Effectiveness of personalized face-to-face and telephone nursing counseling interventions for cardiovascular risk factors: a controlled clinical trial

Vílchez Barboza, Vivian; Klijn, Tatiana Paravic; Salazar Molina, Alide; Sáez Carrillo, Katia Lorena

doi:10.1590/1518-8345.0626.2747

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 24 • 2016 • https://doi.org/10.1590/1518-8345.0626.2747 copy

Effectiveness of personalized face-to-face and telephone nursing counseling interventions for cardiovascular risk factors: a controlled clinical trial¹ 1 Supported by Universidad de Costa Rica, Costa Rica and by Vicerrectoría de Investigación, Universidad de Concepción. Dirección de Postgrado, Universidad de Concepción. Convenio de Desempeño UCO1201, Universidad de Concepción. INNOVA-BIO BIO: Línea para apoyar la realización de Tesis de Postgrado y 11ava Convocatoria Innovación Emprendedora. Paper extracted from doctoral dissertation presented to Programa de Doctorado en Enfermería, Universidad de Concepción, Chile.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

to evaluate the effect and gender differences of an innovative intervention involving in-person and telephone nursing counseling to control cardiovascular risk factors (arterial hypertension, dyslipidemia, and overweight), improve health-related quality of life and strengthen self-efficacy and social support in persons using the municipal health centers' cardiovascular health program.

Method:

a randomized controlled clinical trial involving participants randomized into the intervention group who received traditional consultation plus personalized and telephone nursing counseling for 7 months (n = 53) and the control group (n = 56). The study followed the Consolidated Standards of Reporting Trials Statement.

Results:

women in the intervention group presented a significant increase in the physical and mental health components compared to the control group, with decreases in weight, abdominal circumference, total cholesterol, low-density lipoprotein cholesterol, and the atherogenic index. The effects attributable to the intervention in the men in the intervention group were increased physical and emotional roles and decreased systolic and diastolic pressure, waist circumference, total cholesterol, low-density lipoprotein cholesterol, atherogenic index, cardiovascular risk factor, and 10-year coronary risk.

Conclusion:

this intervention is an effective strategy for the control of three cardiovascular risk factors and the improvement of health-related quality of life.

Descriptors:
Clinical Trial; Risk Factors; Cardiovascular Nursing; Quality of Life; Directive Counselling

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Vivian Vílchez Barboza Universidad de Costa Rica, Escuela de Enfermería Sabanilla San José, Costa Rica E-mail: vivian.vilchez@ucr.ac.cr

Variable			Group			Total			Stadigraph	gl	p-value
			Control		Intervention		n=109
			n=56		n=53
			F	%	F	%	F	%
Gender
	Female		36	64.3	40	75.5	76	69.7	1.61*	1	0.2039
	Male		20	35.7	13	24.5	33	30.3
Age in completed years
	Age range	35-44 years	1	1.8	2	3.8	3	2.8	2.160†	2	0.354
		45-54 years	23	41.1	14	26.6	37	33.9
		55-64 years	32	57.2	37	69.8	69	63.3
Last level of schooling attended/graduated
	Basic Education		10	17.9	10	18.8	20	18.3	7.62*	8	0.4713
	High School Education		29	51.8	28	52.8	57	52.3
	Technical Education		8	14.3	11	20.8	19	17.4
	University Education		9	16	4	7.6	13	11.9
Current marital status
	Single		20		22		42		0.386*	1	0.534
	Cohabitating		36		31		67
Type of family
	Alone		3	5.4	6	11.3	9	8.3	1.29†	2	0.583
	Nuclear		34	60.7	31	58.5	65	59.6
	Extended family		19	33.9	16	30.2	35	32.1
Current occupational situation
	Employed		31		27		58		0.213*	1	0.644
	Inactive Unemployed		25		26		51

Women		Control Group			Intervention Group			Effect of the Intervention (95% Confidence Interval)	Stadigraph	p-value
Women		Pre-test	Post-test	Pre- and Post-test difference	Pre-test	Post-test	Pre- and Post-test difference
Variables
	Physical Health Indicators
	Col-Total	178.2	176	2.22	201.1	178.7	22.4	-20.18 (-36.42; -3.94)	2.48*	0.0156†
	Col-HDL	51.8	52.3	-0.5	52.5	50.6	1.93	-2.43 (-4.52; -0.33)	2.31*	0.0237‡
	Col-LDL	105.3	104.1	1.19	123.4	103.1	20.24	-19.05 (-33.48; -4.61)	2.63*	0.0104†
	LDL/HDL	2	2	0.04	126	2.4	2.1	-0.25 (-0.5; 0.00)	1.97*	0.0527‡
	Triglycerides	105.7	98.1	7.67	126	124.7	1.23	6.44 (-17.47; 30.35)	1384§	0.9834
	TC/HDL	3.5	3.4	0.09	3.9	0.7	0.35	-0.26 (-0.56; 0.03)	1260§	0.1899
	10-year Coronary Risk	2.4	0.8	0.81	2.7	0.8	0.88	-0.07 (-0.49; 0.35)	1361.5§	0.7848
	Systolic Pressure	129.2	133.4	-4.28	133.2	131.6	1.63	-5.9 (-12.16; 0.35)	-1.88	0.0641
	Diastolic Pressure	89.6	77.1	12.47	91.5	78.9	12.63	-0.15 (-5.14; 4.84)	-0.06	0.9515
	Weight	65.4	65.3	0.08	67.3	66.4	0.94	-0.85 (-1.7; -0.01)	1192§	0.0435‡
	Abdominal Circumference	93.1	92.3	0.84	95.8	91.5	4.35	-3.51 (-5.27; -1.75)	1001.5§	0.0001†
	Body Mass Index	27.6	27.6	0.05	28.1	27.7	0.38	-0.33 (-0.69; 0.02)	1204§	0.0583
Health-Related Quality of Life
Physical Health Component		77.1	81	-3.93	79.7	88.9	-9.2	5.27 (0.16; 10.38)	2.06*	0.0433‡
	Body Pain	56.9	60.3	-3.34	60.8	77	-16.25	12.92 (2.52; 23.31)	2.48*	0.0155†
	Physical Function	86.3	90.5	-4.16	89.6	94.3	-4.67	0.5 (-3.01; 4.01)	1439.5§	0.5739
	Physical Role	93.1	94.8	-1.73	94.4	98.4	-4.06	2.33 (-5.11; 9.77)	1466.5§	0.3152
	General Health	72	78.5	-6.48	73.9	85.8	-11.83	5.35 (-2.91; 13.61)	1520§	0.1624
Mental Health Component		68.5	73.3	-4.82	66.9	78.9	-11.95	7.14 (1.21; 13.06)	2.40*	0.0189†
	Social Function	82.5	86.7	-4.17	80.3	95	-14.75	10.58 (0.96; 20.2)	1582§	0.0349‡
	Emotional Role	54.3	57.2	-2.96	52	58.7	-6.67	3.7 (-1.54; 8.95)	1495.5§	0.2074
	Mental Health	70.8	78.3	-7.55	70.5	84.9	-14.4	6.84 (-2.27; 15.96)	1.50*	0.1386
	Vitality	66.4	71	-4.58	65	77	-12	7.42 (0.17; 14.67)	2.04*	0.0451‡
General Self-efficacy		34.3	36.8	-2.5	36	38.4	-2.37	-0.13 (-2.3; 2.05)	0.11*	0.9091
Perceived Social Support		36.5	38.1	-1.58	35.9	39.7	-3.8	2.22 (-6.5; 1.9)	1472.5§	0.3660

Men		Control Group			Intervention Group			Effect of the Intervention (95% Confidence Interval)	Stadigraph	p-value
Men		Pre-test	Post-test	Pre- and Post-test difference	Pre-test	Post-test	Pre- and Post-test difference
Variables
Physical Health Indicators
	Col-Total	175.7	177.1	-1.4	190.5	157.3	33.23	-34.63 (-59.89; -9.38)	2.80*	0.0088†
	Col-HDL	43.3	43.3	0	43.6	41.2	2.38	-2.38 (-5.48; 0.71)	1.57*	0.1258
	Col-LDL	107.7	109.7	-2.03	113.5	87.3	26.25	-28.28 (-48.45; -8.11)	2.86*	0.0075†
	LDL/HDL	2.5	2.6	-0.13	2.6	2.1	0.49	-0.63 (-1.05; -0.21)	298§	0.0045†
	Triglycerides	123.6	120.9	2.65	167	144	23	-20.35 (-59.02; 18.32)	1.07*	0.2919
	TC/HDL	4.1	4	0.05	4.4	3.8	0.54	-0.49 (-0.94; -0.04)	2.23*	0.0033‡
	10-year Coronary Risk	3.5	3.2	0.3	4.7	3.1	1.62	-1.32 (-2.6; -0.03)	271.5§	0.0546‡
	Systolic Pressure	135.1	139.7	-4.55	141.9	132.2	9.77	-14.32 (-24.78; -3.85)	-2.79	0.0089†
	Diastolic Pressure	91.8	83.6	8.20*	99	81.1	17.92	-9.72 (-18.00; -1.44)	-2.4	0.0228‡
	Weight	78.3	78.2	0.05	81.5	80.4	1.06	-1.02 (-2.68; 0.65)	244§	0.3966
	Abdominal Circumference	96.6	96.8	-0.23	101.5	97	4.50	-4.73 (-7.03; -2.42)	4.17*	0.0002†
	Body Mass Index	27.5	27.5	0.03	28.4	28.1	0.37	-0.34 (-0.92; 0.25)	243§	0.4176
Health-Related Quality of Life
Physical Health Component		80.5	86.5	-6.03	84.4	90.3	-5.85	-0.18 (-5.63; 5.27)	0.07*	0.9462
	Body Pain	60	78.5	-18.5	73.1	77.7	-4.62	-13.88 (-31.96; 4.19)	268§	0.0735
	Physical Function	92.7	96	-3.33	89.2	95.9	-6.67	3.33 (-3.35; 10.02)	183§	0.1531
	Physical Role	94.4	92.5	2.88	97.1	100	-2.88	5.77 (-2.88; 14.42)	189§	0.0546‡
	General Health	75	79.2	-4.17	78.2	87.4	-9.23	5.06 (-4.39; 14.51)	1.09*	0.2832
Mental Health Component		72	77.3	-5.26	78.7	81.3	-2.57	-2.69 (-8.63; 3.26)	0.92*	0.3638
	Social Function	85.5	91	-5.5	99.2	95.4	3.85	-9.35 (-18.53; -0.16)	264.5§	0.0791
	Emotional Role	49.7	58	-8.33	59	58	1.03	-9.36 (-16.68; -2.03)	277.5§	0.0131†
	Mental Health	78.2	83.4	-5.2	82.5	91.1	-8.62	3.42 (-6.29; 13.12)	0.72*	0.4784
	Vitality	74.8	76.8	-2	74.2	80.8	-6.54	4.54 (-4.86; 13.94)	0.98*	0.3324
General Self-efficacy		36	37.7	-1.65	37.5	39	-1.46	-0.19 (-3.18; 2.8)	238§	0.5227
Perceived Social Support		37	38.7	-1.7	38.7	41.7	-3	1.3 (-4.67; 7.27)	0.44*	0.6602