Process Evaluation of a Heart Disease Lifestyle Intervention in Underserved South Asian Communities

Introduction: Process evaluations implemented in randomized clinical trials (RCT) are critical to understanding patient-centered outcomes and for improving interventions for larger scale implementation. We assessed participant experiences during a pilot RCT of a community-based, culturally-tailored cardiovascular disease (CVD) prevention intervention for South Asian (SA) immigrants.

Methods: Bilingual staff used a semi-structured interview guide to conduct telephone interviews with intervention participants.  Interviews focused on participants’ perceptions (satisfaction, challenges, and benefits) of the intervention and its components, which included group classes and telephone counseling to initiate and maintain healthy behaviors. Audio recordings were transcribed and coded by three independent reviewers.

Results: Overall attendance at the 6 group classes was on average, 78%. However, after individual make-up sessions, all participants achieved 100% attendance.  Participants found experiential activities (e.g. grocery store trip, self-monitoring with pedometers) to be most helpful because they learned how to incorporate these behaviors into their daily routines.  One participant said, “Since 6 months I have the same weight, all due to these classes.” Participants stressed the importance of having bilingual educators who were from a culturally-concordant background. The follow-up telephone counseling helped participants maintain healthy lifestyle goals, “The phone calls were very good because we stay alert as the call would come, and promise our self to do it.”  Participants said that a family-based intervention may be more effective in this community, “We have been telling everything we learned to our families, but the family should be able to attend classes.” Additionally, some female participants said they preferred women-only classes when learning about exercise.

 Conclusion: SA immigrants had a positive experience in a community-based, culturally-salient CVD prevention intervention.  The effectiveness of this intervention may be improved by incorporating the family. In addition to language and cultural concordance of interventionists, incorporating cultural values is important when developing health interventions for SA.