Adapting a Western Cardiovascular Disease Prevention Program to Local Environments
Authors: Yimsiriwattana W. , Inciong Edwin A , Khantong A. 
Published: September 2012

Abstract
Cardiovascular disease is quickly becoming established as one of the leading causes of death in developing economies, affecting men and women of all races and socioeconomic classes. To respond to and reduce the risks that cardiovascular disease poses to our people and our business, an enterprise-wide, voluntary program — the Cardiovascular Health Program (CHP) -- was developed to target such lifestyle choices such as inactivity, smoking, stress and obesity. This type of risk-prevention program has been shown to reduce the incidence of illness and disability beyond what is achievable through managing disease alone (primary is more impactful than secondary prevention).
This cardiovascular program is available as the online web access. It consists of a cardiovascular risk assessment (CRA), risk profile tools, educational materials and mentoring sessions. The CRA requires participants to complete questionnaire on personal and family medical histories, lifestyle, medications, etc. It identifies current or potential risk factors for cardiovascular disease and classifies the individual at low, moderate or high risk. Individuals at high risk are contacted by the trained mentor who provides direction, encouragement and support for positive lifestyle changes. Participation in the mentoring program occurs over a 12 week period, either face-to-face or by telephone.
Chevron Health and Medical staff in Thailand and the Philippines pioneered in Asia to adapt language, relevant examples, dietary advice, etc for in use with local workforces. After an initial false start using the standard approach, it became clear that a "one size fits all" approach was ineffective, and adaptations were created. In Thailand, Health and Medical first deployed the CHP in October 2009, using the original Western model, including encouraging employees to access the US website independently. After three months, only 95 of 1,500 employees (6.3%) completed the online assessment. A reassessment noted that some employees had limited access to the computers (especially the field personnel). Limitations in bandwidth were also impaired ease of access to this web-based program. The issue was solved by distributing hard-copy questionnaires and by trained mentors assisting access to the online program. The number of participants then increased to 756 and 816 at the end of 2010 and 2011 respectively (figure 1).
Other issues surfaced, such as in 2010 when there were 30 requests to participate in individual one-on-one mentoring, but none were able to complete the defined 12-week program. Problems included an inadequate number of mentors, schedule conflicts between mentors and participants, and waning interest in the program.
In 2011, a group approach was introduced as a mentoring strategy. Sixteen individuals with the same health risk (overweight) were a pilot group and held weekly mentor-led activities, such as discussions on nutrition, group exercise, and sharing experiences of weight reduction. We also continued individual coaching with other identified 36 persons. At the end of the year, 15 of 16 (93.8%) completed the group program, and 16 of 36 (44.4%) completed the individual program (figure 2). Biometrics were evaluated. Group program participants lost an average of 4.9 kilograms while those who completed the individual program had no weight change, or change in their health metrics.