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Effectiveness of a Web-based nutrition education program to reduce cardiovascular disease risk among U.S. Army personnel and their families ("Defend your heart" study)


Cardiovascular disease (CVD) continues to be the leading cause of mortality and morbidity in the United States. Military personnel are also vulnerable to this killer disease due to indulgence in unhealthy behaviors such as cigarette smoking, physical inactivity, poor nutrition, and high stress. Formative assessment identified a need for web-based resources for the Army registered dietitians (RDs) and for deployed or remotely located military beneficiaries. The purpose of the current study was to create and assess the effectiveness of a web-site "Defend Your Heart". This web-site was targeted to two audiences: RDs and a self care program for the military beneficiaries. This self care program was created using the framework of Rosenstock's Expanded Health Belief Model (EHBM). The effectiveness of a web-based self care program was evaluated using a randomized 4-month study with participants either in the web-based group (n=17) or the usual care (n=13) at a U.S. Army hospital. Data were collected at baseline, two months and four months. Variables measured were anthropometric, blood pressure, lipid profile, fasting glucose, C-reactive protein, nutrient intake, physical activity, and EHBM constructs. Data were analyzed using analysis of covariance and using baseline means to adjust the two and four month data. Results indicated a significant reduction of total blood cholesterol, LDL-cholesterol, predicted body fat percent, and estimated body mass index (P<0.05) in the web-based group. The usual group demonstrated a significant increase in self-efficacy score at month four (p<0.05). Significant within group changes for both groups were demonstrated for the reduction in waist circumference and serum triglycerides (p<0.05). Due to a smaller sample size caution is required while interpreting the results. The results of the web-site usability showed that a majority of the RDs (n=34) and web-based participants (n=8) were satisfied with the content and ease of navigation. RDs and web-based groups suggested enhancing web-site eye appeal, interactivity, and printing capability. Web-based programs may serve as an effective alternate mechanism of delivering CVD risk reduction education. The U.S Army needs to invest in further research to launch an effective web-based program for military beneficiaries to reduce CVD risk factors.


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United States Army Medical Service
Cardiovascular system -- Diseases -- Nutritional aspects
Nutrition -- Study and teaching
Web-based instruction


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