Corazones Sanos: The Development of a Hypertension Curriculum for Patients at the Institute or Latin American Concern (ILAC) in Licey al medio, Dominican Republic Open Access

Abstract

Background: There is poor health literacy and high prevalence of hypertension and diabetes among the 40,000 patients in the Institute for Latin American Concern (ILAC) healthcare system in northwestern Dominican Republic. Health literacy and a sense of agency are important in controlling these chronic diseases and ILAC has traditionally had no formal mechanisms in place to address these topics. In other settings, curricula have been created and implemented to increase patient understanding – which has been documented as being on the causal pathway toward disease control.

 

Purpose: The goal of this project was to develop and pilot a hypertension curriculum at the ILAC campus. This curriculum will be incorporated into the operations of the center to provide patients with the information and understanding required to increase their sense of agency and control over their diseases. This curriculum provides a tool to address patient education in an effective way.

 

Methods: The already existing “Su corazon, su vida” NIH curriculum was tailored to the population based on the results of a formative analysis aimed at extracting hypertension and diabetes misinformation and knowledge gaps present in the population. The formative analysis was initially piloted among 20 patients and then implemented with 29 patients. The information extracted from these surveys was applied to the tailoring of the curriculum. The curriculum was piloted in five classes attended by an average of ten patients and a pre-post analysis was conducted to evaluate information retention.

 

Results: The final curriculum was piloted among 50 patients and consisted of nine sections focused on hypertension with supplementary diabetes information added. Overall, hypertension and diabetes understanding both increased significantly with p-values of <0.0001 and 0.0065 respectively.

 

Discussion and future implications: Moving forward, this curriculum must be successfully implemented in a sustainable manner to ensure continuity of increases in patient understanding. Additionally, an electronic medical record (EMR) is set to pilot alongside curriculum implementation. The data extracted from the EMR must be tracked to evaluate whether increases in patient understanding are leading to successful management and control of hypertension and diabetes.

Table of Contents

Introduction…………………..................…………….….. 1

            My perspective ……………………….....…………. 1

            Context …………………….…………….....………. 1

            Problem Statement …………………….……..…….. 4

            Purpose Statement  ...…………………..…………… 4

            Definition of Terms …………………..……….……. 6

            Abbreviations ……………………………....….…… 6

 

Methods ……………………………………………………. 7

            Project Overview ………………………………...…. 7

            IRB Approval ……………………………………..... 7

            Problem Discovery …………………………………. 8

            Formative Analysis ………………………………… 8

            Data Analysis ………………………………………. 10

            Curriculum Development ………………………….. 10

            Curriculum Piloting …………………………………10

            Evaluation …………………………………….....…. 11

            Plan for Sustainability …………………………….... 12

 

Results …………………………………………………….... 12

            Overview …………………………………………..... 12

            Problem Discovery ………………………………….. 12

            Formative Analysis ………………………………….. 16

            Curriculum Development …………………………..... 20

            Curriculum Piloting ………………………………….. 21

            Evaluation …………………………………………..... 23

 

Discussion ……………………………………………………. 27

            Overview ……………………………………………... 27

            Problem Discovery ……………………………………27

            Formative Analysis ………………………………….... 30

            Curriculum Development ……………………………... 32

            Curriculum Piloting …………………………………… 33

            Evaluation ……………………………………………... 36

 

References …………………………………………………….. 38

 

Appendix A: “Corazones Sanos” Pilot Curriculum ………... 39

 

Appendix B: Pre-Post Analysis ………………………………. 47

 

Appendix C: Formative Analysis Survey ……………………. 49

 

Appendix D: Formative Analysis Pilot Survey ……………… 51

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Education, Health
Keyword	Curriculum Diabetes Hypertension
Committee Chair / Thesis Advisor	Ali, Mohammed K., Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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