# Presentation: 080338

## Enhancing Support for Women at Risk for Coronary Heart Disease (CHDRISK)

- Deborah Toobert, Lisa Strycker,
- Russ Glasgow, John Bagdade,
- Karyn Angell, Manuel Barrera, Jr.

## Primary Objectives

- Conduct a randomized trial to compare 6-month outcomes in usual care (UC) compared to modified lifestyle management intervention
- Develop a computer-based touchscreen supportive resources assessment
- Evaluate the longer-term effects of two strategies for supporting healthful lifestyle practices relative to UC:
- lay-led in person group support
- personally tailored computer-based support

## Theoretical FrameworkCHD Risk Intervention Model

**Provide Follow-Up Support and Enhance Social Resources**

**Collaboratively Set Goal(s)**

**Provide Personalized Coping Skills as Needed**

- Theoretical FrameworkCHD Risk Intervention Model

## Theoretical FrameworkPyramid of Support

**Community**
**    ****and Region  **

**Media and**
**Policy       **

**Disease**
**Management**

**All    **
**  ****Other**

**Neighborhood **
**& Physical **
**Environment**

**Work and**
**Organizations**

- Theoretical FrameworkPyramid of Support

**Family **
**& Friends **

**Health **
**Care Team**

**Personal**

**Context**

**Close Relations**

**Coping**

**Culture**

**Formal - Institutional**

**Informal -- Interpersonal**

## Key Questions

- Main: 	Can a comprehensive lifestyle          			management program reduce risk 				for women at high risk for CHD?
- Secondary:
- What are the short-term effects of relatively proximal sources of support?
- What are the effects of both
- (a) lay-led group support and
- (b) computer-based tailored intervention on long-term maintenance?

## Target Population (N = 250)

- Women with type 2 diabetes
- Postmenopausal
- Physically inactive
- High saturated fat diet

## Slide 7

## RE-AIM

- REACH: percent and representativeness of eligible women from primary care providers who participate
- EFFECTIVENESS: above outcomes
- ADOPTION: percent of primary care offices approached who participate
- IMPLEMENTATION: extent to which intervention components are received
- MAINTENANCE: extent to which program components continue to be delivered and to which initial improvements in behavior are maintained

## Intervention

- Lifestyle Management Goals:
- Mediterranean diet
- Stress-management (60 minutes per day)
- Moderate exercise (30 minutes per day)
- Support
- Program Components:
- Three-day retreat
- Weekly 4-hour meetings
- Focus on social support after six months
- lay-led group support, or
- personalized support

## Study/Outcome Variables (Behavioral Endpoints)

- Dietary behavior/intake
- Four-day food records
- Plasma fatty acid composition
- Kristal Fat & Fiber Behavior Questionnaire
- Block Dietary Fat & Fiber Screener

## Study/Outcome Variables (Behavioral Endpoints)

- Physical Activity
- Physical Activity Scale for the Elderly (PASE)
- National Health Interview Survey & College Alumni Study Walking Questions
- Trunk flexion
- Shoulder range-of-motion

## Study/Outcome Variables (Behavioral Endpoints)

- Smoking
- Carbon monoxide levels
- Standardized smoking questions
- Stress Management (Self-monitoring)
- Social Support
- Social Network Index
- Chronic Illness Resources Survey
- Functions of Social Support (to be developed)

## Study/Outcome Variables (Physiologic Endpoints)

- Progression rate in the IMT of carotid arterial wall
- Plasma lipids and lipoproteins (TC, triglycerides, HDL-C, apolipoprotein B, LDL, dense VLDL, LDL)
- HbA1c
- Blood pressure
- Body weight, body mass index, central obesity (waist/hip/ratio)
- Medication use status (e.g., lipid-lowering, hypertension, estrogen

## Study/Outcome Variables (Quality of Life)

- Quality of Life: Medical Outcomes Study General Health Survey (SF-36)
- Illness Intrusiveness Scale

## Study/Outcome Variables(Process Measures)

- Stress
- Challenges to Self-Care
- Chronic Stressors
- Perceived Stress Scale (PSS)
- Other Process Measures
- Center for Epidemiologic Studies Depression Scale (CES-D)
- Self-efficacy for Diet and Exercise Behavior
- Problem solving/coping using the Brief COPE
- Attendance and participant involvement