Lay Advisor Interventions in Rural Populations: A Systematic Review and Meta-analysis.

Autor: Patil SJ; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri. Electronic address: patilso@health.missouri.edu., Lewis M; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri., Tallon EM; Sinclair School of Nursing, University of Missouri, Columbia, Missouri., Wareg NK; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri., Murray KS; Department of Surgery, University of Missouri, Columbia, Missouri., Elliott SG; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri., Stevermer JJ; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri., Kruse RL; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri., Mehr DR; Department of Family and Community Medicine, University of Missouri, Columbia, Missouri.
Jazyk: angličtina
Zdroj: American journal of preventive medicine [Am J Prev Med] 2019 Jul; Vol. 57 (1), pp. 117-126. Date of Electronic Publication: 2019 May 24.
DOI: 10.1016/j.amepre.2019.02.007
Abstrakt: Context: Age-adjusted death rates for heart disease are higher in rural areas than in urban areas. Lay advisors could potentially facilitate improvement in cardiovascular health outcomes. The aim of this systematic review and meta-analysis is to estimate lay advisor intervention effects on cardiovascular health metrics in rural populations.
Evidence Acquisition: Searches of databases including MEDLINE, CINAHL, and Scopus from 1975 through October 2017 retrieved 323 citations, of which 272 abstracts were reviewed. Two authors independently abstracted data from eligible studies. Analysis was conducted in March 2018.
Evidence Synthesis: Of 21 articles included in the systematic review, eight were RCTs and 13 were pre- and post-intervention studies. Of the RCTs, three took place in the U.S. Only two studies had low risk of bias. Using a random effects model, meta-analysis of six RCTs (1,641 participants) showed that lay advisor interventions in rural residents were associated with improvement in HbA1c of 0.4% (95% CI=0.13, 0.66, p=0.004, I 2 =60.65%). From four RCTs (873 participants), lay advisor interventions significantly improved BMI with pooled effect of 2.18 (95% CI=1.13, 3.24, p<0.001, I 2 =0.00%). Most studies had normal baseline blood pressure and cholesterol levels before intervention, and no significant effects were noted for these outcomes. Diverse types of measures used for diet, physical activity, and smoking precluded statistical synthesis.
Conclusions: Lay advisor interventions had significant positive effects on glycemic control and BMI for rural residents; however, further rigorous studies are needed in U.S. rural populations, and elements of effective lay advisor interventions require further investigation.
(Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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