Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care

Stacey L Schepens Niemiec; Cheryl L P Vigen; Jenny Martínez; Jeanine Blanchard; Mike Carlson

doi:10.5014/ajot.2021.042861

Long-Term Follow-Up of a Lifestyle Intervention for Late-Midlife, Rural-Dwelling Latinos in Primary Care

Am J Occup Ther. 2021 Mar-Apr;75(2):7502205020p1-7502205020p11. doi: 10.5014/ajot.2021.042861.

Authors

Stacey L Schepens Niemiec¹, Cheryl L P Vigen², Jenny Martínez³, Jeanine Blanchard⁴, Mike Carlson⁵

Affiliations

¹ Stacey L. Schepens Niemiec, PhD, OTR/L, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles; schepens@usc.edu.
² Cheryl L. P. Vigen, PhD, is Associate Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles.
³ Jenny Martínez, OTD, OTR/L, BCG, is Associate Professor, Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA.
⁴ Jeanine Blanchard, PhD, OTR/L, is Project Manager, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles.
⁵ Mike Carlson, PhD, is Professor of Research, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles.

Abstract

Importance: Rural-dwelling Latinos are an underresourced population in need of accessible and effective wellness programs.

Objective: To evaluate patients' long-term health-related outcomes after lifestyle intervention.

Design: An uncontrolled pilot trial assessing change in health from pretreatment to long-term follow-up (12 mo after intervention completion, no contact) and from posttreatment to long-term follow-up.

Setting: Rural, community-based primary care.

Participants: Latino and Hispanic safety-net primary care patients, ages 50 to 64 yr.

Intervention: A culturally tailored, 4-mo lifestyle intervention co-led by occupational therapy practitioners and Latino community health workers that features telehealth and in-home sessions covering topics such as healthy eating and navigating health care.

Outcomes and measures: Self-reported and physiological outcomes: symptom-well-being (primary), stress, sleep disturbance, social satisfaction, physical activity, patient activation, blood pressure, and weight. Exit interviews addressed health experiences and intervention impact on participants' lives.

Results: Participants (N = 27) demonstrated clinically significant pretreatment to long-term follow-up benefits in all symptom-well-being dimensions (Cohen's d ≥ 0.8, p ≤ .004), with additional gains from posttreatment to long-term follow-up (d ≥ 0.4, p ≤ .05). Significant improvements from pre- to posttreatment in systolic blood pressure, stress, and social role and activity satisfaction were maintained at long-term follow-up. No changes were observed in weight, physical activity, or diastolic blood pressure. Participants described the intervention's sustained positive effect on their wellness.

Conclusions and relevance: A lifestyle intervention led by occupational therapy practitioners and community health workers in a primary care context has potential to achieve long-term health benefits in rural-dwelling, late-midlife Latinos.

What this article adds: This study reveals that rural, late-midlife Latinos showed long-lasting improvements in psychological and physical health after finishing a program that helped them make healthy lifestyle choices. This finding supports the unique contribution of occupational therapy in primary care settings.

MeSH terms

Delivery of Health Care
Follow-Up Studies
Hispanic or Latino*
Humans
Life Style*
Middle Aged
Primary Health Care

Grants and funding

K12 HD055929/HD/NICHD NIH HHS/United States