Feasibility of a Culturally Adapted Positive Psychological Intervention for Hispanics/Latinos with Elevated Risk for Cardiovascular Disease: Results of the "Alegrate!" Trial

Background and Purpose: A paradigm shift in public health and medicine shifts focus from psychological distress and deficits and instead expands its view to include positive psychological assets that focus on human flourishing and resilience. Observational evidence is accruing that links multiple domains of psychological well-being (e.g., happiness, optimism, life meaning and purpose) with favorable cardiovascular health, reduced mortality, and increased healthful longevity. Although evidence links psychological well-being with superior cardiac health, there remains a critical scientific gap as we don’t yet know whether (or how) interventions to cultivate emotional well-being may reduce cardiac risk. This potential therapeutic avenue is particularly important among Hispanics/Latinos as they represent the largest ethnic/minority group in the U.S. and are a vulnerable population that experiences ever-growing health disparities. Therefore, our objective was to pilot a well-being intervention drawing on positive psychology concepts to determine feasibility and acceptability in Hispanics/Latinos at risk for cardiovascular disease (CVD).

Methods: Hispanic/Latino adults (n=19) self-reporting two or more CVD risk factors were enrolled in our single-arm 8-week pilot trial. Our full “¡Alégrate!” [Get Happy!] intervention included eight weekly sessions delivered in-person by a bilingual licensed social worker who taught empirically validated behavioral and cognitive skills known to boost positive affect and overall psychological well-being. Weekly sessions were 90-120 minutes in length. Intervention content focused on the following skillsets: (1) identifying and using personal strengths, (2) noticing positive events in daily life, (3) prolonged appreciation and relishing of positive events, (4) positive reappraisal of stressful events or situations, (5) gratitude, (6) regular practice of mindfulness and meditation, (7) setting and working toward pragmatic and achievable goals; and (8) planning and performing acts of kindness. Feasibility focused on rates of recruitment, retention, and overall satisfaction with content and modality of delivery. In exploratory analyses, we examined pre-post changes in emotional well-being, self-reported health, objective values of sitting blood pressure, and physical activity as per accelerometer data. 

Results: Mean age was 54.1 years; 68.8% female; and 50% had ≤8th grade education. Eleven of 19 Hispanics/Latinos completed the 8-week program for a 57.89% retention rate, with most factors leading to drop-out unrelated to program content or mode of delivery. Most participants felt satisfied overall with each session (97.1%). Largest increases relative to baseline after receiving the intervention were found in engagement in happiness inducing behaviors (e.g., meditation; p=0.06), emotional vitality (p=0.004), and subjective happiness (p=0.01) using metrics of reliable change and effect sizes. Though likely underpowered, no significant pre-post changes were evident for self-reported health, pedometer data, and sitting blood pressure.

Conclusion and Implications: This single-arm trial documented adequate feasibility and acceptability, although strategies to increase retention are warranted. Findings suggest that improvements in emotional well-being are possible using a targeted strength-based approach and that our overall strategy was well-received by an often-under-resourced population that encounters barriers in accessing primary care and mental health treatment. Psychosocial interventions such as this one will likely play a critical role in the future of health and healthcare and in reaching communities underserved by traditional practices.