Addressing Heart Health in Hispanic Communities by Integrating Community Health Workers Community Based Participatory Research Project Health Education and Assessment Research Team H.E.A.R.T. Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013

1. Community Based Participatory Research Project
Health Education and Assessment Research Team
H.E.A.R.T.
September 27, 2013
El Paso, Texas

2. Affiliation People
El Paso, Texas, Lower Valley Community 300 Participants and their families (Phase I)
754 Participants and their families (Phase II)
Community Health Advisory Leadership Council Community Members
Community Health Worker Coalition Pema Garcia and Community Health Workers (CHWs)
City of El Paso Parks and Recreation Department Jose Rodriguez
University of Texas Houston El Paso Regional Campus –
School of Public Health
Hector Balcazar, Lee Rosenthal, Victor Cardenas, Sherrie
Wise, Alisha Hayden, Monica Chavez
Centro San Vicente Melissa Aguirre, Lorraine Hernandez
YWCA El Paso del Norte Region Sandra Braham, Elke Cumming, Anita Rockett, Diana
Hastings, Guillermo Flores, Bertha Torres, Paty Diaz,
Bertha Gonzalez
El Paso Community College Leticia Flores, Souraya Hajjar
The University of Texas at El Paso Maria Duarte, Sandor Dorgo, Cecilia Ochoa, Ximena
Burgos, Julio Ramirez
National Institutes of Health
National Institute of Minority Health and Health Disparities
Grant: R24 MD001785

3. Phase I: Planning
Phase II: Implementation
◦ Planning the large-scale Intervention
◦ Integrating CHWs in a partner CBO
◦ Conducting the Intervention
◦ Building the CHW Coalition

4. Phase I: Planning
(2005 – 2008)
•Identification of a health
problem in a low-income
El Paso area by
Community Health
Advisory Leadership
Council
•Pilot CHW Intervention
•Planning of the H.E.A.R.T.
Phase 2 Project
Phase II: Implementation
(2008 – 2013)
•To conduct an
intervention to address
lifestyle and
environmental factors
that relies on a CHW
culturally-tailored model
•To foster the sustained
integration of the CHW
model in CBOs to improve
healthy behaviors

5. Zip Code
79907
Zip Code
79915
El Paso
County
Total Population 55,132 40,057 820,790
Hispanics, % 52,803 (95.8%) 38,024 (94.9%) 81.4%
Spanish Spoken at Home
ages >5, %
44,289 (87.6%) 33,195 (85.6%) 71%
Median Age, years 32.8 35.8 31.2
Median Household
Income
$29,347 $25,966 36,015

6. • Heart disease leading cause of death in US (~600,000 per year) &
Texas (CDC, 2011)
• More than 1 in 3 American adults have 1 or more types of
Cardiovascular diseases (CVD) (Roger et al, 2012)
• High Blood Pressure – 76 400 000
• Coronary Heart Disease – 16 300 000
• Among Mexican Americans age 20 and older
• Hypertension: 27.8 % men; 28.9 % women
• High cholesterol: 50.1 % men; 46.5 % women
• Overweight & obesity: 77.5 % men; 75.1 % women

7. • Clinical
- BMI > 30 kg/m2
- High Blood pressure
- Total serum cholesterol > 240 mg/dL
- Diabetes
• Behavioral
• Low intake fruits and vegetables
• Diet high in saturated fat
• Lack of physical activity

8.  1) To conduct an intervention that relies on
CHWs to decrease CVD risk factors among
Hispanic families
 2) To foster the sustained integration of the
CHWs in CBOs to improve healthy
behaviors, and ultimately decrease CVD risk
factors
 3) To develop supportive policy environment
for sustain the CHW workforce

9. Health Education Assessment and Research Team
Project

10. Domain Change Agents/ Stakeholders Domain
Objective To establish a multidisciplinary team to deliver
programs and services aimed at reducing CVD risk
factors
Methods Strengthen Partnership and Community Health
Advisory Leadership Council (CHALC)
Established Memorandum of Understanding (MOU)
with partners
Outcome CHALC and Partnership were strengthened
CHW were integrated in YWCA El Paso del Norte
Region

11. Trusted members of the community
 Have a close understanding of the
community they serve
 Prepared to take leadership roles
 Build individual and community capacity
by increasing health knowledge and self-
sufficiency through:
◦ outreach
◦ community education
◦ informal counseling
◦ social support
◦ advocacy.
American Public Health Association, 2008by Paulina Matias, TX

12.  Integration of CHW at partner agency,
YWCA Paso del Norte Region
 Training of CHW
◦ Employer regulations
◦ Professional development
◦ Research Ethics
◦ Data collection and data entry
◦ Curriculum implementation
◦ Training certifications

13. Domain Individual Level/Family Domain
Objective 2 To conduct an intervention to address lifestyle in
the Lower Valley of El Paso, Texas that relies on a
CHW culturally-tailored model in order to:
Specific
Aims
2.1) increase awareness and utilization of
programs by Hispanic families living in the target
community;
2.2) increase healthy behaviors including
intentions and self-efficacy;
2.3) decrease CVD risk factors among Hispanic
families
Methods Plan and implement a large-scale intervention

14. Curriculum
Specialist
•Inventory of
wellness
programs at
partners
agencies
40 participants
(Focus groups)
•Pilot
intervention
754 participants
•Large scale
intervention

15. Lifestyle/Nutrition
Your Heart Your Health
Charlas
Cooking Demonstrations
Environmental/Nutrition
Grocery Store Tours
Lifestyle/Fitness
Aerobics
Swimming
Zumba
Environment/Exercise
Walking Groups
Soccer and Basketball
CHW
Promotores de
Salud

16. • Curriculum: 16 week CHW-led
intervention
• NHLBI “Your Health Your Heart” CHW friendly
curriculum
• Heart-healthy grocery store tours
• Heart-healthy cooking demonstrations
• Charlas (“coffee chats”)
• Scheduled activities at the Parks
• Weekly walking groups
• Weekly Zumba and Latin dance classes
• Family soccer

17. • Conducted by three Community Health Workers,
Paso del Norte Region YWCA employees
• Took place at
• Health fairs within the target community
• Schools within the target community
• Was conducted door-to-door within designated zip codes
(79907 & 79915)

18.  Demographic, anthropometric, and
behavioral measures (self-efficacy and
intentions)
 Data Collection pre- and post-intervention
◦ Time 1 (T1): Baseline
◦ Time 2 (T2): After 16 week intervention
◦ Time 3 (T3): 4 months after intervention

19. 754 Participants
BehavioralDemographics
CVD Risk
Measures
Clinical
SES
Intentions
Self-efficacy
Community Health Workers
Lifestyle-
Fitness
Lifestyle-
Nutrition
Environment-
Nutrition
Environment
-Exercise
Data Collection and Intervention

21. Age, mean ± SD 44.0 ±12.9
Female (n, %) 511 (84.5)
Birthplace
Mexico 386 (63.8)
United States 216 (35.7)
Language spoken for survey
Spanish 517 (84.9)
English 92 (15.1)
Household Income
<$15,0000 328 (54.7)
$15,000 - $25,000 132 (22.0)
>$25,000 140 (23.3)
No Health Insurance 309 (51.3)
Married/Living with a partner 340 (56.4)
Separated/Divorced 126 (20.9)
Widow 33 (5.47)
Years of Education, mean ± SD 12.1 ± 3.7
Employed 234 (38.9)

22. CVD Risk Factor
T1
(Range) n=604
T2
(Range) n=339
p value
T1 to T2
T3
(Range) n=173
p value
T1 to T3
Weight, lb 177.4 (93.8-330) 175.1 (101.6-327.6) <.0001* 173.10 (110.6-280.0) 0.0008*
BMI, kg/m2 31.3 (16.0-54.7) 30.7 (17.0 - 48.88) 0.0003* 30.5 (18.34-49.5)
0.3945
(N/S)
Waist Circum, cm 38.6 (25-61) 37.5 (25 - 61) <.0001* 37.8 (28-59) 0.0246*
Hip Circum, cm 44.1 (30.5-65) 43.5 (33 - 62) <.0001* 43.2 (34.8-61) 0.0008*
Systolic BP, mm Hg 126.9 (91-214) 124.7 (76 - 187) 0.0244* 125.3 (95.7-205.7) 0.0236*
Diastolic BP, mm Hg 76.7 (52.7-115) 75.2 (55 - 103) 0.0025* 74.7 (49.7-110.7) <.0001*
CVD Risk Index 5.54 (0-9) 3.65 (0 - 8) <.0001* N/A
( * =significant; N/S= not significant).
Covariates included in the analysis: gender, years of education, household income, years living in the U.S., & age.
T1= Time 1 (Baseline); T2= Time 2 (4-month follow up); T3 = Time 3 (8 month follow up).

23. Intentions and Self-efficacy Behaviors of Hispanics participating in the HEART project
Behaviors Variable
T1
n=604
T2
n=339
p value
(T1-T2)
Intentions1
Avoid eating fast food more than once a week 8.9975 9.2692 0.0077
Cook using less salt 9.2774 9.4882 0.0259
Avoid eating foods rich in sodium 9.1476 9.3728 0.0287
Self-efficacy2
Can buy and prepare healthy foods for my
family
8.4496 9.1953 <.0001*
Can eat at least 5 servings of fruits and
vegetables
8.2258 8.9053 <.0001*
Can cook using less fat 8.8282 9.4349 <.0001*
Can avoid eating fast food more than once a
week
8.2559 8.8609 <.0001*
Can cook using less salt 8.4223 9.2337 <.0001*
Can avoid eating foods rich in sodium 8.1956 9.0888 <.0001*
Can do at least 30 min of exercise 3 times
week
8.7214 9.3521 <.0001*
1Likert scale, 1=strongly disagree, 10= strongly agree; 2Likert scale, 1= Not at all confident,
10= absolutely confident. Covariates included in the analysis: gender, years of education, household
income, years living in the U.S., and age. T1= Time 1 (Baseline); T2= Time 2 (4-month follow up).

24. Domain Organizational /Policy
Objective
3
To foster the sustained integration of the CHW/PS
model in (CBOs) and public sector settings in El
Paso, Texas through building organizational
experience of and knowledge regarding the
importance of culturally-tailored lifestyle and
environmental interventions in order to increase
service utilization, improve healthy behaviors, and
ultimately decrease CVD risk factors.
Activities Developed a CHW Coalition
CHW Retreat
Outcome CHW Strategic Plan

25.  Paso del Norte CHW/Promotora Workforce
Coalition" was created.
 Coalition’s strategic directions for CHW
workforce advancement include:
◦ 1) Policy and Publicity
◦ 2)Training and Skills Development
◦ 3) Research and Evaluation

27.  To review
local, state and
national
developments in
CHW policy;
especially those
impacted by health
care reform

28. Participants and their families
Community Health Workers
HEART Project Partners
National Institutes of Health
National Institute on Minority Health and Heart Disparities
(NIH Grant: R24 MD001785)