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Cited by 12Health Promotion and Cardiovascular PreventionCardiac Health and Mental HealthCardiovascular Health and Risk Factors

Self-management support using advertising principles for older adults with low income at high cardiovascular risk: a randomized controlled trial

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Campbell, David J.T., Tonelli, Marcello, Hemmelgarn, Brenda R., Faris, Peter, Zhang, Jianguo, Au, Flora, Tsuyuki, Ross T., Mitchell, Chad +7 more·2023·Circulation
DOI 10.1161/circulationaha.123.064189PMC PMC10180012
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Abstract

Background: Self-management education and support (SMES) interventions have modest effects on intermediate outcomes for those at risk of cardiovascular disease, but few studies have measured or demonstrated an effect on clinical end points. Advertising for commercial products is known to influence behavior, but advertising principles are not typically incorporated into SMES design. Methods: This randomized trial studied the effect of a novel tailored SMES program designed by an advertising firm among a population of older adults with low income at high cardiovascular risk in Alberta, Canada. The intervention included health promotion messaging from a fictitious “peer” and facilitated relay of clinical information to patients’ primary care provider and pharmacist. The primary outcome was the composite of death, myocardial infarction, stroke, coronary revascularization, and hospitalizations for cardiovascular-related ambulatory care–sensitive conditions. Rates of the primary outcome and its components were compared using negative binomial regression. Secondary outcomes included quality of life (EQ-5D [EuroQoL 5-dimension] index score), medication adherence, and overall health care costs. Results: We randomized 4761 individuals, with a mean age of 74.4 years, of whom 46.8% were female. There was no evidence of statistical interaction ( P =0.99) or of a synergistic effect between the 2 interventions in the factorial trial with respect to the primary outcome, which allowed us to evaluate the effect of each intervention separately. Over a median follow-up time of 36 months, the rate of the primary outcome was lower in the group that received SMES compared with the control group (incidence rate ratio, 0.78 [95% CI, 0.61 to 1.00]; P =0.047). No significant between-group changes in quality of life over time were observed (mean difference, 0.0001 [95% CI, −0.018 to 0.018]; P =0.99). The proportion of participants who were adherent to medications was not different between the 2 groups ( P =0.199 for statins and P =0.754 for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers). Overall adjusted health care costs did not differ between those receiving SMES and the control group ($2015 [95% CI, −$1953 to $5985]; P =0.320). Conclusions: For older adults with low income, a tailored SMES program using advertising principles reduced the rate of clinical outcomes compared with usual care. The mechanisms of improvement are unclear and further studies are required. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02579655.

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Authors
Campbell, D. J. T., Tonelli, M., Hemmelgarn, B. R., Faris, P., Zhang, J., Au, F., Tsuyuki, R. T., Mitchell, C., Pannu, R., Campbell, T., Ivers, N., Fletcher, J., Exner, D. V., Manns, B. J., & for the Interdisciplinary Chronic Disease Collaboration
Affiliations
  • University of Calgary (CA)
  • University of Alberta (CA)
  • Alberta Health Services (CA)
  • Government of Alberta (CA)
  • Emergence Creative, New York, NY (R.P.).
  • University of Toronto (CA)
Corresponding author
Manns, Braden J.
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-05-16
Volume
147
Issue
20
Pages
1492-1504
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.123.064189
PMC
PMC10180012
OpenAlex
W4323255494
Cited by
12
References
6
Citations by year
2026: 6 · 2025: 2 · 2024: 1 · 2023: 3
FWCI
3.07
Type
journal article
Language
en
Open access
Licence
Locations
  • Circulation (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Canadian Institutes of Health Research (201509-FDN-353640)
  • Alberta Innovates
  • University of Calgary, Clinical Research Fund
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
Keywords
self-management education, cardiovascular risk, advertising principles, older adults, low income, medication adherence, statins, ACE inhibitors, angiotensin receptor blockers, cardiovascular events, health care costs, quality of life, pharmacist referral, primary care referral, health behavior change, factorial trial
MeSH terms
Self-Management, Heart Disease Risk Factors, Advertising, Aged, Alberta, Cardiovascular Diseases, Female, Humans, Male, Quality of Life, Risk Factors

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