Home health aides’ perspectives towards achieving cardiovascular health and life’s essential 8: a qualitative study

Despite frequently providing care to adults with cardiovascular (CV) disease in the home, home health aides and attendants (HHAs) have poor CV health (CVH) themselves, which is problematic for their own health and potentially their patients. We elicited the perspectives of HHAs towards achieving optimal CVH, including the American Heart Association’s (AHA’s) Life’s Essential 8 (LE8). We conducted focus groups and interviews with HHAs from January 2023 to January 2024 in partnership with the 1199SEIU Training and Employment Fund, a benefit fund of the largest healthcare union in the US. We included English-and Spanish-speaking HHAs at risk for poor CVH, defined as having: 1) hypertension, 2) obesity/overweight, and 3) ≥ 1 other CV disease risk factors (hyperlipidemia, diabetes, smoking, and physical inactivity). Twenty-two HHAs employed by 12 home care agencies participated. They had a median age of 60 years (IQR 50, 64), 21 (95%) were female, 9 (41%) were Black, and 12 (55%) were Latinx. Consistent with the Social-Ecological Model, 5 themes emerged. At the individual level, many HHAs were motivated to carry out aspects of the LE8 (diet, physical activity), but faced challenges doing so, including varied perceptions of the severity of their CVH and constraints of their job (e.g. limited time). At the interpersonal level, HHAs perceived that their relationship with their patients influenced their own CVH, as well as that of their patients’. At the organizational level, shift-work and long commutes were barriers to certain LE8 (i.e. sleep). Notably, HHAs sought community among peers to learn about CVH. Policies and structural inequities (health insurance, citizenship) were barriers to achieving CVH. HHAs’ ability to achieve CVH is likely influenced by personal, interpersonal, organizational, and policy-level factors. Findings can inform future interventions better tailored to this workforce and the context in which they provide care. Such interventions can aim to improve not only HHAs’ CVH, but potentially that of their patients.