RESUMEN
BACKGROUND: Cardiovascular disease (CVD) risk reduction programs led by a nurse/community health worker team are effective in urban settings. This strategy has not been adequately tested in rural settings. OBJECTIVE: A pilot study was conducted to examine the feasibility of implementing an evidence-based CVD risk reduction intervention adapted to a rural setting and evaluate the potential impact on CVD risk factors and health behaviors. METHODS: A 2-group, experimental, repeated-measures design was used; participants were randomized to a standard primary care group (n = 30) or an intervention group (n = 30) where a registered nurse/community health worker team delivered self-management strategies in person, by phone, or by videoconferencing. Outcomes were measured at baseline and at 3 and 6 months. A sample of 60 participants was recruited and retained in the study. RESULTS: In-person (46.3%) and telephone (42.3%) meetings were used more than the videoconferencing application (9%). Mean change at 3 months differed significantly between the intervention and control groups for CVD risk (-1.0 [95% confidence interval (CI), -3.1 to 1.1] vs +1.4 [95% CI, -0.4 to 3.3], respectively), total cholesterol (-13.2 [95% CI, -32.1 to 5.7.] vs +21.0 [95% CI, 4.1-38.1], respectively), and low-density lipoprotein (-11.5 [95% CI, -30.8 to 7.7] vs +19.6 [95% CI, 1.9-37.2], respectively). No between-group differences were seen in high-density lipoprotein, blood pressure, or triglycerides. CONCLUSIONS: Participants receiving the nurse/community health worker-delivered intervention improved their risk CVD profiles, total cholesterol, and low-density lipoprotein levels at 3 months. A larger study to explore the intervention impact on CVD risk factor disparities experienced by rural populations is warranted.
Asunto(s)
Enfermedades Cardiovasculares , Enfermeras y Enfermeros , Adulto , Humanos , Enfermedades Cardiovasculares/prevención & control , Proyectos Piloto , Población Rural , Agentes Comunitarios de Salud , Colesterol , Lipoproteínas LDLRESUMEN
BACKGROUND: Cattle production in the United States is heavily supported by Latino/a workers. Beyond injury rates, our understanding of the health status of cattle feedyard workers is limited. The purpose of this study was to describe the health status and health care access among Latino immigrant cattle feedyard workers in the Midwest. METHODS: A cross-sectional design using face-to-face structured interviews with Latino immigrant cattle feedyard workers in Kansas and Nebraska was conducted between May 2017 and February 2020. FINDINGS: A total of 243 workers completed interviews; 91% were men. Over half (58%) had health insurance but few (36%) had a regular health care provider. Few chronic health conditions were reported despite most being overweight (53%) or obese (37%). The sample mean of sleep hours/24 hours was 7.1 ± 1.1. Problem drinking was moderate (42%), cigarette smoking was low (14%), and drug use was extremely low (<1%). Receiving health information from work was associated with less problem drinking, less obesity, lower blood pressure, and better sleep. CONCLUSIONS: Although few workers reported having a chronic health condition, most workers had chronic disease risk (i.e., elevated body mass index, problem drinking) and few had a regular health care provider. Receiving health information at work may have protective health effects. APPLICATIONS TO PRACTICE: Occupational health professionals can partner with feedyard employers to expand current health and safety training programs beyond injury prevention to focus on health more broadly and to connect workers with local health care resources.
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Accesibilidad a los Servicios de Salud , Estado de Salud , Fuentes de Información , Animales , Bovinos , Humanos , Alcoholismo , Enfermedad Crónica , Estudios Transversales , Hispánicos o Latinos , Obesidad , AgriculturaRESUMEN
Few health behavior interventions exist for rural caregivers of persons with dementia (PWD) in the United States. Of interventions that have been studied, little is known about health outcomes that are included in interventions and which interventions are most effective on health outcomes. An integrative literature review of intervention studies for rural caregiver health throughout the United States was undertaken with an emphasis on concepts related to health promotion, self-management, self-care, and/or self-efficacy. Findings from this review indicated multicomponent interventions that included self-care strategies were associated with improvements of caregiver psychosocial health outcomes of depression, burden, self-efficacy, social support, and self-rated health. Sleep problems and endurance potential were the only physical health outcomes measured. To prevent adverse physical health outcomes, interventions with attention to rural context are needed that emphasize health promotion with a focus on health behaviors and health outcome measurement in rural caregivers of PWD. [Research in Gerontological Nursing, 15(2), 101-108.].
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Cuidadores , Demencia , Cuidadores/psicología , Humanos , Calidad de Vida/psicología , Población Rural , Apoyo SocialRESUMEN
BACKGROUND: Hispanic/Latino adults have high rates of hypertension, obesity, and type II diabetes. Mobile health technologies (mHealth) are effective in supporting self-management of lifestyle behaviors; however, the effectiveness in rural Hispanic/Latino adults is unclear. OBJECTIVE: A pilot 12-week self-management mHealth intervention in rural Hispanic/Latino adults with cardiometabolic risk was conducted. METHODS: A randomized, 2-group (intervention and enhanced usual care) design was used to test the use of the MyFitnessPal app, a smart scale, and text messages to support daily self-monitoring of weight, food intake, and steps. RESULTS: Seventy participants enrolled. The intervention group had greater improvement in body mass index ( P = .052) and waist circumference ( P = .043) at 12 weeks and a trend toward greater fitness at 12 and 24 weeks. Both groups improved hemoglobin A 1c level at 12 and 24 weeks. CONCLUSIONS: mHealth using MyFitnessPal, smart scale, and text messages may be effective for improving aspects of cardiometabolic health in rural Hispanic/Latino adults.
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Diabetes Mellitus Tipo 2 , Hipertensión , Telemedicina , Diabetes Mellitus Tipo 2/prevención & control , Hispánicos o Latinos , Humanos , Hipertensión/prevención & control , Proyectos PilotoRESUMEN
BACKGROUND: Most meatpacking workers have pain affecting their back, arms, and/or wrists from work-related repetitive motions, forceful exertion, and awkward positioning. Chronic musculoskeletal pain is associated with obesity, hypertension, type II diabetes, heart attack, and stroke. Hispanic/Latino workers in the meatpacking industry are a vulnerable population; limited English, lack of health insurance, and fear of deportation often deter them from seeking care where preventable cardiovascular risks might be detected. The purpose of this study was to examine perceived health and actual cardiovascular risk among Hispanic/Latino meatpacking workers with musculoskeletal pain in Nebraska. METHODS: Structured interviews were used to examine perceived health, awareness of cardiometabolic risk, and capacity for health self-management. Body mass index (BMI), lipids, blood pressure, Hemoglobin A1c (HbA1c), and cardiorespiratory fitness (step test) were used to examine cardiovascular risk. FINDINGS: Of those interviewed (n = 39), musculoskeletal pain affected usual life activities in 64% (n = 25) of participants. Of those tested (n = 30), 93% (n = 28) had a BMI > 30 kg/m2, 86% (n = 26) had at least one lipid abnormality, 50% (n = 15) had blood pressure > 120/80 mm Hg, and 43% (n = 13) had an HbA1c > 5.7%. Males had greater fitness than females (p = .03), but also greater lifetime risk of heart attack or stroke compared with females (p = .02). CONCLUSION/APPLICATION TO PRACTICE: In this sample, cardiovascular risk exceeded that found in the general Hispanic population in the United States. Occupational health nurses can assist workers to be aware of their risk by measuring and providing culturally and linguistically appropriate education on blood pressure, BMI, cholesterol, and HbA1c.
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Enfermedades Cardiovasculares , Diabetes Mellitus Tipo 2 , Dolor Musculoesquelético , Enfermedades Cardiovasculares/epidemiología , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Hispánicos o Latinos , Humanos , Masculino , Factores de Riesgo , Estados UnidosRESUMEN
BACKGROUND: Meatpacking is dirty, dangerous, and demanding work. In the United States, the industry predominately employs people from racial/ethnic minority backgrounds and immigrants, with 45% of the workforce identifying as Hispanic/Latino. Little is known about how the work environment affects worker engagement in health-promoting activities; however, occupational health professionals are uniquely positioned to advance worker health, safety, and general well-being. METHODS: Hispanic/Latino meatpacking workers with work-related musculoskeletal pain and active health concerns were recruited to participate in a study to explore health, health behaviors, and the work environment. Five focus groups (N = 28) were conducted in Nebraska between March 2019 and February 2020. Thematic analysis using the Health Belief Model constructs was used to explain workers' health behaviors including utilization of occupational health services at their workplace. FINDINGS: Workers believed that there was little they could do to prevent and treat health problems. They understood the perceived threat of health problems and the benefits of self-care, but the perceived barriers often outweighed the benefits. The workplace had few prompts to motivate or incentivize self-care both in and outside of work. In addition, workers did not trust the occupational health office and saw few benefits to accessing services. Together, these conditions resulted in low self-efficacy and limited engagement in health-promoting behaviors. CONCLUSION/APPLICATION TO PRACTICE: Occupational health professionals should promote Total Worker Health and foster trust by providing culturally, linguistically, and literacy appropriate services and by identifying opportunities and reducing barriers for workers to engage in activities to promote their health, safety, and well-being.
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Minorías Étnicas y Raciales , Etnicidad , Hispánicos o Latinos , Humanos , Grupos Minoritarios , Nebraska , Estados UnidosRESUMEN
BACKGROUND: Meatpacking is dangerous, dirty, and demanding (3-D) work-much of which is done by immigrant workers. It is characterized by high rates of occupational injuries and illnesses due to the speed of the production line, repetitive motions, and other inherent exposures. The purpose of this qualitative study was to explore perceptions of safety culture among Hispanic/Latino meatpacking workers in the Midwest. METHODS: Five focus groups with a total of 28 participants were conducted between March 2019 and February 2020 with Hispanic/Latino meatpacking workers in Nebraska. Workers were asked about the type of work performed, how the work was physically done, and perceptions of health risks and exposures. Thematic analysis was used to build a description of safety culture within the meatpacking industry. RESULTS: Three main themes were found: (1) workers depicted a culture where companies cared more about production than people; (2) workers felt powerless in improving their situation; and (3) workers noted that the work was precarious, both dangerous and one where much of the responsibility for safety was shifted to the individual workers. CONCLUSIONS: The meatpacking industry has a poor safety culture. Safety culture within the industry may be improved by ensuring that organizational values and artifacts are aligned with safety by addressing the critical role of supervisors, providing culturally and linguistically appropriate consistent safety training and messaging to the workforce, and enforcing and strengthening safety regulations.
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Emigrantes e Inmigrantes/psicología , Hispánicos o Latinos/psicología , Industria para Empaquetado de Carne , Administración de la Seguridad , Lugar de Trabajo/psicología , Adulto , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Nebraska , Exposición Profesional , Investigación Cualitativa , Trabajo/psicología , Adulto JovenRESUMEN
People compare themselves to others for self-evaluation, practical information, and motivation for healthy behaviors. The effect of active peer models on comparative thinking is unknown. The purpose of this 12-week, randomized, two-group pilot study was to evaluate the effect of a workplace peer modeling intervention on self-efficacy, motivation, and comparative thinking. The attention control group (ACG; n = 24) received general health information. The intervention group (n = 26) met with active peer models, received an exercise prescription and information. No significant group by time interaction effects were found. Comparisons on ability (how well am I doing), opinions (what should I think or believe), future self (think about my future), and modeling (be like someone else) all increased in the intervention group (n = 21) but decreased in the ACG (n = 22). Active peer models may support physical activity behavior change through specific lines of comparative thinking.
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Ejercicio Físico , Conductas Relacionadas con la Salud , Motivación , Grupo Paritario , Autoeficacia , Adulto , Femenino , Humanos , Proyectos Piloto , Lugar de Trabajo/psicologíaRESUMEN
Most working women do not meet current guidelines for physical activity (PA). A 12-week pilot study tested a workplace, peer modeling PA intervention. Inactive female employees from a health system were randomized to an attention control group (ACG; n = 26) or an intervention group (IG; n = 26). The ACG received health information. The IG participated in six group sessions with an active peer model and received an exercise prescription and PA information. Pre and post measures were PA (ActiGraph), Estimated VO2max (cycle ergometer), resting heart rate (HR), glucose and lipids, and cardiovascular risk. Using hierarchical linear modeling, no significant group by time effects were found. Although PA increased in both groups, F( df = 1) = 11.4, p = .002, the IG had greater improvements in fitness (VO2max, HR) and cardiovascular risk (total cholesterol, triglyceride, low density lipoprotein [LDL], calculated risk score) compared with ACG. Results support repeating this intervention in a fully powered study.
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Ejercicio Físico , Promoción de la Salud/métodos , Salud Laboral , Grupo Paritario , Adulto , Estudios de Factibilidad , Femenino , Humanos , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de SaludRESUMEN
A workplace physical activity (PA) study tested a novel use of peers to deliver the intervention. Peer models provided vicarious experience for living physically active lifestyles to a group of inactive women. The purpose of this study was to describe participants' perceptions of the peer modeling intervention. Nine women from the intervention group ( n = 26) participated in a 90-minute focus group. Qualitative description using thematic analysis was used to identify themes from the focus group transcript. Two themes about the intervention were "I am left wanting more" and "focus on food." Two themes about the peer models were "real people" and "it is doable." Focus group participants perceived the peer modeling PA intervention favorably; however, they desired more attention to healthy eating and more time with peer models. Replication of the study accounting for themes identified by focus group participants is needed to strengthen the peer modeling intervention.
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Actitud Frente a la Salud , Ejercicio Físico , Promoción de la Salud/métodos , Salud Laboral , Grupo Paritario , Adulto , Anciano , Femenino , Grupos Focales , Humanos , Persona de Mediana Edad , Investigación Cualitativa , Adulto JovenRESUMEN
PURPOSE: Maintenance of lifestyle changes after cardiac rehabilitation (CR) is suboptimal. In addition, partners of cardiac patients are invited to participate in CR educational sessions and implicitly expected to assist patients with their lifestyle changes. The purpose of this study was to qualitatively examine patient and partner perceptions of phase 2 CR 3 mo after completion of the program. METHODS: A purposive sample of 11 couples (patients post-heart surgery and their spouses) was interviewed following completion of CR. Semistructured, in-person interviews were conducted with patients and spouses separately. Data were analyzed using line-by-line coding to identify themes. RESULTS: Themes were identified in relation to program elements of CR. Exercise themes were as follows: (1) benefitted from exercise and (2) felt held back. Education themes were as follows: (1) received basic education and (2) needed more personalized information. CR environment themes were as follows: (1) developed confidence; (2) made social comparisons; and (3) helped to have partner there. CONCLUSION: Overall, participant perceptions of exercise, education, and the CR environment were very positive. Nevertheless, there is a need to improve educational efforts within CR to rely less on "canned" presentations and more on participants developing their own self-management methods to maintain a healthy lifestyle after CR.
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Rehabilitación Cardiaca/psicología , Procedimientos Quirúrgicos Cardíacos/rehabilitación , Ejercicio Físico/psicología , Anciano , Dieta Saludable , Femenino , Humanos , Entrevistas como Asunto , Estilo de Vida , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Percepción , Investigación Cualitativa , Autoeficacia , Esposos/psicologíaRESUMEN
PURPOSE: Many cardiac patients discontinue heart-healthy eating and physical activity (PA) behaviors in the months following cardiac rehabilitation (CR). Involving the spouse in CR with the patient may be 1 strategy to increase the maintenance of these behaviors after CR. Assisting patients and spouses with the maintenance of healthy eating and PA behavior following CR begins with a better understanding of the couple-focused factors, impacting their experiences with these behaviors. The purpose of this study was to qualitatively examine couple-focused facilitators and barriers to maintaining changes in healthy eating and PA behavior from the perspectives of both cardiac patients and their spouses following phase 2 CR. METHODS: A purposive sample of 11 couples (patients undergoing postcoronary artery bypass graft surgery and their spouses) were selected from a larger randomized control trial. Semistructured, in-person interviews were conducted with patients and their spouses separately following CR. Data were analyzed using line-by-line coding to identify facilitator and barrier themes. RESULTS: Two couple-focused barrier themes emerged: unnegotiated situations and unshared behaviors. Two couple-focused facilitator themes emerged: supportive exchanges and partnerships. CONCLUSION: These findings will help guide interventions targeting changes in diet and PA behavior in both patients and their spouses through minimizing unnegotiated situations, fostering supportive exchanges, and creating a partnership for the couple to work together on shared diet and PA goals. Targeting both patients and their spouses may be an innovative and effective way to intervene to increase adherence to healthy eating and PA behaviors post-CR.