Behavior Change Intervention for Cardiovascular Risk Reduction Among People Experiencing Homelessness (CV-Homes)

Behavior Change Intervention for Cardiovascular Risk Reduction Among People Experiencing Homelessness

Development of a Multiple Health Behavior Change Intervention for Cardiovascular Risk Reduction Among People Experiencing Homelessness: The CV-HOMES Study

National Institutes of Health (NIH), University of Minnesota, National Institute on Minority Health and Health Disparities (NIMHD)

This single-arm trial of the Cardiovascular Risk Reduction Among People Experiencing Homelessness (CV-Homes) intervention alone (n=8) will test the perception and feasibility of anticipated study procedures.

This study is of a set of studies with an overall goal to develop and pilot test a collaborative care intervention using motivational interviewing and behavioral activation alongside education and psychosocial support to improve medication adherence tailored to the experiences of people experiencing homelessness and cardiovascular health risks (CV-H). Our team's central hypothesis is that medication adherence and cardiovascular self-care (and eventual glycemic control, cholesterol control, health care use/cost) will improve with an intervention tailored to the unique context of CV-H. This protocol addresses a pilot study to test patient perceptions of the feasibility and acceptability of study procedures and refine the CV-Homes treatment manual through test cases (n=8). With a hypothesis that the CV-Homes manual and study procedures will be feasible and acceptable to CV-H as measured by self-report and post-treatment interview.

Cardiovascular Health, Homeless persons, Delivery of Health Care, Integrated, Primary care, Social determinants of health

This will be an in-person, phone, or video based behavioral intervention. It will involve a wellness coach assisting participants to set goals related to diabetes self-care and co-morbitities or social conditions that get in the way of health and wellness. There will be encouragement to work on medication adherence and to address getting healthy sleep, quitting tobacco, being more active, and eating better.

There will be 10 sessions offered within 12 weeks to participants. Sessions will last 30-60 minutes. During sessions a wellness coach will use behavioral activation and motivational interviewing to get to know participants and set goals to improve cardiovascular care. The coach will encourage a focus on medication adherence behaviors to the extent that participants are willing. The coach will also help with resources and care coordination. The coach will also provide brief cardiovascular health education as needed.

This will be assessed at the end of the intervention using the 8-item Client Satisfaction Questionnaire, with a score range 8-32, higher score indicating greater satisfaction.

Health related quality of life as measured by the Euro-Qol 5D-5-L which asks 5 questions on a 5-response likert scale with 1 = no problems and 5= unable to; and one question on a scale of 1-100 with 1 being the worst health one can imagine and 100 being the best health one can imagine.

Inclusion Criteria: Age 18 yrs. or older English-speaking Homelessness by federal definition in the last 12 mo. Self-reported diagnosis of moderate or high CVD risk, defined as being told by a medical professional that the participant has hypertension, prediabetes, type 2 diabetes, or heart disease Plan to stay in local area or be reachable by phone for the next 16 weeks Willingness to work on one or more CVD risk reduction behavior change Exclusion Criteria: Active intoxication Active psychosis Presence of a legal guardian Pregnant or lactating people