SAHELI primary results: u.s. south asians need targeted programs to improve heart health

Publications

2024

Culturally Adapted Lifestyle Intervention for South Asian Adults With Cardiovascular Risk Factors JAMA Cardiol. Published online September 11, 2024.

Findings: In this 12-month randomized clinical trial of 549 South Asian adults in the Chicago, Illinois, metropolitan area, a 16-week, culturally adapted, group lifestyle intervention did not lead to greater reductions in cardiovascular risk factors, such as blood pressure, cholesterol, glycated hemoglobin, or weight, compared with monthly health education materials. A culturally adapted, group lifestyle intervention was implemented in community settings to reach US South Asian adults but did not significantly reduce cardiovascular risk factors; more work is needed to increase the effectiveness of lifestyle counseling for this at-risk population.

Social networks as facilitators and barriers to behavior change among U.S. South Asian adult participants of a culturally adapted, group lifestyle intervention

Findings: This qualitative study aimed to characterize how social networks influence cardiovascular health behaviors among U.S. South Asian adults in a culturally adapted, group lifestyle intervention. Knowledge from intervention diffused to participant’s family members. Family members reinforced behavior changes among intervention participants. Practice Implications: Health professionals should ask patients about how their social networks facilitate or hinder behavior changes. Gender and cultural factors may modify how social networks influence behavior change.

A mixed-methods, theory-driven assessment of the sustainability of a multi-sectoral preventive intervention for South Asian Americans at risk for cardiovascular disease Published: 13 September 2024

Findings: Using community-based participatory research, we previously developed and implemented the South Asian Healthy Lifestyle Intervention (SAHELI), a culturally-adapted evidence-based intervention targeting diet, physical activity, and stress management. In this study, we use the Integrated Sustainability Framework to investigate multisectoral partners’ perceptions of organizational factors influencing SAHELI sustainability and strategies for ensuring sustainability. This study identifies common sustainability barriers and facilitators across different sectors, as well as those specific to certain settings. Aligning health equity interventions with community needs and values, organizational activities, and local context and resources is critical for sustainability. Challenges also arise from balancing the needs of specific populations against providing programming for broader audiences.

Presentations

Watch Dr. Kandula’s 12 minute video presentation she delivered on September 28, 2023 about Cultural Adaptation of Evidence-based Dietary Interventions for South Asian Americans here: https://northwestern.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=c894c10a-87e7-4b75-a592-b146017a0365 Dr. kandula presents AT NIH’s conference on Advancing Health Equity Through Culture-Centered Dietary Interventions to Address Chronic Diseases Virtual Workshop

Watch Dr. Kandula’s 29 minute SAHELI Results Presentation at this website: https://northwestern.hosted.panopto.com/Panopto/Pages/Viewer.aspx?id=7deff5b7-706e-48c4-9ec3-b0c8013a2f24

SAHELI Pilot Study Papers

Translating a heart disease lifestyle intervention into the community: the South Asian Heart Lifestyle Intervention (SAHELI) study; a randomized control trial

Findings: This pilot study suggests that a culturally-salient, community-based lifestyle intervention was feasible for engaging medically underserved South Asian immigrants and more effective at addressing ASCVD risk factors than print health education materials.

The South Asian heart lifestyle intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: Design and methods

Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian heart lifestyle intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6 weeks of group classes, followed by 12 weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population.

Qualitative Process Evaluation of a Community-Based Culturally Tailored Lifestyle Intervention for Underserved South Asians

Findings: Intervention success was attributed to trusted CBO setting, culturally concordant study staff, and culturally tailored experiential activities. Participants said that these activities helped increase knowledge and behavior change. Some participants, especially men, found that self-monitoring with pedometers helped motivate increased physical activity. Participants said that the intervention could be strengthened by greater family involvement and by providing women-only exercise classes. Staff identified the need to reduce participant burden due to multicomponent intervention and agreed that the CBO needed greater financial resources to address participant barriers. 

Community-based delivery and cultural adaptation of an evidence-based lifestyle intervention were effective and essential components for reaching and retaining medically underserved SAs in a cardiovascular disease prevention intervention study.

Publications

2016

An Exercise Intervention for South Asian Mothers with Risk Factors for Diabetes

Findings: This pilot study suggests that a culturally-tailored exercise intervention that included exercise classes for children was feasible and had physical and psychosocial benefits in South Asian mothers with risk factors for DM.

2015

Life stage influences on US South Asian women's physical activity

Findings: Sociocultural norms, family constraints, and lack of awareness about the benefits of (physical activity) PA strongly influenced PA among (South Asian) SA women. Culturally salient intervention strategies might include programs in trusted community settings where women can exercise in women-only classes with their children, and targeted education campaigns to increase awareness about the benefits of PA across life stages.

2013

South Asian American Perspectives on Overweight, Obesity, and the Relationship Between Weight and Health

Findings: South Asian Americans may underestimate their weight status and the effect of their weight on their risk for chronic diseases. Interventions to promote weight loss among South Asian Americans should focus on modifying perceptions of normal weight and personalizing the relationship between overweight and chronic diseases.

2012

A community and culture-centered approach to developing effective cardiovascular health messages

Findings: A community and culture-centered approach to developing cardiovascular health promotion messages revealed tensions between the researcher’s vantage point of “cultural targeting” and the community’s perceptions and reactions to these messages. Engaging communities in every phase of message design, incorporating their EMs, recognizing community heterogeneity, and addressing economic and structural barriers, are critical steps to ensuring that health promotion messages reach their intended audience and achieve true cultural appropriateness.

Explanatory models of coronary heart disease among South Asian immigrants

Findings: South Asians’ EMs of CHD encompassed the biomedical model; however, EMs also included psychosocial and spiritual factors. Practice implications: Clinicians and health educators should be aware that South Asian individual's EM of CHD may include psychosocial and spiritual factors which can affect CHD prevention behaviors.

South Asian American perspectives on overweight, obesity, and the

Findings: South Asian Americans may underestimate their weight status and the effect of their weight on their risk for chronic diseases. Interventions to promote weight loss among South Asian Americans should focus on modifying perceptions of normal weight and personalizing the relationship between overweight and chronic diseases.

2010

Knowledge gaps and misconceptions about coronary heart disease among US South Asians

Findings: A majority of South Asians in this study believed that CHD is not preventable and had low awareness of modifiable risk factors. As a first step, CHD education should target the knowledge gaps that may affect risk factor control and behavior change. Educational messages may need to be somewhat different for subgroups (e.g., by education and language) to be maximally effective.