For Jacob Kariuki, PhD, AGNP-BC, his interest in healthcare started at a very young age while growing up in Kenya. Kariuki saw firsthand the struggles the people in his country faced in terms of healthcare. He said the focus was on communicable diseases, and cardiovascular health took a backseat.
He made it a mission of his to be the change and earned his BSN in ’08 from the University of Eastern Africa, before heading to the United States. Kariuki landed at the University of Massachusetts, Boston, earning his MSN in ’13, a Post-Masters Certificate in Adult Gerontology in ’15 and a PhD in nursing in ’16.
The important work he’s doing today in Pittsburgh started as a graduate student at UMass Boston. Kariuki coordinated a community-based outreach program in the Roxbury neighborhood that included weekly sessions to teach people about diet and exercise, while also monitoring their cardiovascular risk factors. In one year, he saw people who were on multiple medications needing less pills because their providers were taking note of their improving health.
“I think that gave me a lot of confidence that if we can be persistent in doing little things which makes a difference, we can actually see a lot of interesting outcomes over time,” he said.
Kariuki took his research a step further when he came to the University of Pittsburgh’s School of Nursing in 2016. He applied for grant funding and went out into the community to find out why people were struggling with their health and how he could help.
“I went to the Homewood area, Hill District, and a lot of places to recruit for our focus group, and that’s where people gave me a lot of thoughts,” he said. “The African American folks that I brought in for the focus group were very articulate in letting me know that they really care about their health. What they were struggling with was, I know what I need to do, but how to is the problem.”
He said his goal is to help inactive people who live in underserved and less walkable neighborhoods become more active.
“They let me know that one of the most effective things that we know can help people and improve their cardiometabolic health is physical activity, but it was not so easy for them, so telling them just to take a walk would not cut it,” he said. “We started working on a project that would help them move a little bit more considering their home environment, their fitness levels and considering what they could do and what they prefer to do.”
Kariuki said physical activity recommendations given by health care providers can be very generic, and may not take into account where someone lives, how safe their neighborhood is to walk in, kids and childcare needs, multiple jobs, and time. The conversation became deeper, and he learned people are keener to follow an exercise regimen when the trainers are relatable.
“{They would emphasize} ‘we are tired of going to exercise programs where nobody looks like you and people have expectations on things you can not do,’” he said. “That made me realize that as much as race and ethnicity is an issue that we need to pay a lot of focus on, there is also a bigger and broader problem which is people who really struggle with weight issues normally feel neglected.”
Kariuki said he learned a lot by just listening to his target population: they wanted programs that were led by someone struggling just like them, that would be convenient, accessible at any time and inexpensive. His research landed him onto open-source platforms like YouTube, and he searched for workouts intentionally created to target people struggling with weight issues and low fitness.
“I came across people who were like 400 pounds and who were chronicling their journey towards increased physical activity,” he said. “Some of them had a million views and I was reading the comments and saw people confessing they had weight issues and appreciating this content. For me, it was like ahh ha! If we can curate this content over time, we can actually develop our own platform that will make it easier for people to access and use these workouts.”
He collected about sixty workouts and invited people to participate which he said was a hit.
“People were really getting excited,” he said. “I remember that conversation. It was very, very delightful. You could see people seeing themselves doing that. They feel like, ‘this is me. I can do it.’”
Kariuki developed a 12-week study were 25 people had access to a website with exercise videos. The group spent two hours watching the videos every week and offered feedback.
“Oh boy were they opinionated,” he said. “We got over 800 comments on the workouts, and we used that feedback to be more laser focused in identifying things that would be interesting to our targeted audiences.”
In 2019, Kariuki expanded his research into two groups: one solely on African Americans and a second that was race/ethnicity agnostic. His goal was to recruit 82 people to take part in the study: he got them all. Only one person dropped out of the study while two were withdrawn due to personal issues unrelated to the study. He called his research “The Active You Study.”
“That title was very intentional because when people think about others who are active, they don’t see themselves in there,” he said. “It was easy for people to remember, and we also thought it would help motivate them. One of the things that I think is important in behavioral interventions is making people believe in themselves. A lot of them are used to being called lazy and sometimes we do not do a very good job listening to the struggles people have.”
“Human beings are sophisticated and there are a lot of things that affect their motivation and ability to do anything,” he continued. “One of them is the confidence in their ability to do something, so we hope that what we are doing is playing a small role in helping that.”
Kariuki said he is still collecting preliminary data and it’s too early to tell if the program is helping people improve their cardiometabolic health. He said he applied for a grant for another trial that would recruit 500 people and follow their progress for a year.
“When we do that, we will be able to say with confidence if our program makes a difference when it comes to cardiometabolic health,” he said.
Kariuki said while he continues to work in the African American communities in Pittsburgh, he is also collaborating with colleagues in the Psychology department on another project focusing on brain and cardiovascular health among community dwelling Kenyans. “In the next 2-3 years, my research team will have a global footprint because we can learn a lot from the data we collect locally and globally.”