The Morehouse-Emory Cardiovascular Center for Health Equity Study: Clinical Intervention Project

The internet can be an effective tool for driving behavior change but minority populations
are less likely to engage or use this tool effectively. Health information technology (also
called ehealth or e-health) can provide continuous and systematic connections to patients
that will support their personal roles and responsibilities in their health care management.
Ehealth technology allows for the tailoring of tools to the individual, timely information
delivery, standardized messaging, layered content for more motivated participants, and the
potential for greater efficiency/cost savings. Ehealth is able to provide effective and
sustainable self-management tools for patients with chronic diseases. There is a significant
trend towards information seeking on the internet among populations that have lower health
literacy and are less trusting of the health system but, although minority and health
disparities populations have increasing access to wireless and mobile technology, this has
not translated to increased use of ehealth technologies.

The ehealth application used in this study aims to use the internet to engage vulnerable
populations in improving their cardiovascular health. The intervention uses an enriched
information environment, dynamic, personalized feedback on relevant health parameters, and
social networks to impact health literacy, optimism and other resilience factors. This study
will test two approaches to engagement with a robust ehealth application (Health360x) for
high risk minority patients who reside in resilient and at risk neighborhoods within metro
Atlanta. The Health360x application is a system that frames behavior as changeable and
adaptable in a bidirectional manner, based on the behavioral constructs of Capability,
Opportunity, and Motivation. Capability is the psychological and physical capacity to engage
in the activity concerned, including the necessary knowledge and skills. Opportunity refers
to factors that lie outside the individual, that facilitate or prompt the behavior.
Motivation is largely governed by the brain processes that energize and direct behavior,
including goal directed conscious decision-making, habitual processes, emotional response, as
well as analytical decision-making.

This study is part of a larger project that is a partnership between investigators at Emory
University and Morehouse School of Medicine who are actively involved in investigating ethnic
disparities and incorporating the role of resilience factors in improving health status among
black persons in metro Atlanta. The aim of this multi-disciplinary team is to establish a
unique cohort in order to examine the associations between personal factors (psychosocial
factors, socio-economic class, healthy behaviors and health beliefs) and environmental
influences (neighborhood) on health behaviors and physiologic measures.

Four hundred subjects from "at risk" and "resilient" census tracks in metro Atlanta who
completed the population surveys will be invited to participate in the Baseline Clinical
Study, which is part of the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity
Study. The clinical trial described here will recruit 150 participants from the MECA study
for a clinical intervention examining cardiac outcomes between participants who are
randomized to received Health360x (a web-based and mobile-based application) or Health360x
plus personalized health coaching.

Participants will receive instruction on using the Health360x application and will use
Health360x alone or Health360x with a health coach for 6 months. Measures of cardiovascular
health will be assessed at baseline and after the 6 month long intervention.

Inclusion Criteria:

- Already participating in the Baseline Clinical Study

- Life Simple 7 (LS7) score of 8 or lower

- Internet access

- Self-reported ability to participate in physical activity

- English fluency

Exclusion Criteria:

- Coronary Artery Disease (CAD) documented by CAD diagnosis or prior acute myocardial
infarction, percutaneous coronary intervention, coronary artery bypass surgery, or
chronic angina

- Aortic stenosis

- History of chronic diseases that may alter brachial artery flow-mediated vasodilation
measurements, such as peripheral vascular disease, HIV/AIDS, lupus, or cancer

- Inability to participate in increased physical activity

- History of alcohol or drug abuse or psychiatric diagnosis that would interfere with
ability to participate

- Women who are pregnant and/or breastfeeding

- Cognitive deficits severe enough to preclude participation or any medical or surgical
problem that precludes meaningful participation

- Unwillingness to use the internet