Tailoring Chronic Disease Interventions to Meet Specific Needs of Women: A Case Example of a Hypertension Program.

BACKGROUND: Women have a unique risk profile for cardiovascular disease (CVD) due to underlying sociocultural and biological determinants. Current CVD prevention and treatment interventions, however, largely remain agnostic to the influences of an individual's sex assigned at birth or gender identity. This study describes a process for tailoring existing evidence-based interventions to the biological and sociocultural determinants of health for women. METHODS: This study adapted the Team-supported, Electronic Health Record (EHR)-leveraged, Active Management (TEAM) CVD preventative care intervention designed for telehealth-based remote hypertension (HTN) care in rural Veterans. Tailoring choices were informed by a 12-month process including a focused literature review, qualitative interviews with women's health experts, and feedback from providers and women Veterans on existing intervention materials. RESULTS: Literature review and qualitative interview findings informed the modification of patient- and provider-facing TEAM materials. Patient-facing material modifications included the addition of information relevant to sex-specific CVD risk factors, addressing gender-related barriers to CVD risk reduction, and including diverse visual representation and inclusive language. Provider-facing materials were modified through a new EHR template to comprehensively address sex-specific CVD risk factors. These changes resulted in individualized care plans to better address gaps in HTN management among women. CONCLUSION: Tailoring existing evidence-based interventions is an achievable and practical strategy to incorporate the sociocultural and biological determinants of CVD health specific to women. This approach could be used to adapt other programs and interventions designed to address health conditions that occur among both men and women but which are sensitive to important biological and sociocultural determinants. These findings highlight the broad discourse on sex- and gender-sensitive health care interventions and advocate for the integration of these interventions into routine clinical practice.

Duke Scholars

Author Leah L Zullig Population Health Sciences

Author Jennifer M. Gierisch Population Health Sciences

Author Karen M. Goldstein Medicine, General Internal Medicine

Author Hayden Barry Bosworth Population Health Sciences

Author Allison A. Lewinski School of Nursing