Ralston Penny A, Wickrama Kandauda K A S, Coccia Catherine C, Lemacks Jennifer L, Young-Clark Iris M, Ilich Jasminka Z
Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, Florida.
Department of Human Development and Family Science, University of Georgia, Athens, Georgia.
Am J Prev Med. 2020 Mar;58(3):361-369. doi: 10.1016/j.amepre.2019.09.024. Epub 2019 Dec 19.
Church-based interventions have been shown to improve the dietary health of underserved populations, yet few studies have examined sustainability of health behavior change over time. This paper examines dietary outcomes over a 24-month period (baseline and 6, 18, and 24 months) for fruit and vegetable and fat consumption behaviors of African-American participants in the Health for Hearts United church-based intervention in North Florida.
This quasi-experimental, longitudinal trial was conducted from 2009 to 2012. Data were analyzed in 2018.
SETTING/PARTICIPANTS: Six churches in a 2-county area (3 treatment, 3 comparison) were selected for the study using community-based participatory research approaches. Participants were African-American adults (aged ≥45 years; n=211 at baseline) randomly selected from the churches, stratified by age and sex.
Health for Hearts United intervention was developed by the 3 treatment churches. The 18-month intervention was implemented in 3 6-month phases, framed around 3 conceptual components, which included 4 types of programs and 4 key messages.
Fruit and vegetable consumption was assessed using a single item (fruit and vegetable intake) and the National Cancer Institute Fruit and Vegetable Screener. Fat consumption was determined using a single item (fat intake) and the National Cancer Institute Fat Screener. Background characteristics included age, sex, educational level, and marital status.
Significant time effects only were found for daily fruit and vegetable intake (p<0.001), fat intake (p<0.001), and the Fat Screener (p<0.001) with dietary improvements in both treatment and comparison groups across the intervention phases. Fruit and Vegetable Screener results showed that time (p<0.001) and the interaction between time and treatment (p<0.01) were significant, with increases in fruit and vegetable consumption over time for both the treatment and comparison groups and with the increase differing between groups. Post hoc analysis revealed that the treatment group had greater increases in fruit and vegetable consumption than the comparison group between Phases 1 and 3 (p=0.03).
Dietary behaviors of mid-life and older African Americans can be improved and sustained over 24 months using a church-based heart health intervention, with similar improvements noted for both comparison and treatment participants.
This study is registered at www.clinicaltrials.govNCT03339050.
基于教会的干预措施已被证明能改善服务不足人群的饮食健康，但很少有研究考察健康行为改变的长期可持续性。本文考察了北佛罗里达州“心系健康联合教会”干预项目中，非裔美国参与者在24个月期间（基线期以及第6、18和24个月）水果、蔬菜和脂肪消费行为的饮食结果。
这项准实验性纵向试验于2009年至2012年进行。2018年对数据进行了分析。
背景/参与者：采用基于社区的参与性研究方法，在一个两县地区选择了六所教会（3所干预组，3所对照组）进行研究。参与者为从教会中随机选取的非裔美国成年人（年龄≥45岁；基线期n = 211），按年龄和性别分层。
3所干预组教会制定了“心系健康联合教会”干预措施。为期18个月的干预分三个6个月阶段实施，围绕三个概念性组成部分展开，包括4种类型的项目和4条关键信息。
使用单一项目（水果和蔬菜摄入量）以及美国国立癌症研究所水果和蔬菜筛查工具评估水果和蔬菜的消费情况。使用单一项目（脂肪摄入量）以及美国国立癌症研究所脂肪筛查工具确定脂肪的消费情况。背景特征包括年龄、性别、教育水平和婚姻状况。
在干预阶段，治疗组和对照组的每日水果和蔬菜摄入量（p < 0.001）、脂肪摄入量（p < 0.001）以及脂肪筛查工具评估结果（p < 0.001）均出现显著的时间效应，饮食均有改善。水果和蔬菜筛查工具的结果显示，时间（p < 0.001）以及时间与治疗的交互作用（p < 0.01）具有显著性，治疗组和对照组的水果和蔬菜消费量均随时间增加，且两组增加幅度不同。事后分析显示，在第1阶段和第3阶段之间，治疗组的水果和蔬菜消费量增幅大于对照组（p = 0.03）。
使用基于教会的心脏健康干预措施，可在24个月内改善并维持中年及老年非裔美国人的饮食行为，干预组和对照组参与者均有类似改善。
