Culturally Tailoring a Stroke Intervention in Community Senior Centers (SPIRP)
6 décembre 2019 mis à jour par: Catherine A. Sarkisian, University of California, Los Angeles
Implementing and Testing a Culturally-Tailored Stroke Risk Factor Reduction Intervention in Community Senior Centers
Stroke is a cruel disease that disproportionately kills and disables African-Americans, Latinos, Chinese-Americans and Korean-Americans; seniors with high blood pressure are at particularly high risk. There is a higher incidence of hemorrhagic stroke in African Americans, Latinos, and Chinese Americans relative to non-Latino whites. Asian-Americans have up to 1.4 higher relative risk of stroke death compared to U.S. non-Latino whites. A critical need therefore exists for a sustainable and scalable mechanism to disseminate culturally-tailored stroke knowledge/prevention education in community-based settings where large numbers of these high-risk ethnic minority older adult groups are regularly served, such as in federally funded Multipurpose Senior Centers (MPCs) that exist across the nation (16 of which are in Los Angeles alone).
The overall objective of the proposed study is to develop and test the implementation of a training program for case managers at senior centers to implement a stoke knowledge/prevention education program among four high-risk ethnic minority older adult groups--Korean-American, Chinese-American, African-American, Latinos. We propose to develop a culturally-tailored case manager training curriculum, implement the training at 4 community-based sites, and evaluate the training model using a randomized wait-list controlled trial (n=244) testing the hypothesis that training case managers will decrease older adult participants' stroke risk in a sustainable fashion through increasing their preventative behavior (i.e. increasing their physical activity--mean steps/day--at 1 and 3 months).
Findings will inform similar community-academic partnership efforts around stroke and other disease-specific prevention research/interventions; they will also determine next steps in terms of whether this case manager-centric model can be scaled up and deployed in other community-based settings.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Description détaillée
As many as 30% of ischemic strokes in the U.S. population can be attributed to physical inactivity.
With the goal of eliminating racial/ethnic stroke disparities, this interdisciplinary team proposes to develop, implement, and test a culturally-tailored behavioral intervention to reduce stroke risk (primary prevention) by increasing physical activity (walking) for 4 different racial/ethnic groups (Korean-Americans, Chinese-Americans, African-Americans and Latinos) in Los Angeles community senior centers.
The intervention combines stroke and stroke risk factor knowledge (using materials developed by the American Heart Association and American Stroke Association) with theoretically-grounded behavioral change techniques and focuses on reducing stroke risk by increasing physical activity (walking).
The study team will conduct focus groups (n=144) to identify culture-specific beliefs about stroke and stroke risk factors, to assess the feasibility and acceptability of the intervention, and will work with Community Action Panels to culturally-tailor the intervention.
The intervention will consist of 4 weeks of twice-weekly 1-hour group sessions implemented at 4 community senior centers by trained case managers who are part of the regular senior center staff and supported by congressionally-mandated Older Americans Act Title III funding.
The project team will test the effectiveness of the intervention in a randomized wait-list controlled trial (n=240) testing the hypothesis that the intervention will increase mean steps/day (measured by pedometer) at 1 and 3 months, and that the increase will be mediated by changes in stroke/stroke risk knowledge and self-efficacy.
Blood pressure will be examined as a secondary outcome.
In collaboration with the SPIRP Biomarker Collection & Analysis Core, the team will collect biological specimens (finger pricks) to explore the relationship between the intervention and biological markers of health; they will also explore the relationship between the intervention and healthcare seeking or taking medications to control stroke risk factors.
The team will evaluate the barriers and facilitators of successfully integrating the intervention into the senior centers in order to inform large-scale implementation of the culturally-tailored stroke risk factor reduction/walking intervention.
Type d'étude
Interventionnel
Inscription (Réel)
240
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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California
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Los Angeles, California, États-Unis, 90012
- Chinatown Service Center
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Los Angeles, California, États-Unis, 90057
- St. Barnabas Senior Services
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Montebello, California, États-Unis, 90640
- Mexican American Opportunity Foundation
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Watts, California, États-Unis, 90059
- Watts Labor Community Action Committee
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-
Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
60 ans et plus (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Non
Sexes éligibles pour l'étude
Tout
La description
Inclusion Criteria:
- age 60 years and older
- reported history of high blood pressure
Exclusion Criteria:
- younger than 60 years of age
- not self-identifying as the racial-ethnic group for the intervention planned at that site
- inability to communicate verbally in the appropriate language in a group setting (either due to lack of language skills, hearing impairment, or other disability)
- inability to sit in a chair and participate in a 1-hour discussion session
- inability to walk (the use of assistive devices such as canes and walkers is not an exclusion criterion)
- not available to attend the baseline data collection session and subsequent weekly intervention sessions
- plans to move away from the region during the next 6 months
- lacking cognitive capacity to provide informed consent to participate
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: La prévention
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Walking Intervention
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4-week series of twice-weekly 1-hour group-based case-manager-led interactive sessions. The intervention will provide the knowledge necessary to improve stroke risk factors. Case manager group leaders will teach that seeing a healthcare provider regularly and monitoring blood pressure prevents strokes; all participants will be provided with the National Institute on Aging booklet, "How to Talk to your Doctor" and the contact information for their healthcare provider. Participants will be given a pedometer and be trained to use it to measure steps, with the goal of reaching 10,000 steps each day. The intervention will utilize attribution retraining to teach seniors that stroke risk factors including sedentary lifestyle should not be attributed to "old age." |
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Aucune intervention: Wait-list control
After 3 months, participants will be invited to participate in the intervention.
No additional measures or outcomes will be recorded.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Change from Baseline in Mean steps/day at 3 months
Délai: 3 months
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Measured via pedometer.
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3 months
|
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Change from Baseline in Mean Steps/day at 1 month
Délai: 1 month
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Measured via pedometer.
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1 month
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
|
Stroke and stroke risk factor knowledge
Délai: baseline, 1 month, and 3 months
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Stroke Action Survey (STAT)
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baseline, 1 month, and 3 months
|
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Self Efficacy
Délai: baseline, 1 month, and 3 months
|
Chronic Disease Self Efficacy Scale and the Outcome Expectations Scale for Exercise
|
baseline, 1 month, and 3 months
|
|
Blood pressure
Délai: baseline, 1 month, and 3 months
|
baseline, 1 month, and 3 months
|
|
|
BMI (kg/m^2)
Délai: baseline, 1 month, and 3 months
|
baseline, 1 month, and 3 months
|
|
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LDL cholesterol
Délai: baseline and 3 months
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Point-of-service CardioChek meter
|
baseline and 3 months
|
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Glycosylated hemoglobin
Délai: baseline and 3 months
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Measured through finger prick.
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baseline and 3 months
|
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c-reactive protein
Délai: baseline and 3 months
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measured through finger prick
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baseline and 3 months
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Healthcare seeking
Délai: baseline and at 3 months
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Measure visits to a healthcare provider via survey.
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baseline and at 3 months
|
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Medications to control stroke risk factors
Délai: baseline and at 3 months
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Via survey, ask for names and doses of medications for hypertension, cholesterol, diabetes.
|
baseline and at 3 months
|
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Socioeconomic status
Délai: baseline
|
baseline
|
|
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Acculturation
Délai: Baseline
|
Modified Marin Acculturation Scale
|
Baseline
|
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Medical comorbidities
Délai: Baseline
|
Katz/Charlson Comorbidity index
|
Baseline
|
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Social support/network
Délai: Baseline, 1 month, 3 months
|
Interpersonal Support Evaluation List (ISEL)
|
Baseline, 1 month, 3 months
|
|
Neighborhood Walkability
Délai: baseline
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Neighborhood Environment Walkability Scale (NEWS)
|
baseline
|
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Health-related QOL
Délai: baseline, 1 month, and 3 months
|
Medical outcomes study, Short Form (SF) 12
|
baseline, 1 month, and 3 months
|
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Depressive symptoms
Délai: baseline, 1 month, and 3 months
|
Patient Health Questionnaire
|
baseline, 1 month, and 3 months
|
|
Disability
Délai: baseline, 1 month, and 3 months
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Activities of Daily Living (ADL) Summary scale survey
|
baseline, 1 month, and 3 months
|
Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Publications et liens utiles
La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.
Publications générales
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- Tennstedt S, Howland J, Lachman M, Peterson E, Kasten L, Jette A. A randomized, controlled trial of a group intervention to reduce fear of falling and associated activity restriction in older adults. J Gerontol B Psychol Sci Soc Sci. 1998 Nov;53(6):P384-92. doi: 10.1093/geronb/53b.6.p384.
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Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 octobre 2014
Achèvement primaire (Réel)
1 août 2016
Achèvement de l'étude (Réel)
1 janvier 2018
Dates d'inscription aux études
Première soumission
30 juin 2014
Première soumission répondant aux critères de contrôle qualité
1 juillet 2014
Première publication (Estimation)
3 juillet 2014
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
9 décembre 2019
Dernière mise à jour soumise répondant aux critères de contrôle qualité
6 décembre 2019
Dernière vérification
1 décembre 2019
Plus d'information
Termes liés à cette étude
Mots clés
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- RFA-NS-12-007
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