Cardiovascular Diseases Clinical Trial
To promote cardiovascular health through nutritional education in a low literacy population enrolled in English as a Second Language (ESL) courses in the San Diego Community College District.
BACKGROUND:
The investigator originally applied for the grant in response to an NHLBI initiative on "CVD
Nutrition Education for Low Literacy Skills". The initiative originated within the
Prevention and Demonstration Branch of the DECA, was approved by the September 1988 National
Heart, Lung, and Blood Advisory Council, and released in July 1990. However, the grant was
not awarded as part of the RFA.
DESIGN NARRATIVE:
An estimated 1,800 students in 90 different classes were randomly assigned to the special
nutritional intervention or an attention-control condition where a certification course in
cardiopulmonary resuscitation (CPR) was taught. Specially trained ESL teachers actually led
the intervention classes, which were designed in accordance with the NHLBI and American Red
Cross guidelines, respectively. Specific educational content for the intervention group
included sources of dietary fat and cholesterol nutrients affecting blood pressure, basic
shopping skills, food preparation skills , and dealing with special occasions, i.e.,
potlucks. A booster session was held to monitor progress, provide reinforcement for success
or additional problem solving for difficulties, review materials, and plan maintenance.
Consistent with a Social Learning (Cognitive) Theory (SLT) framework, all sessions included
modeling*, role playing, corrective feedback and social reinforcement, homework, and
confidence building activities. With attention to the specific needs of this population
which was low in literacy (at least in English), the smallest amount of information
necessary was presented, each point was made as vividly as possible, participants restated
and otherwise demonstrated their mastery of the material, and frequent repetition was used.
A substantial period of formative research emphasized specific adaptations of existing
material to make it appropriate for this population.
Measurement occurred at baseline, at three months and at a six months follow-up. Measures
included blood pressure, total cholesterol, height/weight, waist and hip circumference,
24-hour dietary recall, SLT-based knowledge, attitude and behavior variables, the
Comprehensive Adult Student Assessment System (CASAS) Life Skills Reading Test and Spanish
literacy through the Cloze technique. All self-report measurement except the CASAS was
conducted in English or Spanish, primarily through oral interview. SLT knowledge, attitude,
and behavioral measures of instructors in study and non-study classes were also assessed.
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