Cost-effectiveness of minimal contact education strategies for cholesterol change.

OBJECTIVES

To compare the effectiveness and cost effectiveness of minimal contact nutrition interventions that varied in intensity on lowering total blood cholesterol (BC) levels.

DESIGN

A randomized trial in which public, work, religious, and medical sites were randomly assigned to one of six minimal-contact nutrition interventions for lowering total BC.

SETTING

36 public, work, religious, and medical sites in southern New England (total sites = 144).

PARTICIPANTS

The number of eligible participants at baseline was 10,144, which included 1425 Hispanics, who were over-recruited for this study.

INTERVENTION

One of six brief interventions was provided to participants: 1) feedback tip sheet only; 2) tip sheet plus Rate Your Plate (RYP); 3) tip sheet, RYP, plus Let's Eat Kit (LEK); 4) all written materials plus CD audio intervention (AUD); 5) all written materials plus counseling from a trained lay person (LAY-C); and 6) all written materials plus counseling by a nutritionist (NUT-C). The educational materials were adapted to be culturally and linguistically appropriate for a Hispanic audience, and the counselors for the Hispanic participants were bilingual.

MEASURES

Total blood cholesterol levels were measured using fingerstick methods at baseline, 3 months, and 12 months after the intervention.

RESULTS

Blood cholesterol (BC) was significantly reduced from baseline to 12-month follow-up among most experimental groups. Only LAY-C and NUT-C conditions demonstrated significant BC reductions at three months. The BC change in the NUT-C group was statistically different from the feedback only condition at three months only. At three-month followup, BC was reduced 1.6% for the total sample, 2.8% for participants with borderline-high BC levels, and 3.4% for participants with high BC. Generally, the two conditions receiving counseling resulted in the largest percentage changes in BC levels. When examining BC change data by ethnicity, Hispanic participants in the audio condition achieved the largest overall 12-month change (4%). Generally, total costs increased as the intensity of the experimental condition increased. When comparing 3-month and 12-month cost effectiveness, LAY-C and NUT-C were approximately the same, whereas LEK and AUD conditions tended to become more expensive than the other interventions.

CONCLUSIONS

Brief nutrition counseling is an effective component of BC reduction programs. Culturally tailoring programs can result in substantial reductions in BC among Hispanic participants. Overall, even the most expensive intervention was fairly inexpensive compared to other, more intensive clinical interventions.