Month: June 2019 (Page 1 of 5)

Carlie Charles

Thomas, Naomi. (October 9, 2018) How church communities can help lower African-Americans’ blood pressure.CNN. https://www.cnn.com/2018/10/09/health/church-hypertension-blood-pressure-intervention-study/index.html (Accessed June, 27, 2019)

• Naomi Thomas wrote an article that discusses an upstream intervention strategy of the intentions to lower and mediate the rates of hypertension in the black community. The study took a different approach and geared towards a faith-based intervention and situated their study in 32 churches across New York City. The study consisted of 373 people and they were split into two group—one received the intervention and the other was categorized into the control group. The group that received the intervention was dedicated 11 90-minute sessions held weekly and focused on educating individuals of healthy life choices. In addition, the intervention group received 3 monthly motivation phone calls to report their progress in lifestyle changes. The control group received only one session educating on lifestyle changes in high blood pressure and the other ten focused on a variety of other topics such as fire safety and Alzheimer’s along with no motivational phone calls from leaders. Church member’s blood pressure was recorded upon initiation of the program, six months, and nine months since the program started. The intervention group had a systolic blood pressure decrease from 5.8 to 5.3 mmHg.

• According to  Ogedegbe, the director of NYU Langone’s Center for Healthful Behavior Change, clinically speaking, the reduction was to observed as a significant decrease. Centralizing the focus groups in the church, members felt more inclined to be cooperative because the church created space for members to share their progress and challenges with the comfort of freedom from judgment.

• The use of the church was significant in the design of the study. Kiser, senior program director at the Interfaith Health Program mentioned that “Faith-based settings are sources of trusted information.” She also mentioned that “It strengthens disease prevention and health promotion activities.” The study also implemented the use of lay health advisors— which are members of the community who volunteer to help for a cause—was an important aspect of the study because it involved regular people in the community an absolved the need to have doctors or clinic officials to conduct the focus groups. Lay Health advisors were also important to consider in the black community because of the culture of how the community beliefs shape around people who are considered strangers means that they are less inclined to absorb the information given by such individuals. In addition, this was not the first time an effort like this was introduced. Thomas also mentioned of a study that was published by the New England Journal of Medicine discovered that when health educators were placed in locations such as barbershops, 63.6% showed lowered blood pressure to a healthy state. Thomas stressed that using the community as agents to promote health with the knowledge and use of medicine, then increased the level of health and health benefits would be observed.

• The church in the black community can play a crucial role in the role of the diffusion of innovations. In the black community, the church is a central component of social life. Pastors and church leaders can play the role of the innovators because they have substantial power to influence the entire congregation to appeal to new ideas. If the intervention was adopted by widely recognized black pastors in the black community such as Bishop T. D. Jakes, initially many of his followers would adopt the idea and other pastors would adopt the idea as well because of the flow of the hierarchy and this would spread to churches across the nation.

a.  The intervention that the article focused on was increasing how much people walk through a 12-week program. It has been proven countless times that exercise is beneficial in many ways, but we are exercising less and less. This lack of physical activity is now estimated to be the 4th risk factor of mortality on a global scale. Researchers in the Population Health Research Institute at St. George’s University of London realized that most studies that were conducted in the past only presented short term outcomes of increased physical activity; so in this study, they decided to study the results of the intervention up to 4 years after. 

b.  Two trials were created for the research; one was called PACE-UP, which was made for adults aged 45 to 75 and the other was called PACE-Lift made for adults aged 60 to 75 years. The participants that were recruited from 10 primary care practices in London. 

The PACE-UP trial had three different groups. The first was the control group who received usual care with no intervention. The second received the intervention program material and instructions in the mail, and the third received the same materials and instructions during the first visit to their three nurse physical activity consultations. The PACE-Lift group had two groups, the control and the intervention group that received assistance from nurses. 

Intervention groups from the two trials were given a pedometer and was asked to increase their step count in increments over the 12 weeks. Data was recorded at 3 months, 12 months, and then at 3 years for PACE-UP and 4 years for PACE-Lift but in the end combined all the groups due to their similarity. The intervention groups maintained an increase of 30 minutes in their weekly moderate to high intensity activity after the 4 years. 

The data they collected showed that both fatal (which yielded a Hazard Ratio (HR) of 0.24, which means that there are less risk of developing a disease or condition if one takes this action) and non-fatal cardiovascular diseases (HR = 0.34) were lower in the intervention group. The risk of fractures were also lower in the intervention group, yielding an HR of 0.56. 

c. I think the data presented sounds promising, especially with the many other studies that prove the benefits of exercising. However, I feel I need more information and data to determine if the intervention is effective for everyone. We aren’t told the number/percentage of the participants who were able to maintain the increase in physical activity for 4 years. I am sure there were people who decided to quit. If 70% of the people quit (I know it is unrealistic, but just as an example), the intervention is not effective for the majority even if it produces great results for the 30%. That isn’t a very effective intervention method for the general population. Furthermore, I would like to know what the program was and the difference between conventional walking programs. 

d. Based on the Diffusion of Innovations theory, I think this method has the potential to catch on. Some people are Innovators, so they would jump on this new program. If they like it or think it is effective/innovative, the word would spread to the Early Adopters. After the adopters like them, both the Early and Late majority would catch up to testing out the program for themselves. The Laggards will be hard to convince, but reliable statistics of the effectiveness, as well as social pressure, could make them try the program out for themselves.

Reference:

Harris, T. (2019, June 25). Walking intervention tied to long-term health benefits. Retrieved June 25, 2019, from https://www.healio.com/internal-medicine/nutrition-and-fitness/news/online/{b960fe50-f9cc-4944-b47c-93601bc3c9c7}/walking-intervention-tied-to-long-term-health-benefits

Silberner, Joanne. (June 24, 2019). They Thought This HIV Strategy Couldn’t Work. But It Did. National Public Radio, Inc. https://www.npr.org/sections/goatsandsoda/2019/06/24/733674936/they-thought-this-hiv-strategy-couldnt-work-but-it-did (Accessed June 26, 2019).

This article focuses on a team’s intervention plan to prevent the spread of HIV in South Africa and Zambia. Their method is called treatment as prevention (or “test and treat”). Researchers from London School of Hygiene and Tropical Medicine, Imperial College, and various other institutions formed this team, and funded this project called PopART (Population Effects of Antiretroviral Therapy to Reduce HIV Transmission).

Through this project, they found that door to door intervention proved to be the most effective, and they managed to reduce HIV incidence by 30%.

HIV testing began in 14 communities, with about 50,000 people in each neighborhood or town. The door to door intervention plan included training community health workers and having them visit people’s homes to discuss HIV and prevention, distribute condoms, and offer on-the-spot testing.

It was interesting because when people were offered treatment immediately through the “test and treat” intervention, there was only a 7% drop in new HIV infections. In the other group where they utilized the “test and treat” plan, they did not begin treatment until an individual’s white blood cell counts fell below a certain level. This group was the one that had the 30% reduction in HIV incidence.

It is believed that the difference might be due to the upkeep of medication and treatment, but researchers are still trying to understand the difference.

I’m pretty convinced by this intervention’s effectiveness because it makes sense that people may not completely understand the method of treatment or availability of resources until someone comes to their door and explains it to them, especially in countries with less resources or health education. If their local community center is far away, they may not reach out for help or even be aware of the ways in which the community health center can help. It is very possible that people may not be aware of the modes of treatment they can pursue for a disease such as HIV. Therefore, it makes sense to me that a door-to-door treatment and health education plan for intervention would be more effective than a stagnant community center.

I believe that this intervention will need more funding for the training of the community health workers and overall programming. However, the efficacy of this treatment and the gravity of HIV both make this a priority to pursue from a policy and health checkpoint.

From a diffusion of innovation theory, this idea has a relative advantage due to its success rate, it addresses a major world health concern, it is fairly easy to understand, it can be tested in different communities, and it produces tangible results. Hence, I believe that it should catch on because this intervention may be a very valuable one that can change the lives of millions of people.