What it takes to promote community programs for Hispanics to reduce cardiovascular disease risk: The Texas experience

Given the magnitude of Hispanic health related disparities in cardiovascular disease risk factors observed in many populations of Hispanic origin, there is a need to act now with solutions that matters to communities. Public health solutions must be connected to the environment where people live and work. Translational science of cardiovascular disease risk reduction will have little impact if it is not connected to the community. Community-based participatory research (CBPR), in conjunction with community transformation is what project HEART addressed for 8 years working in the border community of El Paso Texas. Project HEART believed in the community health worker model and through various community interventions tailored to Hispanic adults, was able to deliver a combination of a randomized intervention and subsequently, an ecological study that brought environmental changes. We report several outcomes of community transformation that took place in two zip codes where these two 8-year interventions were delivered. The CBPR approach delineates how efforts from various constituencies including a health clinic, parks and recreation department of the City of El Paso, the YWCA, and the El Paso Community College embraced the community health worker model. A variety of evaluation strategies are described that capture the complexity of outcomes that these two studies addressed. In addition to meaningful statistical differences in outcomes such as cholesterol reduction and behavioral changes, the ecological study showed beyond clinical outcomes, how communities began to change their infrastructures to allow culturally-relevant programs to be utilized by residents of El Paso Texas.