We will develop and demonstrate the efficacy of a set of original, cardiovascular (CVD) nutrition education materials designed to reduce intake of sodium (Na) fat, and cholesterol and which will be appropriate for urban black adults with 5th to 8th grade reading levels. We will design materials to accomplish the objectives of conventional nutrition education/behavior change programs, but avoiding the usual dependency of traditional programs on strategies that require a high level of reading and arithmetic. Guiding principles will be 1) the need to identify the foodrelated conceptual, cultural, and social frameworks of members of the target audience and 2) to develop a program that builds upon already-developed, alternative communication and coping skills. The core of the system will be a) a protocol for office-based patient assessment and follow up, b) an educational/motivational videotape to be viewed in the clinical setting, c) scripts and supporting materials for a 4-week minicourse to be led by a clinic staff member or volunteer, and d) a package of audiocassettes and supporting printed materials to facilitate self-directed learning over an extended time period. Printed materials will emphasize the use of cards (hence the acronym 'CARDES') that deliver single concepts about nutrition or behavior change and that permit manipulation, selection, and reorganization of information. CARDES will be developed and evaluated in cooperation with Howard University Hospital in Washington, D.C. Using a randomized two-group design and a 12-24 month follow up, serum cholesterol and blood pressure levels of persons (n = 450) counseled with the CARDES program will be compared with values for a control group (n=450) receiving usual care. Process measures will describe adherence outcomes and determinants. Secondary outcomes related to CVD risk factor status will also be evaluated. Prior to the evaluation, a pilot study will determine the best sequence for delivering the information related to dietary change (i.e., Na first, fat/cholesterol first, or concurrent). Subsequent to the evaluation and prior to development of the final system and dissemination plan, the potential utility of CARDES with other black populations with low literacy skills will be assessed. This project should lead to an improved capability for reducing risks related to hypertension and elevated cholesterol in black populations by enabling interventions to reach the subpopulations that are only marginally literate.
