The Health Freedom Path To Wellness Program: A Novel Educational And Behavioral Intervention To Promote Cardiovascular Health Equity

Background: African Americans (AAs) and adults living in urban communities continue to experience disproportionately high rates of cardiovascular disease (CVD) and associated risk factors (e.g., hypertension, diabetes, obesity) despite decades of recognition of these disparities. Methods: The Health Freedom Path to Wellness Program is an innovative community-based educational and behavioral intervention to reduce disparities in CVD risk factors. The goal of this study was to test the effectiveness of the Circle of Friends (COF) educational and social support component of the Health Freedom intervention. The Health Freedom-COF incorporated six weekly one-hour long sessions led by lay health workers trained in CVD health education based on the AHA’s Simple 7 guidelines, blood pressure (BP) measurement, physical activity, and behavior change strategies, and culminated in a 5K celebration walk that gives participants an opportunity to learn about Maryland’s important role in the Underground Railroad. Results: Study participants included 353 adults in Maryland (93% AAs, mean age: 53 years; 85% female; and 35% with annual incomes <$50,000). At baseline, mean BP(SD) was 127.4 (17.6)/77.1 (10.8) mmHg; mean weight in pounds (SD) was 191.6 (45.2); 43.1% had diagnosed hypertension, and 15.0% had diabetes. Compared with their pre-intervention assessments, adults who completed the intervention experienced an average reduction of -5.2 mm Hg systolic blood pressure (95% CI: 4.1-6.3, p<0.001) and -3.3 mm Hg diastolic BP (95% CI: 2.5-4.1, p<0.001). At baseline, only 3.3% of participants reported a weekly consumption of 5+ fruit servings; 5.9% reported 5+ vegetable servings, and 12.8% reported 5+ days of physical activity. However, after completing the program, 22.4% of participants reported a weekly consumption of 5+ fruit servings; 28.6% reported 5+ vegetable servings, and 46.7% reported 5+ days of physical activity. Conclusions: The Health Freedom educational and behavioral intervention was associated with improvements in blood pressure, diet, and physical activity among socially at-risk adults.