Successfully Taking An Effective Health Literacy and Integrative Health Intervention to Underserved Communities within the United States

Theoretical Background and research questions/hypothesis:  Many adults struggling with adoption and adherence to healthy behaviors that can improve or prevent chronic diseases, such as diabetes and heart disease, are members of traditionally underserved populations. To determine if these behavioral outcomes within this population could be improved using an integrative health approach, the Canyon Ranch Institute (CRI) successfully implemented the CRI Life Enhancement Program (CRI LEP), aimed at low-income and medically-underserved communities in the South Bronx, NY; Cleveland, OH; Sullivan County, MO; and Tucson, AZ. To reach individuals at high risk for chronic disease, Canyon Ranch Institute (CRI) partnered with  Federally Qualified Health Centers (FQHCs) and rural Critical Access Hospitals (CAHs)  in medically underserved areas (MUAs)  that identified and recruited participants from within their patient populations and local communities. The CRI LEP includes participatory group sessions, social support, fitness instruction, cooking demonstrations, a nutritionist-guided grocery store trip, and rigorous evaluation. The CRI LEP’s integrative approach provides a focus on participants’ sense of purpose and spirituality. Uniquely, the program provides participants with four individual hour-long one-on-one planning consultations with medical, nutrition, behavioral, and fitness professionals. 

Methods:  An extensive data collection and evaluation strategy measures physiological, physical, behavioral, attitudinal, and knowledge outcomes at pre, post, three months post, one year post, and process evaluation stages. Measures included assessments of nutrition, physical fitness, stress, and a serum analysis that included cholesterol, hemoglobin AIC, and ultra C-reactive protein. At various sites, a total of 14 groups have completed the CRI LEP successfully. Final evaluation data available at this point for five of these groups (N=56) find healthy and statistically significant changes were identified via matched pair t-test analysis in knowledge, attitudes, and behavior related to nutrition, fitness, and stress management, and multiple clinical risk factors for chronic diseases were reduced.

Results:   Significant results include up to a 56% reduction in PHQ-9 depression scores, a 113% increase in exercise time, a 71% reduction in the amount of soda consumed, a 66% increase in the healthy days index, a 44% reduction in stress, a 23% increase in self-efficacy scores for taking part in exercise and maintaining healthy nutrition, and a 67% increase in the number of mentally and physically healthy days in the previous month. Participants have reported their physician removed them from an insulin-based management of diabetes because their lifestyle management was sufficient as a result of participation in the CRI LEP.  Multiple significant Pearson’s correlations between outcomes reflect the intentionally cross-cutting approach to integrative health. Evaluation and programming is ongoing; the most up-to-date data available from all locations will be included in the presentation.

Conclusions:   Results from the Canyon Ranch Institute Life Enhancement Program demonstrate that an integrative health approach based on best practices of health literacy can improve mental health and physical health, with statistically and clinically significant changes.

Implications for research and/or practice:  Qualitative and quantitative analysis of the Canyon Ranch Institute Life Enhancement Program provides evidence that a health literate, integrative health approach to preventing chronic disease can have significant and positive outcomes.