title: Community-based cardiovascular health interventions in vulnerable populations: a systematic review.
abstract: BACKGROUND
  Although cardiovascular health has been improving for many Americans, this is not true of those in "vulnerable populations." To address this growing disparity, communities and researchers have worked for decades, and as a result of their work, a growing body of literature supports the use of community engagement as a component of successful interventions. However, little literature synthesizes community-based interventions that address this disparity among a wide range of vulnerable populations.
  
  
  OBJECTIVE
  This article provides a critical review of community-based cardiovascular disease interventions to improve cardiovascular health behaviors and factors among vulnerable populations based on the American Heart Association's 7 metrics of ideal cardiovascular health.
  
  
  METHODS
  In February 2011, 4 databases (PubMed, PsychInfo, CINAHL, and Scopus) were searched using the following keywords: vulnerable populations OR healthcare disparities AND cardiovascular disease AND clinical trials OR public health practice AND English.
  
  
  RESULTS
  This search strategy resulted in the retrieval of 7120 abstracts. Each abstract was reviewed by at least 2 authors, and eligibility for the systematic review was confirmed after reading the full article. Thirty-two studies met eligibility criteria. Education was the most common intervention (41%), followed by counseling or support (38%) and exercise classes (28%). Half of the interventions were multicomponent. Healthcare providers were the most frequent interventionists. Interventions aimed at decreasing blood pressure were the most promising, whereas behavior change interventions were the most challenging. Almost all of the interventions were at the individual level and were proof-of-concept or efficacy trials.
  
  
  CONCLUSIONS
  This analysis provides a step toward understanding the current literature on cardiovascular interventions for vulnerable population. The next step should be integrating the identified successful interventions into larger health systems and/or social policies.
authors.affiliation: Benita Walton-Moss, FNP-BC, DNS Associate Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Laura Samuel, RN, FNP Doctoral Candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Tam H. Nguyen, RN, MSN/MPH, PhD Research Associate, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Yvonne Commodore-Mensah, RN, BSN Doctoral Candidate, School of Nursing, Johns Hopkins University, Baltimore, Maryland. Matthew J. Hayat, PhD Assistant Professor, Rutgers University, College of Nursing, Newark, New Jersey. Sarah L. Szanton, RN, CRNP, PhD Assistant Professor, School of Nursing, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Benita
authors.initials: B
authors.lastname: Walton-Moss
authors.forename: Laura
authors.initials: L
authors.lastname: Samuel
authors.forename: Tam H
authors.initials: TH
authors.lastname: Nguyen
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Commodore-Mensah
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Hayat
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Szanton
mesh_terms: D002318:Cardiovascular Diseases / Q000451:nursing / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration*; D006266:Health Education / Q000458:organization & administration*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration; D035862:Vulnerable Populations / Q000706:statistics & numerical data*