A Systematic Review of Health-Related Outcomes from Community Health Worker Interventions in Health Promotion, Disease Prevention and Chronic Disease Management

Community health workers (CHWs) can serve as a bridge to the health care system for both disease prevention and management. We aimed to conduct a systematic review of the effectiveness of CHW interventions in the areas of health promotion, disease prevention and chronic disease management. Methods: We searched Medline, the Cochrane Database, and CINAHL from their inception through October 2008 using 12 different terms for CHWs including the MESH term community health aides. We included studies with a comparison group that were conducted in the United States, published in English, and included at least 40 participants. Two reviewers independently assessed each abstract and full text articles for inclusion. Disagreements were resolved by consensus. Data was extracted onto a standard form by one reviewer and checked for completeness and accuracy by a second reviewer. Trained reviewers abstracted data and assessed the methodologic quality (internal validity) of studies using predefined criteria based on the U.S. Preventive Services Task Force and the National Health Service Centre for Reviews and Dissemination (U.K.) criteria. Results: Our initial search identified 992 articles. Of these, 24 studies met the inclusion criteria and addressed disease prevention or management. Identified studies were diverse in terms of target population, intervention design, and condition of interest. All of the studies focused on low income or minority populations. Trial duration ranged from 3 months to 4 years. Nineteen studies were randomized controlled trials and 5 were observational. Of the 24 studies, 2 were rated good quality, 14 fair, and 8 poor. Heterogeneity of study designs, conditions of interest and outcomes precluded quantitative synthesis of the results. Eleven studies addressed disease prevention, including pediatric immunizations (3), cardiovascular disease (2), diabetes prevention (1), HIV prevention (1), second-hand smoke exposure (1), colorectal cancer prevention (1), and general preventive care (2). Eight of eleven studies found that CHW interventions were more effective than usual care in either changing knowledge (2 of 2), behavior (4 of 6), health outcomes (2 of 4) or health care utilization (2 of 2). Thirteen studies addressed disease management, including diabetes mellitus (4), hypertension (4), asthma (2), back pain (1), tuberculosis (1), and mental health (1). In diabetes management, two of four studies found that a CHW intervention was more effective than usual care in decreasing HgbAlc. Studies addressing hypertension management (4) did not show a significant difference in blood pressure control between groups, although participants in the CHW groups improved when compared to baseline values. Both asthma studies demonstrated that CHW interventions were effective in reducing unscheduled health care services, but no more effective than comparisons for improving symptoms. Conclusions: CHWs have been used in many different health conditions, largely targeting low income and minority populations. CHW interventions in the area of disease prevention show promising benefits in improving patient knowledge and health care utilization, when compared to usual care. For chronic disease management, the majority of CHW interventions failed to show greater improvement in health outcomes than usual care except in asthma.Master of Public Healt

Using Positive Deviance for Determining Successful Weight- Control Practices

Based on positive deviance (examining the practices of successful individuals), we identified five primary themes from 36 strategies that help to maintain long-term weight loss (weight control) in 61 people. We conducted in-depth interviews to determine what successful individuals did and/or thought about regularly to control their weight. The themes included weight-control practices related to (a) nutrition: increase water, fruit, and vegetable intake, and consistent meal timing and content; (b) physical activity: follow and track an exercise routine at least 3×/week; (c) restraint: practice restraint by limiting and/or avoiding unhealthy foods; (d) self-monitor: plan meals, and track calories/weight progress; and (e) motivation: participate in motivational programs and cognitive processes that affect weight-control behavior. Using the extensive data involving both the practices and practice implementation, we used positive deviance to create a comprehensive list of practices to develop interventions for individuals to control their weight

Beneficial effects of replacing diet beverages with water on type 2 diabetic obese women following a hypo-energetic diet: a randomized, 24-week clinical trial

Abstract AIMS: To compare the effect of replacing diet beverages (DBs) with water or continuing to drink DBs in patients with type 2 diabetes during a 24-week weight loss program. The primary endpoint was the effect of intervention on weight over a 24-week period. The main secondary endpoints included anthropometric measurement and glucose and fat metabolism during the 24-week period. METHODS: A total of 81 overweight and obese women with type 2 diabetes, who usually consumed DBs in their diet, were asked to either substitute water for DBs or continue drinking DBs five times per week after lunch for 24 weeks (DBs group) during a weight loss program. RESULTS: Compared with the DBs group, the water group had a greater decrease in weight (water, -6.40 ± 2.42 kg; DBs, -5.25 ± 1.60 kg; P = .006), in BMI (water, -2.49 ± 0.92 kg/m2 ; DBs, -2.06 ± 0.62 kg/m2 ; P = .006), in FPG (water, -1.63 ± 0.54 mmol/L; DBs, -1.29 ± 0.48 mmol/L, P = .005), in fasting insulin (water, -5.71 ± 2.30 m lU/mL; DBs, -4.16 ± 1.74 m lU/mL, P = .011), in HOMA IR (water, -3.20 ± 1.17; DBs, -2.48 ± 0.99, P = 003) and in 2 hour postprandial glucose (water, -1.67 ± 0.62 mmol/L; DBs, -1.35 ± 0.39 mmol/L; P = 0.027) over the 24-week period. However, there was no significant time × group interaction for waist circumference, lipid profiles and HbA1c within both groups over the 24-week period. CONCLUSION: Replacement of DBs with water after the main meal in obese adult women with type 2 diabetes may lead to more weight reduction during a weight loss program

The weight-loss experience : qualitative exploration

BACKGROUND: Long-term weight management consists of weight-loss, weight-loss maintenance, and weight-gain stages. Qualitative insights into weight management are now appearing in the literature however research appears to be biased towards explorations of weight-loss maintenance. The qualitative understanding of weight loss, which begets weight-loss maintenance and might establish the experiences and behaviours necessary for successful long-term weight management, is comparatively under-investigated. The aim of this study was to investigate the weight-loss experiences of a sample of participants not aligned to clinical intervention research, in order to understand the weight-loss experiences of a naturalistic sample. METHODS: Participants (n=8) with weight-loss (n=4) and weight-maintenance experiences (n=4) were interviewed using a semi-structured interview to understand the weight-loss experience. Interview data was analysed thematically using Framework Analysis and was underpinned by realist meta-theory. RESULTS: Weight loss was experienced as an enduring challenge, where factors that assisted weight loss were developed and experienced dichotomously to factors that hindered it. Participants described barriers to (dichotomous thinking, environments, social pressures and weight centeredness) and facilitators of (mindfulness, knowledge, exercise, readiness to change, structure, self-monitoring and social support) their weight-loss goals in rich detail, highlighting that weight loss was a complex experience. CONCLUSIONS: Weight loss was a difficult task, with physical, social, behavioural and environmental that appeared to assist and inhibit weight-loss efforts concurrently. Health professionals might need to better understand the day-to-day challenges of dieters in order to provide more effective, tailored treatments. Future research should look to investigate the psycho-social consequences of weight-loss dieting, in particular self-imposed social exclusion and spousal sabotage and flexible approaches to treatment

Parenting and digital media: from the early days of the web to contemporary digital society.

Parents have accessed websites, online discussion forums and blogs for advice, information and support since the early days of the World Wide Web. In this article, we review the literature in sociology and related social research addressing the ways in which digital media have been used for parenting-related purposes. We begin with the longer-established media of parenting websites, online discussion forums, blogs, email, mobile phones and message and video services and then move on to the newer technologies of social media and apps. This is followed by a section on data privacy and security issues. The concluding section summarises some major issues arising from the review and points to directions for further research

eHealth interventions for the prevention and treatment of overweight and obesity in adults: A systematic review with meta-analysis

A systematic review of randomized controlled trials was conducted to evaluate the effectiveness of eHealth interventions for the prevention and treatment of overweight and obesity in adults. Eight databases were searched for studies published in English from 1995 to 17September 2014. Eighty-four studies were included, with 183 intervention arms, of which 76% (n=139) included an eHealth component. Sixty-one studies had the primary aim of weight loss, 10 weight loss maintenance, eight weight gain prevention, and five weight loss and maintenance. eHealth interventions were predominantly delivered using the Internet, but also email, text messages, monitoring devices, mobile applications, computer programs, podcasts and personal digital assistants. Forty percent (n=55) of interventions used more than one type of technology, and 43.2% (n=60) were delivered solely using eHealth technologies. Meta-analyses demonstrated significantly greater weight loss (kg) in eHealth weight loss interventions compared with control (MD -2.70 [-3.33,-2.08], P<0.001) or minimal interventions (MD -1.40 [-1.98,-0.82], P<0.001), and in eHealth weight loss interventions with extra components or technologies (MD 1.46 [0.80, 2.13], P<0.001) compared with standard eHealth programmes. The findings support the use of eHealth interventions as a treatment option for obesity, but there is insufficient evidence for the effectiveness of eHealth interventions for weight loss maintenance or weight gain prevention

A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project

Abstract Background Because residents of the southeastern United States experience disproportionally high rates of cardiovascular disease (CVD), it is important to develop effective lifestyle interventions for this population. Methods The primary objective was to develop and evaluate a dietary, physical activity (PA) and weight loss intervention for residents of the southeastern US. The intervention, given in eastern North Carolina, was evaluated in a 2 year prospective cohort study with an embedded randomized controlled trial (RCT) of a weight loss maintenance intervention. The intervention included: Phase I (months 1–6), individually-tailored intervention promoting a Mediterranean-style dietary pattern and increased walking; Phase II (months 7–12), option of a 16-week weight loss intervention for those with BMI ≥ 25 kg/m2 offered in 2 formats (16 weekly group sessions or 5 group sessions and 10 phone calls) or a lifestyle maintenance intervention; and Phase III (months 13–24), weight loss maintenance RCT for those losing ≥ 8 lb with all other participants receiving a lifestyle maintenance intervention. Change in diet and PA behaviors, CVD risk factors, and weight were assessed at 6, 12, and 24 month follow-up. Results Baseline characteristics (N = 339) were: 260 (77 %) females, 219 (65 %) African Americans, mean age 56 years, and mean body mass index 36 kg/m2. In Phase I, among 251 (74 %) that returned for 6 month follow-up, there were substantial improvements in diet score (4.3 units [95 % CI 3.7 to 5.0]), walking (64 min/week [19 to 109]), and systolic blood pressure (−6.4 mmHg [−8.7 to −4.1]) that were generally maintained through 24 month follow-up. In Phase II, 138 (57 group only, 81 group/phone) chose the weight loss intervention and at 12 months, weight change was: −3.1 kg (−4.9 to −1.3) for group (N = 50) and −2.1 kg (−3.2 to −1.0) for group/phone combination (N = 75). In Phase III, 27 participants took part in the RCT. At 24 months, weight loss was −2.1 kg (−4.3 to 0.0) for group (N = 51) and −1.1 kg (−2.7 to 0.4) for combination (N = 72). Outcomes for African American and whites were similar. Conclusions The intervention yielded substantial improvement in diet, PA, and blood pressure, but weight loss was modest. Trial registration clinicaltrials.gov Identifier: NCT0143348