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Translating Comparative Effectiveness Research Into Practice: Effects of Interventions on Lifestyle, Medication Adherence, and Self-care for Type 2 Diabetes, Hypertension, and Obesity Among Black, Hispanic, and Asian Residents of Chicago and Houston, 2010 to 2013

Rashid, Jamila R. PhD; Leath, Brenda A. MHSA; Truman, Benedict I. MD, MPH; Atkinson, Donna Durant PhD; Gary, Lisa C. PhD; Manian, Nanmathi PhD

Journal of Public Health Management and Practice: September/October 2017 - Volume 23 - Issue 5 - p 468–476
doi: 10.1097/PHH.0000000000000525
Research Articles: Research Full Report
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Context: In the United States, racial/ethnic minorities account for disproportionate disease and death from type 2 diabetes, hypertension, and obesity; however, interventions with measured efficacy in comparative effectiveness research are often not adopted or used widely in those communities.

Objective: To assess implementation and effects of comparative effectiveness research–proven interventions translated for minority communities.

Design: Mixed-method assessment with pretest–posttest single-group evaluation design.

Setting: US Department of Health and Human Services, Office of Minority Health, research contractor, and advisory board; health centers, including a federally qualified community health center in Chicago, Illinois; and public housing facilities for seniors in Houston, Texas.

Participants: A total of 97 black, Hispanic, and Asian participants with any combination of health care provider–diagnosed type 2 diabetes, hypertension, or obesity.

Interventions: Virtual training institutes where intervention staff learned cultural competency methods of adapting effective interventions. Health educators delivered the Health Empowerment Lifestyle Program (HELP) in Chicago; community pharmacists delivered the MyRx Medication Adherence Program in Houston.

Main Outcome Measures: Participation rates, satisfaction with interventions during January to April 2013, and pre- to postintervention changes in knowledge, diet, and clinical outcomes were analyzed through July 2013.

Results: In Chicago, 38 patients experienced statistically significant reductions in hemoglobin A1c and systolic blood pressure, increased knowledge of hypertension management, and improved dietary behaviors. In Houston, 38 subsidized housing residents had statistically nonsignificant improvements in knowledge of self-management and adherence to medication for diabetes and hypertension but high levels of participation in pharmacist home visits and group education classes.

Conclusion: Adaptation, adoption, and implementation of HELP and MyRx demonstrated important postintervention changes among racial/ethnic participants in Chicago and Houston. The communities faced similar implementation challenges across settings, targets of change, and cities. Available resources were insufficient to sustain benefits with measurable impact on racial/ethnic disparities beyond the study period. Results suggest the need for implementation studies of longer duration, greater power, and salience to policies and programs that can sustain longterm interventions on a community-wide scale.

Supplemental Digital Content is Available in the Text.

Urban Health Program, University of Illinois at Chicago, and Office of Minority Health, US Department of Health and Human Services, Rockville, Maryland (Dr Rashid); Westat, Inc, Rockville, Maryland (Ms Leath and Drs Atkinson, Gary, and Manian); and National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Truman).

Correspondence: Jamila R. Rashid, PhD, Urban Health Program, University of Illinois at Chicago, 808 S Wood St, Chicago, IL 60612 (jrashid@uic.edu).

All authors contributed equally to this work.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (http://www.JPHMP.com).

The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

This study was made possible through a $2 million contract with the US Department of Health and Human Services, Office of Minority Health, awarded to Westat, Inc, through a competitive government contracting process. The authors thank C. Kay Smith for her editorial assistance.

The authors have no conflicts of interest to declare.

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.