Participants were included in the study if they were aged 18 years or older, living in the community at the time of the study, planning to stay for the next 12 weeks, and willing to sign an informed consent form. The refusal rate for eligible participants was less than 3%; reasons given included not having time and family reasons. No additional exclusionary criterion was included. A total of 550 adults participated. Of those, 452 (82%) completed the pretest (baseline) and posttest (12-week postintervention follow-up) surveys and the anthropometric and clinical measurements. Ninety-eight participants (18%) did not complete the full program. Reasons for withdrawal were searching for or having started a new job and no longer being able to attend the sessions, no longer having time to attend the sessions, or having to take care of someone (child or adult). Most children and grandchildren in the community were at school, allowing participants to have time to attend the sessions.

Recruitment of promotores was done through community networks of the collaborative Department of Health (DH)–Universidad Iberoamericana (DH-UIA) and the target community. A total of 22 promotores were recruited and agreed to participate in the training, and the 12-week intervention Salud para su Corazón training was conducted by a lead promotora from El Paso, Texas. All promotores completed the 5-day training workshop and received the Su Corazón Su Vida curriculum materials (16–20). The team training for the promotores was conducted by researchers from the DH-UIA and the University of Texas, School of Public Health, El Paso Regional Campus (UTSPH-El Paso) (21). The promotores were assigned to 9 sites in different geographic areas of the community; working in pairs, they delivered 9 Salud para su Corazón lessons (16–18). Promotores started working in 2 health clinics; however, most group workshops were held at participants’ homes. Promotores were responsible for recruiting community participants primarily through outreach to neighborhood and community sites near the health clinics, and they formed groups with approximately 20 participants.

In 2008, the DH-UIA in Mexico City, DF, in collaboration with the UTSPH-El Paso, initiated a promotores program as part of the university’s commitment to social responsibility within the community (21). The partnership focused on CVD risk factors in the community that were consistent with the Salud para su Corazón materials and programs to allow community organizations to pilot test the Salud para su Corazón model. The community of Santa Fe was selected because it is a tight-knit community in Mexico City, DF, with significant health risk (eg, people of low socioeconomic status [SES]). Community leaders (21) were invited to participate during an intensive week of well-defined and structured promotores training activities, following protocols similar to those previously implemented in other Salud para su Corazón programs in the United States (16–18).

A community-based, pretest–posttest design without a control group was used as part of this pilot outreach program. A sample of 550 participants was examined at baseline (pretest) and given a 12-week behavior-change intervention. After the intervention, participants were re-examined and asked to complete the follow-up posttest survey (20,22). The study sample size was calculated to allow for detection of significant pretest and posttest differences from 18% to 24% (α = 0.05, sample power = 0.80). Randomization and use of a control community presented fiscal challenges and was not feasible. Conducting a randomized trial necessitated negotiating to identify control communities and finding resources that were not available at that time; furthermore, community leaders felt all participants should receive the intervention. The UIA-DH has a solid presence in the target community; it operates a community-based organization that offers varied social and development programs to surrounding neighborhoods.

Sessions were delivered at each site in group format once per week for approximately 2 hours, for a total of 12 weeks. At least once every 2 weeks, sessions were supervised by a team researcher who visited each site. Salud para su Corazón workshops were implemented over a 3-year period (2009–2012). After a session ended, a new group was formed and the same protocols for recruitment and intervention delivery were used to complete each of the 12-week interventions until the completion of all workshops.

The Su Corazón su Vida curriculum was adapted to the Mexican context and included 8 lessons (1 lesson per session). An extra ninth lesson on diabetes prevention and control, and the corresponding educational materials that accompany the lesson, were developed in collaboration with the UTSPH-El Paso team, because the topic was considered relevant in the curriculum for the target community. Identical questionnaires were used for the pretest and posttest to evaluate change related to the intervention.

Pretest and posttest anthropometric measurements were taken by health care providers at the DH–UIA Nutrition Clinic. Anthropometric measurements of weight, height, and waist circumference were measured using standardized protocol in the DH-UIA Nutrition Clinic (23). Body mass index (BMI, kg/m²) was calculated using the World Health Organization reference values (24). Overweight was defined as a BMI of 25.0 to 29.9 and obesity was defined as a BMI of 30.0 or higher.

Clinical measures included blood pressure measurements and fasting glucose levels. Blood pressure was measured twice at each visit by health care providers in the dominant arm using the manual auscultation method with a mercury sphygmomanometer (American Diagnostic Corporation). Blood pressure was categorized as high blood pressure (ie, hypertension) if the participants had a systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher on 2 separate readings (25). Standard classifications for fasting plasma glucose levels were used for diagnoses of prediabetes (100–125 mg/dl or 5.6–6.9 mmol/l) and diabetes (≥126 mg/dl or 7.7 mmol/l) (26).

Three validated self-administered questionnaires were used from previous Salud para su Corazón programs (12–14,20). A cardiovascular health knowledge survey and a program evaluation questionnaire contained closed-ended, curriculum-based questions (19). To assess behavioral changes the “My Habits” survey was used (12,18,20). The survey assessed participants’ heart-healthy behaviors and performance skills associated with reduction in salt or the consumption of foods with high sodium content (reduction of sodium intake) and cholesterol and fat consumption; weight control; and personal and family daily physical activity (eg, used stairs, got off bus and walked, walked, gardened). Additionally, participants recorded their personal physical activity (with or without family) by 3 exercise types: type A was 10 minutes, 3 times per day on some days of the week; type B was 30 minutes per day on some days of the week; and type C was 30 minutes per day, 3 or more times per week. Acceptance of the program was done using previous Salud Para Su Corazón protocols (14,16–18).

Participants were evaluated at baseline and after the 12-week intervention was completed (pretest and posttest). Frequencies of responses to each question were calculated on the basis of computed percentages and standard errors (SEs) or averages and standard deviations (SDs). We used t tests and χ²-tests to evaluate pretest and posttest differences for heart healthy habits, performance skills, and anthropometric and clinical measurements. Age categories were created on the basis of the mean and mode of the continuous age distribution (yielding 2 age groups with reasonable distribution of participants, representing mean values and ranging a span of 25-year difference for categories): aged 60 years or younger (mean age, 44.6 y) and older than 60 years (mean age, 70.4 y). The McNemar test was used to assess differences in proportions. Participants were stratified by socioeconomic risk factors (eg, health care access, access to healthy food) to examine differences between age groups (12,13,27).

A total of 22 promotores participated; their mean age was 46.1 years, and 86% were women. All promotores reported they had access to health care services and had attended some school (Table 1).

Of all participants, the mean age of those aged 60 years or younger was 44.6 years, and the mean age of those older than 60 was 70.4 years. Most participants aged 60 or younger were women (56.3%). The proportion of participants who completed secondary school was lower among adults older than 60 (6.7% vs 17.9%, P = .04) than for those aged 60 or younger. A lower proportion of adults older than 60 (45.2%) than adults 60 or younger (51.2%) were employed; therefore, a lower proportion of adults older than 60 (45.7%) received income than did adults 60 years or younger (51.3%, P = .05) (Table 1).

No significant differences were found between pretest and posttest anthropometric measurements among adults aged 60 or younger (Table 2). The posttest proportion of adults older than 60 classified as overweight (40.7%) was higher than those aged 60 or younger (30.0%; P = .045). Secondary analyses showed that adults who were classified as obese at baseline (pretest) were reclassified as overweight at posttest measurements, resulting in an increase in overweight estimates at the 12-week follow-up; adults who were classified as normal weight remained constant from baseline to follow-up (data not shown).

Pretest mean glycemic values among adults older than 60 years were higher than among adults aged 60 years or younger (129.9 mg/dl and 104.9 mg/dl; P = .03) (Table 2). Posttest mean systolic blood pressure among adults older than 60 years was higher than among those aged 60 years or younger (140.9 mm Hg and 120.2 mm Hg; P = .02). Among those older than 60 years, the pre- to posttest comparison showed a decrease in the mean glycemic values (129.9 to 116.7; P = .03) but an increase for the mean systolic blood pressure (125.9 to 140.9; P = .04).

Comparing pretest to posttest responses among adults aged 60 or younger, positive responses for the reduction of cholesterol and fat consumption (P = .03) and weight control decreased (P = .04) (Figure 1). Among participants older than 60, posttest positive responses for reduction in sodium intake (P = .008) and weight control increased (P = .009) but decreased for cholesterol and fat consumption (P = .02), compared with the pretest responses.

Among adults aged 60 or younger, the percentage of those who engaged in type A exercise (for 10 minutes, 3 times/day on some days of the week) increased from baseline to follow-up, but the change was not significant (Figure 2). The percentage of participants who engaged in type B exercise (30 minutes/d on some days of the week) decreased from pretest to posttest (34.2% to 29.7%, P = .04), and the percentage of adults aged 60 or younger who engaged in type C exercise (30 minutes, ≥3 times/week) increased from baseline to follow-up (30.6% to 65.0%, P < .001). Similarly, there were increases from pretest to posttest among those aged 60 or younger in the percentage of positive responses for those who walked or gardened (P = .30). However, there was a decrease from pretest to posttest in the percentage of positive responses for adults who reported type B exercise (30 min/d, some days of the week, P = .04) and among those who reported using a bus and walked (P = .02). Among adults older than 60, the percentage of positive responses for all 3 types of reported exercise increased from pretest to posttest (P < .001 for all) and increased for the daily physical activities (used the bus and walked, walked, or gardened, P < .001, or used the stairs, P = .04) (Figure 2). Adults aged 60 or younger who felt that they “cannot take the first step” to modify lifestyle behaviors at pretest decreased from 25.0% to 6.8% at posttest (P = .03) (Table 3). Adults who felt they were “taking action” to modify lifestyle behaviors increased from 31.5% to 63.0% (P < .001) for those 60 or younger and increased for those older than 60 from 30.0% to 45.0% (P < .001).

We found no significant differences in the acceptance of the program among participants as evaluated by the pretest and 12-week follow-up surveys (data not shown). All adults 60 or younger and 98.8% adults older than 60 were satisfied with the educational materials provided during the sessions. All adults older than 60 and 97.8% of adults 60 or younger were satisfied with the instruction and guidance they received from the promotores during the sessions, and 97.8% adults 60 or younger and 93.8% adults older than 60 were satisfied with the encouragement and support they received from the promotores during the sessions.