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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1122 — Enhancing Adherence to the Dietary Approaches to Stop Hypertension (DASH) Diet Using a Tailored Behavioral Intervention

Roberts HJLin IMundy LFriedberg JP, and Hubben AK, VA NY Harbor Healthcare System; Lipsitz SR, Harvard University; Natarajan S, VA NY Harbor Healthcare System;

Objectives:
The Dietary Approaches to Stop Hypertension (DASH) diet is an effective method to lower blood pressure. This complex diet targets multiple nutritional components such as limiting fat and sodium and increasing fruit and vegetable consumption. It can be difficult for patients to follow. Tailored interventions based on the Transtheoretical Model (TTM) are effective in improving adherence in chronic conditions like hypertension. Previous research has shown that tailored interventions can impact patients’ willingness to change their diets. However, few have assessed the effectiveness of this model to promote better adherence to the DASH diet. We aimed to determine if a TTM-based tailored stage-matched intervention (SMI) is effective in increasing DASH diet adherence.

Methods:
We evaluated the effects of 6-month phone-based tailored and non-tailored behavioral interventions on DASH diet adherence in Veterans with uncontrolled hypertension. We enrolled and randomized 533 Veterans into a tailored stage-matched intervention (SMI) based on TTM, a non-tailored health education intervention (HEI), or usual care (UC) with no intervention. We used the validated Harvard DASH score using data from Willett Food Frequency Questionnaires to determine dietary adherence at baseline and 6 months. The score ranged from 8 to 40, with 40 representing perfect adherence. Comparison between groups was by Wilcoxon rank sum tests that controlled for clustering by physicians and baseline DASH scores.

Results:
There were no significant differences between the groups at baseline. At baseline, SMI, HEI, and UC had mean DASH scores of 23.6, 23.8, and 24.0, respectively (p = .73). At 6 months, compared to the UC group, SMI was associated with a 1.28 point increase in DASH score (p = .01) and HEI had a non-significant 0.49 increase in DASH score (p = .39).

Implications:
A phone-delivered TTM-based intervention that targeted multiple nutritional components was effective in improving adherence to the complex DASH diet. This provides empirical evidence that TTM-based tailored interventions can successfully increase patients’ adherence to the DASH diet.

Impacts:
A TTM-based tailored intervention delivered by phone may be a convenient and effective way to promote adherence to the complex dietary recommendations of the DASH diet and improve health outcomes in Veterans.


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