Abstract P365: Systematic Review of Self-Management Interventions for Black Women With Cardiovascular Risk Factors

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death among Black women, and when compared to their non-Hispanic White counterparts, they are about 50% more likely to have uncontrolled high blood pressure (BP). The disproportionate burden of CVD in Black women highlights the need for CVD prevention programs in this population. The present systematic literature review assessed the efficacy of self-management interventions for Black women with CVD risk factors. Hypothesis: Self-management interventions that target more than one health practice, when administered to Black women with CVD risk factors, will decrease CVD risk and improve clinical outcomes. Methods: Searches were run on PubMed, Cochrane, CINAHL, and PsycINFO databases based on the following inclusion criteria: papers written from September 22, 2018; English language; US studies only; original research reports; prospective clinical trials; cardiovascular health promotion/self-management interventions that target at least two health practices (individual or group, in-person or remotely delivered, or person-person synchronous); primary prevention; comorbid conditions without a cardiovascular event; at least one patient level outcome (self-reported or biological); Black women at least 18 years of age only. Data extraction included participant demographics; intervention characteristics; self-management/health behavior domains; research design; and study outcomes. Results: Of the 1041 abstracts screened (262 duplicates removed), 87 full-text articles were screened, and 11 papers from 10 unique trials (N= 1,635) were chosen for inclusion. Intervention durations ranged from 5-weeks to 12-months, with a frequency of intervention dose ranging from daily contact to bi-weekly meetings. Of the 10 unique trials, the majority targeted physical activity (n=8), nutrition (n=5), weight loss (n=3), health knowledge (n=2), and BP control (n=2). Interventions were mostly offered in groups (n=9), and some included individual components (n=2). Nine of the eleven papers reported statistically significant improvements in CVD risk factors including weight loss (n=6), physical activity (n=2), BP control (n=2), waist circumference (n=1), and depression (n=1). Few papers (N=1) addressed mental health, and none addressed other social determinants of health. Conclusions: Evidence to date indicates that self-management interventions are not only feasible but also appear to improve CVD risk factors and clinical outcomes in Black women with CVD risk. Future research should assess best practices for the implementation of culturally informed CVD risk prevention programs in underserved populations. Further intervention development should focus on the influence that social determinants of health such as discrimination, stress, and mental health may have on self-management and CVD risk in this population.