Cardiovascular disease (CVD) is the leading cause of death for American Indians/Alaska Natives (AI/ANs)—for whom the rate of CVD is higher than in the general population. CVD and its risk factors also are associated with problems in pregnancy. Detecting and treating CVD and its risk factors in women of reproductive age may improve pregnancy and long-term health outcomes. Additionally, reproductive health care is the only kind of medical care some women seek. Therefore, the Washington researchers are developing and evaluating a CVD risk-reduction program for women of childbearing age for use during reproductive health care visits. The intervention is delivered by health educators and case managers drawn from the local community and trained in motivational interviewing (MI). Changes in risk factors and identifying and treating chronic disease will be tracked for women enrolled in the program.
The MI method assumes that people resist changing health behaviors because they doubt their own ability to change or they are uncertain that change is worth the effort. Using MI, a health educator works to eliminate this ambivalence by providing accurate health information and eliciting self-motivational statements. The case manager helps the client create an action plan for change, make and keep medical appointments, and improve patient-provider communication.
The researchers are collaborating with two AI/AN community clinics—the Seattle Indian Health Board clinic in Washington (urban) and the Pine Ridge Indian Health Service facility of the Oglala Sioux Tribe in South Dakota (rural). To test the intervention, the researchers are recruiting nonpregnant women aged 18–44 years during reproductive health care visits. Participants will be screened for several chronic diseases and risk factors including diabetes, high blood pressure, high cholesterol, overweight and obesity, physical inactivity, smoking, and depression.
Women at risk are referred to the health educator who helps the participant choose a risk factor to improve. Participants receive educational materials, learn about risk reduction strategies and services available, and determine their readiness to change the targeted behavior. Over a 3-month period, the health educator has 4 half-hour telephone sessions with the participant followed by a final 1-hour, in-person meeting. During these sessions, the health educator uses MI to help the participant move from a stage of thinking about changing health behavior to achieving change. At the end of every session, the woman fills out a questionnaire used to measure her motivation to change.
At follow up, the researchers will evaluate any changes in the participants' risk factors and assess how well participants kept medical and counseling appointments.