Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care

Stacey L Schepens Niemiec, Cheryl L P Vigen, Jenny Martínez, Jeanine Blanchard, Mike Carlson, Stacey L Schepens Niemiec, Cheryl L P Vigen, Jenny Martínez, Jeanine Blanchard, Mike Carlson

Abstract

Importance: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs.

Objective: To evaluate patients' long-term health-related outcomes after lifestyle intervention.

Design: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up.

Setting: Rural, community-based primary care.

Participants: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr.

Intervention: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care.

Outcomes and measures: Self-reported and physiological outcomes: symptom-well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants' lives.

Results: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom-well-being dimensions (Cohen's d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention's sustained positive effect on their wellness.

Conclusions and relevance: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos.

What this article adds: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.

Copyright © 2021 by the American Occupational Therapy Association, Inc.

Figures

Figure 1.
Figure 1.
Symptom well-being outcome as assessed at multiple time points using the MYMOP2 among participants with LTFU (N = 27) Note. Lower scores indicate improvements in outcome. The MYMOP2 profile score is the mean of the four subscales. All change values were significant from pretreatment to LTFU (p ≤ .004) and from posttreatment to LTFU (p ≤ .05) except for Symptom 2 severity at posttreatment to LTFU (p = .2). Effect sizes were medium to large, ranging from −0.8 to −1.3 for pretreatment to LTFU and −0.4 to −0.7 for posttreatment to LTFU. LTFU = 1-yr long-term follow-up; MYMOP2 = Measure Yourself Medical Outcome Profile

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