Os Efeitos Moderativos da Raça e da Etnia em uma Intervenção de Entrevistas Motivacionais para Melhorar a Saúde Física entre Pacientes com Doença Arterial Periférica: Análise Secundária de um Ensaio Piloto Randomizado

Resumo original em inglês

O que aconteceu

In a pilot randomized trial, face-to-face or telephone motivational interviewing (MI) was more efficacious than a smartphone app after 3 months for increasing 6-minute walk distance (primary outcome) and reducing body weight (secondary outcome) in patients with peripheral artery disease (PAD). Little is known about intervention heterogeneity related to social determinants of health (SDOH).

This study aimed to explore whether SDOH are associated with the MI intervention effects on walking distance and weight loss and generate intervention heterogeneity hypotheses.

Community dwellers in Wichita, Kansas, were recruited through community outlets and screened for PAD. Consented participants were randomly assigned to MI (n=16) or an app (n=13). Survey instruments were used to measure SDOH, demographics, and adverse childhood experiences, which were assessed for their associations with 6-minute walk distance change and weight loss. Difference-in-differences (DiD) comparisons of median changes between SDOH strata were conducted using Wilcoxon and Kruskal-Wallis nonparametric tests.

ClinicalTrials.gov NCT03694652; https://clinicaltrials.gov/ct2/show/NCT03694652.

RR2-10.2196/30295.

O que encontraram

For 6-minute walk distance, pretest-posttest changes were significantly greater among participants of "other" race and ethnicity than among non-Hispanic White participants (DiD=44.0 m, 95% CI 19.2-164.2; P=.004), and no DiDs for other SDOH were significant. Significant median pretest-posttest increases in walking distance were observed in those with a college or higher educational attainment (48.8 m, 95% CI 28.0-61.4), unmarried individuals (40.4 m, 95% CI 0.5-56.0), those living with family (55.7 m, 95% CI 30.5-199.5), those who talked to and saw family or friends 3 or more times a week (46.4 m, 95% CI 17.2-69.4), and those without unmet daily needs (46.5 m, 95% CI 7.6-67.1). For weight loss, we did not observe significant DiDs with any SDOH. However, a significant median weight loss was observed in every SDOH stratum where we observed a significant increase in 6-minute walk distance. Significant weight loss was also observed in 5 additional SDOH strata: male individuals, household income below US $30,000, never served in military, employed status, and no stress. The improvements in weight loss and walking distance were highly consistent in both direction and size across SDOH strata.

Por que isso importa

This pilot study was the first to explore potential SDOH-related intervention effect modification and heterogeneity. The significant association between walking distance and race and ethnicity suggested a potential effect modification. Significant pretest-posttest improvements in both outcomes were found in the same SDOH strata. The highly consistent evidence across both outcomes and all SDOH strata provided confidence in potential intervention efficacy and heterogeneity despite the small sample size. Our findings were consistent with established associations between SDOH and general functions in patients with PAD, suggesting likely mediation pathways through health literacy and social support. Future interventions should consider heterogeneity to target socially disadvantaged patients with PAD to bridge disparities and maximize benefits.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.