Needs and preferences of women with prior severe preeclampsia regarding app-based cardiovascular health promotion.

BACKGROUND: Women with prior severe preeclampsia are at an increased risk for cardiovascular diseases later in life compared to women who had a normotensive pregnancy. The objective of this study was to assess their needs and preferences regarding app-based cardiovascular health promotion. METHODS: Patients (n = 35) of the Follow-Up PreEClampsia Outpatient Clinic (FUPEC), Erasmus MC, the Netherlands, participated in an anonymous online survey. The main outcomes under study were women's needs for health behavior promotion, and their preferences with respect to intervention delivery. Descriptive statistics were used to evaluate needs, and thematic analysis was used to analyze preferences. RESULTS: Women's primary need for health behavior promotion pertained to their fat and sugar intake and physical activity; for some, to their mental health (practices), fruit and vegetable intake, salt intake, and water intake; and for a few, to their alcohol and tobacco use. Most women preferred an app-based intervention to include, in descending order: the tracking of health-related metrics, an interactive platform, the use of behavior change strategies, the provision of information, and personalization. CONCLUSION: Cardiovascular health promotion targeting women with prior severe preeclampsia should feel relevant to its audience. App-based interventions are likely to be well received if they target fat and sugar intake and physical activity. These interventions should preferably track health-related metrics, be interactive, contain behavior change strategies, provide information, and be personalized. Adopting these findings during intervention design could potentially increase uptake, behavior change, and behavior change maintenance in this population.

Interorganizational network findings from a nationwide cardiovascular disease prevention initiative.

OBJECTIVES: To use network analysis in order to evaluate the effectiveness of interorganizational networks in implementing policy, systems, and environmental interventions for cardiovascular disease prevention throughout the United States. METHODS: Evaluators conducted an interorganizational network (ION) survey to examine information sharing and joint planning within organizational relationships in 15 community-based cardiovascular disease prevention partnership networks. Density and betweenness centrality scores at the node- and network-level were calculated for each partnership network using UCINET© network analysis software. Common data patterns were then extracted using a multiple case study format. RESULTS: Network density scores ranged from 0.50 to 1.00 (M = 0.84, SD = 0.14) for information sharing and 0.43-1.00 (M = 0.77, SD = 0.15) for joint planning. Centralization indices ranged from 0.00 to 0.11 (M = 0.04, SD = 0.03), and 0.00-0.17 (M = 0.06, SD = 0.05), respectively. Overall, 73.33 % of communities were successful in meeting their partnership goals. CONCLUSIONS: When planning and implementing interorganizational networks, high betweenness centrality and more hierarchically structured networks were identified as the most salient partnership characteristics to programmatic success. The network findings were triangulated with previously published qualitative data to provide context. These findings provide valuable insight on how national networks can be designed and leveraged to implement systematic community health projects.

Formación de voluntarios como promotor es comunales de la salud cardiovascular en el programa Cartago da vida al corazón: 10 años de experiencia. Área demostrativa iniciativa CARMEN - Costa Rica / Training of volunteers as community promoters of cardiovascular health in the program Cartago gives life to the heart: 10 years of experience. Demonstration area CARMEN initiative - Costa Rica

Resumen Objetivos: Dar a conocer la metodología y los resultados de la formación de promotores de la salud cardiovascular en el programa " Cartago da vida al corazón" Introducción: La enfermedad cardiovascular es el problema número uno de la salud en una gran cantidad de países de Latinoamérica. Esta enfermedad es de origen más conductual que biológico y se inicia en gran proporción por efecto de los estilos de vida inadecuados en la población. La intervención de la enfermedad se realiza usando estrategias individuales para los casos y poblacionales para los grupos en riesgo. La participación de la comunidad en la producción de su salud cardiovascular es una estrategia que ha demostrado tener un mayor impacto que las intervenciones individuales. Basado en la idea promocionada por el Ministerio de Salud de los Educadores Comunitarios de Salud (ECOS), se adaptó y validó una estrategia para promocionar la salud cardiovascular en las comunidades cartaginesas. Métodos: Se identificaron y motivaron los candidatos, se capacitaron durante un mínimo de 90 horas en los conocimientos básicos sobre los factores de riesgo cardiovascular, su medición y técnicas educativas. Se realizaron actividades de práctica con el grupo en formación y se le brindaron los elementos mínimos necesarios para que puedan planificar sus acciones elaborar proyectos comunales simples y evaluar su trabajo. Teóricamente a los promotores formados se les dio seguimiento sobre sus actividades en la comunidad y se les dio refrescamiento sobre conocimientos y practicas útiles en sus acciones. Resultados: Se han realizado seis cursos de formación en el que participaron 94 voluntarios, de éstos 50 se mantienen activos, algunos realizan acciones comunales como dar educación a grupos comunales, otros tienen grupos para realizar ejercicio físico y la mayoría colaboran con el programa en la realización de los talleres comunales de promoción de la salud cardiovascular. El 100% de los evaluados, ha logrado modificar por lo menos 1 factor de riesgo, 87% han modificado 2 factores, 76% modificaron tres factores, 52% cuatro factores y 32% 5 factores y más. Discusión: Es bien teorizado que la salud se producirá en mejor forma cuando se incorpore activa y sostenidamente la participación de la comunidad en los programas de salud. Sin embargo, este siempre ha sido un problema dado la participación siempre es escasa. En este proyecto se partió de la hipótesis que se mejora la participación y la acción dando a los voluntarios los elementos siguientes: motivación, capacitación, independencia funcional, seguimiento y evaluación. Se persigue que los voluntarios se empoderen del problema cardiovascular y sus factores de riesgo en sus comunidades y que por su propia iniciativa desarrollen acciones de intervención del riesgo. Los que están trabajando lo hacen bien, la falla ha estado en el seguimiento y re-motivación pues no se ha llevado a cabo en la forma en que propuso originalmente.

Abstract Aims: Publish the methodology and the results of the cardiovascular health promoters training in the Program Cartago da vida al corazón" (Catago gives life to the heart"). Introduction: Cardiovascular disease is the first health problem in a large number of Latin American countries. This disease have a behavioral origin rather than biological and initiate in a large proportion because of inappropriate life styles in the population. The control of this disease is performed using individual strategies for cases and population strategies for groups in risk. Community participation in its own cardiovascular health production is a strategy that has shown having a better impact than individual interventions. Based on the idea of Educadores Comunitarios de Salud (ECOS), Health Community Teachers, promoted by the Ministry of Health, a strategy was adopted and validated for promoting cardiovascular health in the communities-of-Cartago-city. Methods: Candidates were identificated and motivated. They were trained for a minimum of 90 hours about basic knowledge related to cardiovascular risk factors, its measurement and educative techniques. It was conducted practical activities with the group being trained and they were given minimum required elements so they can plan their actions, prepare simple comunal projects and evaluate their work. Trained promoters were monitored about their activities in the community and were updated about their knowledge and useful practices for their actions. Results: Six training courses were conducted with the attendance of 94 volunteers from which 50 are still active. Some of they conduct activities like educate community groups, others have groups for physical exercising and most of them participate in the program conducting cardiovascular health promotion community workshops. Out of those that were evaluated, 100% have modified at least one risk factor, 87% have modified two factors, 76% modified three factors, 52% four factors and 32% five factors ore more. Discussion: It is well theorized that health will be produced better when community participation in the health programs is active and continuous. However, this have always been a problema because of the scarce participation. This Project started from the hypothesis that participation and action are improved by giving to the volunteers the following elements: motivation, training, functional independence, monitoring and evaluation. It is pursued to empower volunteers about the cardiovascular problem and its risk factors in their communities and to achieve that they develop risk intervention actions by their own initiative. Those that are working are doing well, the fault has been the monitoring and the remotivation since it has not been conducted as it was originally proposed.

Evaluation of a pilot hypertension management programme for Guatemalan adults.

Corazón Sano y Feliz is a hypertension management intervention developed to address deficiencies in the management of hypertensive patients in Guatemala. From 2007 to 2009, Corazón Sano y Feliz was pilot-tested in the community of Mixco. Corazón Sano y Feliz comprises a clinical risk assessment and treatment component implemented primarily by nurses, and a health education component implemented by community health workers. To accomplish our secondary objective of determining Corazon Sano y Feliz's potential for change at the patient level, we implemented a one-group pretest-posttest study design to examine changes in clinical measures, knowledge and practices between baseline and the end of the 6-month intervention. Two nurses and one physician set up a hypertension clinic to manage patients according to risk level. Twenty-nine community health workers were trained in CVD risk reduction and health promotion and in turn led six educational sessions for patients. Comparing baseline and 6-month measures, the intervention achieved significant improvements in mean knowledge and behaviour (increase from 54.6 to 59.1 out of a possible 70 points) and significant reductions of mean systolic and diastolic blood pressure (27.2 and 7.7 mmHg), body mass index (from 26.5 to 26.2 kg/m(2)) and waist circumference (89.6-88.9 cm). In this pilot study we obtained preliminary evidence that this community-oriented hypertension management and health promotion intervention model was feasible and achieved significant reduction in risk factors. If scaled up, this intervention has the potential to substantially reduce CVD burden.

Promoting cardiovascular health worldwide: strategies, challenges, and opportunities.

Cardiovascular disease is the leading cause of death in the world, affecting not only industrialized but, above all, low- and middle-income countries, where it has overtaken infectious diseases as the first cause of death and its impact threatens social and economic development. The increased prevalence of cardiovascular disease in recent years together with projected mortality for the coming decades constitute an irrefutable argument for the urgent implementation of well-planned interventions to control the pandemic of cardiovascular diseases, especially in the more economically deprived countries. The combination of behavioral, social, environmental, and biological factors, and others related to health care systems, that contribute to the development of cardiovascular diseases requires a multi-sector strategy that promotes a healthy lifestyle, reduces cardiovascular risk factors, and cuts mortality and morbidity through quality health care services. These proposals should be guided by leaders in the scientific community, government, civil society, private sector, and local communities.