A Community Engagement Method to Design Patient Engagement Materials for Cardiovascular Health

Aimee F. English; L. Miriam Dickinson; Linda Zittleman; Donald E. Nease; Alisha Herrick; John M. Westfall; Matthew J. Simpson; Douglas H. Fernald; Robert L. Rhyne; W. Perry Dickinson

doi:10.1370/afm.2173

Article Figures & Data

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Table 1

Population Characteristics of Standard and Enhanced Regions

Characteristic	Greeley, Colorado^a	Denver, Colorado^b	Hobbs, New Mexico	South Valley, Albuquerque, New Mexico^c
Community description	Largely rural agricultural communities Population ~75,000 Approximately 30% Hispanic Lower average income and higher rates of poverty than rest of state	Population >3 million Among fastest growing urban centers in the United States 80% White with approximately 30% of its residents identifying as Latino	Among eastern-most counties in New Mexico. Population ~35,000 Highest percentage of African American population in the state Describe themselves as a part of West Texas, because geographically they are closer to Texas than most other places in New Mexico Oil and gas are the main sources of income in the region	Urban/rural mix; high-density areas are intermingled with agricultural land Population ~40,000 Predominantly Hispanic, with many recent immigrants from Latin America
Themes and messages	Early intervention is key, emphasized knowing personal heart health numbers, including blood pressure, cholesterol, 10-yr ASCVD risk Track health data over time Provide context around CVD risk (What does 7% risk mean for me?) Wanted a conversation starter for patient to discuss CVD risk with health professionals	You only have 1 heart—your life depends on it Know your risk, even if you feel fine Act now to lower your risk Wanted to design products for any age-group Use brochure to grab attention and dig deeper into actions with the Risk Factor Check List	A clean spiritual life requires a healthy physical life—complete spiritual, physical, and mental health are needed to be whole Focus on what we can control, not what we can’t (eg, family history) Heart disease does not discriminate; no matter one’s heritage, ethnicity, religion, etc, we are all at risk Many members from faith-based community; our bodies are worthy of care Taking care of health is actually cheaper (“sale”) than consequences of CVD event Encouraged implementation in community, but also in practice setting	Messages aim to elicit a feeling—think about family, love, prevention in a multi-generational sense Educate ALL ages and get the entire family involved—youth can help the family change and adults and seniors want to be around for their family Focus on Latino communities Prevent second chances. Don’t wait for something to happen to take action “Know your numbers before your ‘check heart’ light comes on” Implement in community, but also in practice setting Attention to the need for materials to be in both Spanish and English
Product description	Heart Chart, a personal tracking tool for blood pressure, cholesterol, BMI and 10-y ASCVD risk, which provides comparison to normal age-related risk over time Recipe cards with information about CVD prevention	An informational brochure about cardiovascular disease prevention labeled “You only have one heart” A similarly themed poster A checklist of CVD risk factors	Big sign saying “Big Sale!” with information about CVD risk reduction Hand-held, heart-shaped fan with “We are all different but we all have heart–heart disease does not discriminate.” Magnet that reads “Our bodies are miracles… but we have to treat them that way!”	Trifold brochure informational brochure titled “Prevent second chances” One-page handout with key heart health numbers in the form on the image of a car dashboard Informational poster with a picture of a family Grocery bag that says “Cuídalo” and displays the ABCS
Example product

ABCS = aspirin use, blood pressure, cholesterol management, smoking cessation; ASCVD=atherosclerotic cardiovascular disease; BMI = body mass index; CVD = cardiovascular disease.
↵a Northeast Colorado.
↵b Denver and Golden, Colorado.
↵c Parts of Albuquerque and unincorporated San Bernalillo county.

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Table 2

Population Characteristics of Standard and Enhanced Regions

	Colorado				New Mexico

	Standard (n=13)		Enhanced (n=13)		Standard (n=8)		Enhanced (n=8)

Variable	Mean (SD)	Min/Max	Mean (SD)	Min/Max	Mean (SD)	Min/Max	Mean (SD)	Min/Max
Total population, No.²³	137,376 (188,581)	7,264/572,003	197,019 (241,165)	9,358/622,263	39,872 (38,989)	1,975/145,400	97,866 (174,455)	687/667,092
Non Hispanic white, %²³	74.6 (14.8)	53.2/91.5	76.6 (11.2)	52.2/87.9	40.3 (18.6)	10.2/75.3	39.9 (12.8)	18.1/67.8
Hispanic, %²³	19.7 (13.9)	4.8/42.3	17.5 (9.5)	7.5/38.4	43.5 (18.3)	13.6/81.7	48.7 (14.5)	19.2/76.9
Below poverty level, %²⁴	14.3 (5.3)	8.4/26.6	12.8 (4.4)	4.3/20.8	21.7 (6.4)	4.4/35.0	19.9 (5.2)	11.9/28.6
Unemployment rate, %²⁴	8.0 (1.5)	5.0/10.2	8.1 (1.4)	5.2/9.6	8.0 (3.2)	4.2/19.0	7.0 (1.9)	4.5/10.2
Uninsured adults, No.²⁵	18,489 (26,710)	635/75,329	24,117 (32,218)	1,475/94,305	6,547 (6,639)	354/24,747	16,060 (27,611)	98/103,316
Median income, $²³	53,302 (11,149)	35,126/73,576	54,803 (15,574)	35,423/95,973	41,228 (16,715)	28,275/106,686	39,207 (7,737)	27,430/50,694
NP per 10,000²⁶	8.0 (1.6)	4.8/10.1	8.5 (2.3)	5.5/12.0	3.9 (2.3)	0.0/9.2	3.7 (1.9)	0.0/6.7
Physician^a per 10,000²⁶	5.9 (2.1)	1.2/9.0	6.2 (1.9)	4.1/10.6	7.9 (3.6)	2.1/18.5	6.7 (4.0)	0.0/14.4

Max=maximum; Min=minimum; NP=nurse practitioner.
↵a Primary care physician.

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Table 3

Boot Camp Translation Participants by Boot Camp Translation Site

Site of BCT (Region of Recruitment)	Community Partners/Academic Participants No./No.	Examples of BCT Partner Backgrounds
Hobbs, NM (Hobbs, NM)	12/2	Community health workers, local pastor, county commissioner, educator, survivors and caregivers of people with CVD, local health extension agent
South Valley, NM (parts of Albuquerque and unincorporated Bernalillo County)	10/2	Community health workers, retired environmental engineer, medical assistants, members of a family-run organic farm, social worker, nursing student, local health extension agent
Greeley, CO (Northeast Colorado region)	11/3	Retired teacher and farmer, reading instructor and rancher, retirees, small business owner, public health professional, local practice facilitator, practice manager
Denver, CO (Denver and Golden)	12/3	Community members, pastor, community health worker/Promotora, teacher, retirees (retail manager, business consultant, accountant, engineer), public health student, primary care clinicians, public health professionals