Background: The Center for Health Evaluations, Education, Research and Engagement (CHEVERE) study is a research program at Lincoln Hospital designed to explore the cultural, social and psychological factors that either facilitate or serve as barriers to behavioral change in the South Bronx community. The focus of our Phase II, non-blinded, prospective study is to develop process improvement methodologies by evaluating the effectiveness of shared decision-making (SDM) compared to conventional usual decision-making (UDM) models to target obesity and hypertension in minority populations of the Bronx, NY. SDM interventions create a dialogue between provider and patient, synergizing the preferences of the patient with an evidence-based approach to clinical practice.
Methods: A prospective, non-randomized pilot study was conducted in minority, high risk adults to identify and explore modifiable dietary behaviors. Subjects were randomized to an SDM or UDM group. Medical providers oversaw care and the implementation of interventions for the respective cohort.The Rate Your Plate (RYP) questionnaire was used as a tool designed to evaluate the nutritional value of a diet. Scores range from 23 to 69 with a higher score denoting better diet nutritional value. A score of 54 was considered the threshold for a diet consisting of healthy nutritional choices. Ambulatory clinic patients were screened after a regularly scheduled clinic visit. The survey was completed during the initial encounter with follow-up at 3 and 6 months.
Results: Our results at 6 months were consistent with previous SDM studies showing an improvement in the SDM mean RYP scores greater than the results of the UDM cohort. In addition the mean RYP score of 56.5 crossed the threshold for a healthy diet in the SDM cohort. Although the usual decision making cohort also improved their mean RYP score at the 6 month follow up, the mean score did not cross the threshold for a healthy diet. Our analysis between the two cohorts at 6 months did not show a statistically significant difference between the mean RYP scores and we attribute this to our population size.
We then looked at the 23 questions in the survey to identify which diet/nutritional questions had <50% of answers with the ideal score of 3. Our goal was to work on nutritional plans that could focus on these particular areas for our Phase III trial. When divided into minority groups, at initial visit, LX had 6/23 questions where <50% of the group had the ideal healthy diet choice. In the AA cohort there were 12/23 questions. At 6 month follow-up the LX cohort improved to 4/23 and the AA also improved to 7/23.
Conclusions: These results were consistent with what we observed during the questionnaire administration. Dietary choices varied considerably amongst minority groups and patients were more compliant to making positive healthy dietary choices when they had options or goals consistent with their specific cultural values and palate.
SDM interventions show a greater effect on behavioral change and our study has shown that SDM is effective in the minority populations in the South Bronx that are particularly susceptible to hypertension and obesity.