Background/Context: Research consistently shows an association between high stress levels and increased risk for chronic conditions, including cardiovascular disease (CVD). Furthermore, low socioeconomic status (SES) and minority communities experience both a higher prevalence of CVD and higher levels of chronic stress than the general population. However, few behavioral interventions incorporate stress reduction as an integral part of disease management. Given the disproportionate burden of stress, CVD and related risk factors among low income and minority populations, addressing stress management is key to improving both mental and physical health outcomes in these communities.

Description: Take Heart is an evidence-based group CVD self-management program adapted for low income minority adults in Detroit. Based on feedback from community members during the adaptation process, stress management was added as one of the key intervention modules. Specifically, the Take Heart curriculum was modified to address how stress affects the heart and body, and barriers to and strategies for managing stress. Take Heart enrolled 453 participants, all with diagnosed heart disease and/or at least two related risk factors, 75% female, 86% African American, with a mean age of 65 (range 50-92). To assess the impact of the stress management module, quantitative and qualitative data was collected from intervention participants in-person and through telephone interviews.

Lessons Learned: Of the heart-health related problems participants chose to work on, stress-management was among the top five. Furthermore, participants who selected exercise, nutrition, or quitting smoking as their problem frequently set goals to reduce their stress levels to facilitate behavior change. After completing the stress management module, participants reported increased knowledge and awareness of stress triggers, how stress impacts the body, and stress reduction techniques.

Recommendations/Implications: Take Heart offers one example of the critical role of stress reduction in chronic disease self-management, particularly in low income and minority communities. To learn more about how to reduce this key risk factor, interventions that rigorously measure the effectiveness of culturally adapted strategies are needed. By addressing the physical and mental health consequences of stress, we increase the potential benefits of chronic disease self-management, particularly among our most vulnerable populations.