Cardiovascular disease and stroke prevention educational-behavioural programs for culturally and/or linguistically diverse communities: a systematic review and meta-analysis.

Abstract

Aims: To identify the types of cardiovascular disease (CVD) and stroke prevention educational-behavioural programs for people from culturally and/or linguistically diverse (CALD) backgrounds and investigate their effect on CVD risk factors and disease knowledge.

Methods and results: Four electronic databases were searched from inception to September 2023. Mean difference (MD) and standardised MD was calculated using random-effects model, and heterogeneity was assessed using the I2 statistic. Studies that were not included in the meta-analysis were narratively described. The Cochrane Risk of Bias tool and Joana Briggs Institute Critical Appraisal checklist were used to assess the quality of the included studies. Sixteen studies originating from USA and UK (4 RCTs and 12 quasi-experimental pre-post studies) with n=2331 participants (mean age 57.2 years, 50% women) were included. The programs were multi-component, 15 of which were culturally adapted and 1 was co-designed. Most were delivered face-to-face in groups. In contrast to the results among the pre-post studies, the pooled analysis showed that educational-behavioural programs may have little to no effect on SBP (MD 1.18 mmHg, 95% CI -2.42-4.79) and HbA1c (MD -0.29%, 95% CI -0.89-0.32). The results for LDL cholesterol, BMI, physical activity and dietary intake were also mixed except for CVD or stroke knowledge which demonstrated statistically significant improvements after the intervention.

Conclusion: The effect of educational-behavioural programs on CVD risk factors is inconclusive but may improve CVD or stroke knowledge. Co-designing programs underpinned by behaviour change theories/techniques with stakeholders and target CALD communities may enhance their potential impact. Future studies should use more rigorous study design i.e., RCTs, valid and reliable outcome measures to reduce inherent bias and strengthen the evidence base for the effectiveness of these programs.