Professional Abstract
Objective
To compare the effectiveness of a culturally tailored healthy lifestyle program with education on chronic disease management in improving daily physical activity, other healthy behaviors, and health-related outcomes among African-American men with or at high risk for chronic diseases
Study Design
| Design Element |
Description |
| Design |
Randomized controlled trial |
| Population |
333 African-American men with or at high risk for chronic diseases
|
Interventions/
Comparators |
- Culturally tailored healthy lifestyle program
- Education on chronic disease management only
|
| Outcomes |
Primary: overall daily physical activity
Secondary: sedentary behavior, steps per day, dietary behavior, medication adherence, stress management, help-seeking behaviors, body mass index, blood pressure, glucose, hemoglobin A1c, serum creatinine, glomerular filtration rate, lipid panel, quality of life
|
| Timeframe |
1-year follow-up for primary outcome |
Compared with men of other races in the United States, African-American men have disproportionately higher rates of chronic disease. This randomized controlled trial assessed the effectiveness of a culturally tailored healthy lifestyle program called Active & Healthy Brotherhood (AHB) for managing and reducing the risk for chronic diseases among African-American men. In a prior pilot study, the research team tailored AHB to address stressors associated with living up to gender-role norms and barriers African-American men face to being active, eating healthy, and managing stress.
In this study, the research team randomly assigned participants to AHB or to the education-only group. AHB included a basic health education session and 16 weekly sessions on building self-efficacy for healthy lifestyle skills. Sessions included small-group exercises to enhance social support and accountability for healthy lifestyle goals. After AHB, participants received three phone calls to review progress, identify barriers to healthy behaviors and solutions, recognize successes, and adjust goals. The education-only group received the basic health education session and information about improving healthy behaviors.
The study included 333 African-American men from four counties in North Carolina. Study participants were not meeting guidelines for physical activity or fruit and vegetable intake or had diabetes, hypertension, or cardiovascular disease. The average age was 51.
Study participants wore fitness trackers to measure daily physical activity, sedentary behavior, and daily walking. They also completed assessments on health-related outcomes at the beginning of the study and again at follow-up assessments 6 and 12 months later.
African-American men served as members of the research team, helped design AHB, and provided feedback throughout the study.
Results
After 6 and 12 months, participants in AHB and those men in the education-only group did not differ significantly in overall daily physical activity.
After six months, participants in AHB had larger decreases in blood pressure, hemoglobin A1c and glucose levels (all p<0.05), after adjusting for baseline values and age. These differences were not maintained at 12-month follow-up. After 12 months, participants in AHB had larger increases in steps per day and larger decreases in daily calories from saturated fat and total fat (all p<0.05), after adjusting for baseline values and age. The two groups did not differ significantly in any other secondary outcomes at either timepoint.
Limitations
The study did not reach its recruitment goal of 400 participants; 25% of participants assigned to AHB did not attend any sessions. These factors limited the study’s ability to detect effects from AHB.
Conclusions and Relevance
Although overall daily physical activity did not improve, African-American men in AHB had larger improvements in steps per day and nutrition-related outcomes compared with those men who received only education on chronic disease management.
Future Research Needs
Future research could continue to investigate ways to manage and reduce risk for chronic diseases among African-American men and to better engage African-American men as participants in clinical research studies.
