crackers) • Step 3: Describe patient’s current stage and ask about current physical activity and low fat practices (past or present) • Use open-ended questions

  36. Steps for Counseling • Step 4: Choose 1-2 behavioral topics to address (stage-matched) • E.g., barriers, social support, confidence, rewards, pros/cons • Step 5: State that the nurse will work with the patient to help her set specific goals for physical activity and diet • Step 6: Ask if the patient has any questions & wish her well

  37. Stage 1 Counseling – Examples of Behavioral Topics • Provide accurate information and compelling evidence • Help weigh pros and cons of change • Help identify barriers to change • Explore misconceptions & encourage thinking about change • Assess confidence (stage 1b) • Encourage small attempts (stage 1b)

  38. Stage 2 Counseling – Examples of Behavioral Topics • Reinforce and praise attempts • State recommendations • Encourage firm commitment to a regular program • Discuss barriers and encourage patient-generatedsolutions • Encourage use of social support networks

  39. Stage 3 Counseling – Examples of Behavioral Topics • Praise patient • Discuss rewards • Discuss obtained/needed social support • Identify high risk situations and patient-generated solutions • Encourage variety for enjoyment

  40. Next Steps for Delivering Lifestyle Counseling Genova McFadden, MSW

  41. Next Steps • Complete CD ROM training and return post-tests to USC for CMEs (6 CMEs for CD ROM, 1.5 for today) • by November 2, 2005 • Review of audiotapes and feedback by HHER staff • Participate in HHER Staff presentations at staff meetings (CMEs provided) • Call Sara Wilcox (777-8141) if you have any questions about training or any problems with the CD ROM

  42. Thank you for your time and participation!Questions & Comments?

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