H.U.B city steps: methods and early findings from a community- based participatory research trial to reduce blood pressure among African Americans

Department of Human Nutrition, Foods and Exercise, Virginia Tech, 1981 Kraft Drive (0913), Blacksburg, VA 24061, USA.
International Journal of Behavioral Nutrition and Physical Activity (Impact Factor: 4.11). 06/2011; 8(1):59. DOI: 10.1186/1479-5868-8-59
Source: PubMed


Community-based participatory research (CBPR) has been recognized as an important approach to develop and execute health interventions among marginalized populations, and a key strategy to translate research into practice to help reduce health disparities. Despite growing interest in the CBPR approach, CBPR initiatives rarely use experimental or other rigorous research designs to evaluate health outcomes. This behavioral study describes the conceptual frameworks, methods, and early findings related to the reach, adoption, implementation, and effectiveness on primary blood pressure outcomes.
The CBPR, social support, and motivational interviewing frameworks are applied to test treatment effects of a two-phased CBPR walking intervention, including a 6-month active intervention quasi experimental phase and 12-month maintenance randomized controlled trial phase to test dose effects of motivational interviewing. A community advisory board helped develop and execute the culturally-appropriate intervention components which included social support walking groups led by peer coaches, pedometer diary self-monitoring, monthly diet and physical activity education sessions, and individualized motivational interviewing sessions. Although the study is on-going, three month data is available and reported. Analyses include descriptive statistics and paired t tests.
Of 269 enrolled participants, most were African American (94%) females (85%) with a mean age of 43.8 (SD = 12.1) years. Across the 3 months, 90% of all possible pedometer diaries were submitted. Attendance at the monthly education sessions was approximately 33%. At the 3-month follow-up 227 (84%) participants were retained. From baseline to 3-months, systolic BP [126.0 (SD = 19.1) to 120.3 (SD = 17.9) mmHg; p < 0.001] and diastolic BP [83. 2 (SD = 12.3) to 80.2 (SD = 11.6) mmHg; p < 0.001] were significantly reduced.
This CBPR study highlights implementation factors and signifies the community's active participation in the development and execution of this study. Reach and representativeness of enrolled participants are discussed. Adherence to pedometer diary self-monitoring was better than education session participation. Significant decreases in the primary blood pressure outcomes demonstrate early effectiveness. Importantly, future analyses will evaluate long-term effectiveness of this CBPR behavioral intervention on health outcomes, and help inform the translational capabilities of CBPR efforts.

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    • "CBPR has been recommended as an effective approach to promote behavior change in underserved populations [30]. Yet, few studies have used CBPR to address obesity in high-risk groups ([31] [32] [33] [34] [35] [36]); and no published studies to our knowledge have employed CBPR within the context of a randomized controlled trial (RCT) to encourage weight loss in low-income African-American women. Given the limitations of the current literature, we adapted an evidenced-based intervention, " Obesity Reduction Black Intervention Trial " (ORBIT) [37] [38] [39], using CBPR to create " Doing Me! Sisters Standing Together for a Healthy Mind and Body " (Doing Me!), a culturally relevant, community-based weight loss intervention targeting low-income African-American women 30–65 years of age. "
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    ABSTRACT: Despite the high prevalence of obesity among African American women and modest success in behavioral weight loss interventions, the development and testing of weight management interventions using a community-based participatory research (CBPR) approach has been limited. Doing Me: Sisters Standing Together for Healthy Mind and Body (Doing Me!) is an intervention adapted from an evidence-based behavioral obesity intervention using a CBPR approach. The purpose of Doing Me! is to test the feasibility and acceptability of this adapted intervention and determine its efficacy in achieving improvements in anthropometrics, diet, and physical activity. Sixty African American women, from a low-income, urban community, aged 30-65 years will be randomized to one of two arms: 16-week Doing Me! (n=30) or waitlist control (n=30). Doing Me! employs CBPR methodology to involve community stakeholders and members during the planning, development, implementation, and evaluation phases of the intervention. There will be thirty-two 90-minute sessions incorporating 45minutes of instruction on diet, physical activity, and/or weight management plus 45minutes of physical activity. Data will be collected at baseline and post-intervention (16weeks). Doing Me! is one of the first CBPR studies to examine the feasibility/acceptability of an adapted evidence-based behavioral weight loss intervention designed for obese African American women. CBPR may be an effective strategy for implementing a weight management intervention among this high-risk population. Copyright © 2015. Published by Elsevier Inc.
    Contemporary clinical trials 06/2015; 43. DOI:10.1016/j.cct.2015.06.006 · 1.94 Impact Factor
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    • "Participants received monetary compensation for their time involved in data assessments . Further details regarding study methodology are published elsewhere (Zoellner et al., 2011). "
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    ABSTRACT: The objective of this secondary analysis was to evaluate the utility of several participant adherence indicators for predicting changes in clinical, anthropometric, dietary, fitness, and physical activity (PA) outcomes in a lifestyle intervention, HUB City Steps, conducted in a southern, African American cohort in 2010. HUB City Steps was a 6-month, community-engaged, multicomponent, noncontrolled intervention targeting hypertension risk factors. Descriptive indicators were constructed using two participant adherence measures, education session attendance (ESA) and weekly steps/day pedometer diary submission (PDS), separately and in combination. Analyses, based on data from 269 primarily African American adult participants, included bivariate tests of association and multivariable linear regression to determine significant relationships between seven adherence indicators and health outcome changes, including clinical, anthropometric, dietary, fitness, and PA measures. ESA indicators were significantly correlated with four health outcomes: body mass index (BMI), fat mass, low-density lipoprotein (LDL), and PA (-.29 ≤ r ≤ .23, p < .05). PDS indicators were significantly correlated with PA (r = .27, p < .001). Combination ESA/PDS indicators were significantly correlated with five health outcomes: BMI, percentage body fat (%BF), fat mass, LDL, and PA (r = -.26 to .29, p < .05). Results from the multivariate models indicated that the combination ESA/PDS indicators were the most significant predictors of changes for five outcomes-%BF, fat mass, LDL diastolic blood pressure (DBP), and PA-while ESA performed best for BMI only. For DBP, a one-unit increase in the continuous-categorical ESA/PDS indicator resulted in 0.3 mm Hg decrease. Implications for assessing participant adherence in community-based, multicomponent lifestyle intervention research are discussed.
    Health Education & Behavior 07/2014; 42(1). DOI:10.1177/1090198114537069 · 2.23 Impact Factor
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    • "The average age of health coaches was 28.1 (SD = 4.7) years, seven were female, two were African American, and six were White. There was an average of 2.1 (SD = 1.9) years of experience providing clinical services (Zoellner et al., 2011). "
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    ABSTRACT: The Client Evaluation of Motivational Interviewing was used to assess motivational interviewing experiences in a predominantly female, African American sample from the Southeastern United States who received motivational interviewing–based feedback during a multicomponent lifestyle intervention. Motivational interviewing was experienced differently than a primarily White, male, Northeastern mental health sample.
    Measurement and Evaluation in Counseling and Development 03/2014; DOI:10.1177/0748175614544687 · 0.71 Impact Factor
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