A mixed-methods, theory-driven assessment of the sustainability of a multi-sectoral preventive intervention for South Asian Americans at risk for cardiovascular disease

Ha Ngan Vu*, Saihariharan Nedunchezhian, Nicola Lancki, Bonnie J Spring, C. Hendricks Brown, Namratha R. Kandula

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: South Asian Americans bear a high burden of atherosclerotic cardiovascular disease (ASCVD), but little is known about the sustainability of evidence-based interventions (EBI) to prevent ASCVD in this population. Using community-based participatory research, we previously developed and implemented the South Asian Healthy Lifestyle Intervention (SAHELI), a culturally-adapted EBI targeting diet, physical activity, and stress management. In this study, we use the Integrated Sustainability Framework to investigate multisectoral partners’ perceptions of organizational factors influencing SAHELI sustainability and strategies for ensuring sustainability. Methods: From 2022 to 2023, we conducted a mixed-methods study (quant- > QUAL) with 17 SAHELI partners in the Chicago area. Partners’ settings included: community organization, school district, public health department, and healthcare system. Descriptive statistics summarized quantitative results. Two coders used a hybrid thematic analysis approach to identify qualitative themes. Qualitative and quantitative data were integrated and analyzed using mixed methods. Results: Surveys (score range 1–5: higher scores indicate facilitators; lower scores indicate barriers) indicated SAHELI sustainability facilitators to be its “responsiveness to community values and needs” (mean = 4.9). Barriers were “financial support” (mean = 3.5), “infrastructure/capacity to support sustainment” (mean = 4.2), and “implementation leadership” (mean = 4.3). Qualitative findings confirmed quantitative findings that SAHELI provided culturally-tailored cardiovascular health education responsive to the needs of the South Asian American community, increased attention to health issues, and transformed perceptions of research among community members. Qualitative findings expanded upon quantitative findings, showing that the organizational fit of SAHELI was a facilitator to sustainability while competing priorities were barriers for partners from the public health department and health system. Partners from the public health department and health system discussed challenges in offering culturally-tailored programming exclusively for one targeted population. Sustainability strategies envisioned by partners included: transitioning SAHELI to a program delivered by community members; integrating components of SAHELI into other programs; and expanding SAHELI to other populations. Modifications made to SAHELI (i.e., virtual instead of in-person delivery) had both positive and negative implications for sustainability. Discussion: This study identifies common sustainability barriers and facilitators across different sectors, as well as those specific to certain settings. Aligning health equity interventions with community needs and values, organizational activities, and local context and resources is critical for sustainability. Challenges also arise from balancing the needs of specific populations against providing programming for broader audiences.

Original languageEnglish (US)
Article number89
JournalImplementation Science Communications
Volume5
Issue number1
DOIs
StatePublished - Dec 2024

Funding

We acknowledge the participants and study teams at Metropolitan Asian Family Services, Endeavor HealthSystem, Village of Skokie Health and Human Services, Skokie-Morton Grove District 69, and Northwestern University who contributed to the SAHELI trial. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. This study was supported by the National Heart, Lung, and Blood Institute (1R01HL132978, K24HL155897). Dr. Milkie Vu was supported by the National Institutes of Health (National Cancer Institute, T32CA193193 and National Center for Advancing Translational Sciences, KL2TR001424).

Keywords

  • Cardiovascular health
  • Cultural adaptation
  • Health equity
  • Lifestyle evidence-based interventions
  • Populations experiencing health disparities
  • South Asian Americans
  • Sustainability

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics
  • Public Health, Environmental and Occupational Health

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