A total of 33 promotores delivered the intervention. The average number of families per promotor(a) was seven, with a range of 2 to 13 families per promotor(a). The Table presents the number of promotores working with participant families, the total number of families, and the mean number of families per promotor(a) at each site.
Most promotores were women aged 20 to 67; the average age was 41. About 65% of the promotores were born outside the United States. Of the 33 promotores, 5% reported having attended only primary school or less, 18% reported having some high school education, 28% reported having a high school diploma or GED, 30% reported having some college or technical school education, and 18% reported being college graduates. Overall, most promotores reported being bilingual. As would be expected, the preferred language varied depending on whether the promotores were born in the United States; a greater proportion preferred English or English and Spanish if they were born in the United States. Most promotores (78%) had worked as lay health educators before participating in the SPSC-NCLR program, with experience ranging from 6 months to 20 years.
Improving heart health of families
The location for conducting family education sessions varied slightly depending on the topic; the most common locations were family homes (35%) and community centers (32%). Other locations (e.g., church, school) were also used for about 27% of the family education sessions. Fewer than 5% of the family education sessions were conducted in health centers. The surveyed families received an average of about seven educational sessions out of the possible eight. Almost all families (89%) were given information on at least seven topics, including diabetes.
Promotores asked the main respondent for the family, usually the mother, to provide the estimated number of individuals in the family at risk for CVD. Among the main respondents for the 223 families, 57% reported that no one in their family was at risk for CVD; 42% reported that they had at least one family member at risk.
shows CVD risks reported by individual family members. When promotores asked individual family members to report on a list of risk factors, 80% of the 320 individuals surveyed had at least one risk for heart disease. The mean number of risks per family member surveyed, excluding those who reported having no risks, was three. The overall mean number of risks, including the individuals who reported having no risks, was two. The two most common risks factors for CVD among all individuals surveyed were being overweight (50%) and a lack of physical activity (45%). Only 9% of the respondents reported that they smoked, a low percentage compared with other factors.
Heart disease risks reported by individual family members (n = 320) participating in the Salud Para Su Corazón outreach program. Data collected by promotores using questionnaires, 2001.
| ||Percentage of families reporting on heart disease risks, by response|
|Yes||No||Don't know, not applicable, or blank|
|Have high cholesterol||16||62||22|
|Have high blood pressure||16||64||20|
|Exposed to secondhand smoke||19||75||6|
|Aged 45+ men, 55+ women||21||74||5|
|Heart disease runs in family||30||53||17|
|Lack of physical activity||45||48||7|
Changes in pretest and posttest scores for the families' practices of heart-healthy behaviors are presented in . Families showed improvement in heart-healthy behaviors. Paired t tests of the increases in average overall scores and for each topic were statistically significant (P < .001). For the 190 families that completed both surveys, the average pretest overall score was 41% and the average posttest overall score was 59%, representing an average improvement in the total score of 18% (95% confidence interval [CI], 16%–21%).
Figure 2 Average scores, by topic, for heart-healthy habits among families (n = 190) participating in both the pretest and posttest as part of the Salud Para Su Corazón outreach program. Score percentages calculated based on maximum score of 100. Asterisk (more ...)
|Pretest Score||Posttest Score|
|What does the family do to be more physically active?*||27||40|
|Cholesterol and fat||43||69|
|Salt and sodium||49||65|
The greatest improvement was observed for the items on practices related to cholesterol and fat, with an average pretest score of 43% and an average posttest score of 69%, an improvement of 26% (95% CI, 23%–30%). On topics such as "What is the family doing to be more physically active?" an average improvement of 13% was found (95% CI, 9%–16%). An improvement of 17% (95% CI, 14%–21%) was found for the physical activity topic. An average improvement of 21% (95% CI, 18%–24%) was found in practices related to weight reduction and control. Improvements were also observed on items related to salt and sodium consumption.
describes the distribution of responses across the four possible response categories. Chi-square tests of changes in the distribution were statistically significant (P < .001), even though this test does not correct for a potential underestimation of the effect due to the correlation between pretest and posttest scores for individual respondents.
Figure 3 Distribution of responses on family heart-healthy habits among families (n = 190) participating in both the pretest and posttest as part of the Salud Para Su Corazón outreach program. Asterisk (*) indicates that data refer only to mother. Data (more ...)
| ||Percentage of families practicing heart-health behaviors, by frequency|
|What does the family do to be more physically active?*||Pretest||48||29||13||10|
|Cholesterol and fat||Pretest||33||27||17||24|
|Salt and sodium||Pretest||24||27||25||24|
Community referrals and screenings
Of the 223 families surveyed, promotores referred 74% to health care providers for blood pressure screening and 81% for blood cholesterol screening. They also weighed and measured the waist circumferences of family members for 77% of the families. Among the 101 families that received the educational session on diabetes, 70% were referred for a blood glucose check. According to the data collected by promotores through the group education questionnaires, promotores referred participants in 89% of the 56 classes taught on cholesterol for blood cholesterol screening and referred participants in 86% of the 37 classes taught on diabetes for blood glucose screening. Promotores also measured the weight and waist circumferences in 34% of the 32 classes taught on maintaining a healthy weight. No data were collected for blood pressure screenings.
Based on the promotores interviews conducted in 2003, five of the seven sites reported that more than 90% of the participants referred for screening in 2001 were actually screened, and one of the sites reported that 100% of the participants referred were screened. Another site reported that it did not have this information. To ensure that the participants would be screened after taking the class, some of the promotores opted for providing transportation to a clinic after the class, while others decided to bring a nurse to the session to do the screening. In other locations, promotores kept track of the percentage of participants who were screened by asking them for the screening results during follow-up visits. In still other locations, promotores arranged for free screening of class participants in an effort to increase the number of people getting screened for the different heart risk factors. The interaction between promotora and screening activities on reducing CVD risk factors was not explored because of limitations in data collection.
Reaching beyond families
According to the data collected from 223 families, SPSC–NCLR reached other people beyond the original participant families. Responses to questions on information sharing revealed that family respondents were likely to share information they learned about heart-healthy behaviors with friends in their neighborhood, friends in other cities, friends in their country of birth, relatives in their country of birth, or people at work. The results showed that family respondents were just as likely to share information about one topic as another, with the exception of smoking (). Fewer than 33% of families shared information with friends in other cities, friends in their country of birth, relatives in their country of birth, or people at work. The lower proportion of families that shared information about smoking, compared with other topics, may reflect the fact that most respondents reported being nonsmokers.
Audiences with whom families participating in Salud Para Su Corazón outreach program (n = 223) shared educational information received, by topic. Data collected by promotores using questionnaires, 2001.
| ||Percentage of families who shared information, by topic|
|Audience with whom information was shared||Salt||Cholesterol||Weight control||Physical activity||Smoking|
|Friends in neighborhood||47||46||45||48||41|
|Friends in other U.S. cities||24||23||25||27||21|
|Relatives in the U.S.||47||48||49||49||41|
|Friends in country of birth||24||20||19||17||17|
|Relatives in country of birth||25||21||23||21||19|
|People at work||27||27||27||25||25|
Participants' evaluations of SPSC–NCLR programs
Family participants expressed a very high level of satisfaction with the program. Overall, of the 207 families participating in the survey on satisfaction, 96% were very satisfied with the program. Accordingly, the level of satisfaction with specific aspects of the program was also very high (). For example, the majority of the families surveyed (95%) rated the information they received through the program (instruction and guidance) as very important, including information on cholesterol and fat, blood pressure, weight control and serving information, physical activity, smoking, and salt and sodium.
Percentages of families satisfied with guidance provided by the Salud Para Su Corazón outreach program (n = 207). Data collected by promotores using questionnaires, 2001.
|Percentages of families satisfied with program guidance, by satisfaction level|
|Very satisfied||Somewhat satisfied||Somewhat dissatisfied||Very dissatisfied|
|Instruction and guidance||95||5||0||1|
|Encouragement and support||94||6||0||1|