Heart Matters: Collaborate and Leverage Evidence in an African American Rural Network to Implement Risk Reduction Strategies for CVD (Heart Matters: Co-Learn to Reduce CVD)

心脏问题：在非裔美国人农村网络中合作并利用证据来实施 CVD 风险降低策略（心脏问题：共同学习减少 CVD）

• 批准号: 10463643
• 负责人: Giselle Corbie
• 金额: $ 61.08万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10463643
• 关键词: Address; Adoption; Adult; Affect; African American; African American population; Behavior; Biological Markers; Blood Pressure; Cardiovascular Diseases; Cholesterol; Clinic; Clinical; Collaborations; Communities; Consolidated Framework for Implementation Research; County; Disease Outcome; Effectiveness; Enrollment; Evidence based program; Feedback; Funding; Goals; Heart; Hybrids; Individual; Knowledge; Learning; Maps; Methods; Morbidity - disease rate; North Carolina; Outcome; Participant; Patient Self-Report; Penetration; Physical activity; Protocols documentation; Randomized; Randomized Controlled Trials; Readiness; Research; Risk Reduction; Rural; Rural Community; Science; Site; Social support; System; Testing; Training; Training Support; Translations; United States; base; behavioral outcome; burden of illness; cardiometabolism; cardiovascular disorder risk; concept mapping; cost effective; cost effectiveness; dietary; disease disparity; effectiveness evaluation; effectiveness implementation design; efficacy testing; feasibility testing; feasibility trial; high risk; implementation barriers; implementation determinants; implementation evaluation; implementation outcomes; implementation strategy; improved; innovation; model building; mortality; organizational readiness; recruit; rural African American; rural counties; rural setting; stakeholder perspectives; success; treatment arm; trial design; uptake

ABSTRACT Cardiovascular disease (CVD) exacts a disproportionate toll on rural African American communities in the Southeast. Implementing and scaling a proven-effective, evidence-based program (EBP) is essential to mitigate growing disparities in CVD risk among rural communities. We previously adapted PREMIER, an EBP, into Heart Matters and conducted a randomized controlled feasibility trial at seven host sites in two rural counties in eastern North Carolina (NC), largely populated with African Americans with high CVD burden. As with PREMIER, systolic blood pressure and self-reported physical activity and dietary behaviors significantly improved in the intervention arm compared to controls after 6 months. Heart Matters’ success, however, was dampened by critical implementation barriers at the organizational level, including limited readiness, partial collaboration between stakeholders, and low organizational efficacy to implement an EBP, which reduced fidelity and penetration of Heart Matters. To address implementation barriers, our research team will investigate the implementation and effectiveness of the Heart Matters EBP by scaling to five rural counties in Eastern NC. Guided by the Consolidated Framework for Implementation Research, our overall objective is to partner with organizations to scale and test Heart Matters implementation to other rural African American communities, and support translation of evidence to practice in eastern NC. In year 1, we will collaborate with our longstanding community-academic coalition to identify and recruit eligible organizations from our study setting (Edgecombe, Franklin, Nash, Vance, and Warren Counties). We will engage organizations (n=60) in formative research using concept mapping to identify and map contextual implementation factors affecting EBP implementation in rural African American communities. We will use these findings to refine existing training protocols and develop an organizational collaborative called “Collaborate and Leverage Evidence in an African American Rural Network” or Co-LEARN. In year 2, we will identify Co-LEARN sites (n=18) and employ participatory systems science methods to develop an implementation blueprint through: 1) shared learning aimed at training and capacity building and 2) shared action planning aimed at continuous quality improvement of implementation strategy at the site-level. The objective of Co-LEARN is to increase organizational readiness, strengthen network collaborations, and enhance organizational efficacy to implement a CVD EBP. In years 3-4, we will employ a hybrid type II implementation effectiveness design to conduct a cluster randomized controlled trial (n=486). We will evaluate outcomes of implementation (e.g., acceptability, adoption, penetration), CVD biomarkers (e.g., blood pressure, cholesterol, physical activity) and cost effectiveness of Heart Matters. Our long-term goal is to increase acceptability, adoption, and penetration of CVD EBPs in rural United States by building organizational readiness and capacities to implement sustainable and cost-effective EBPs to mitigate CVD disparities.

抽象的 心血管疾病 (CVD) 对美国农村非裔美国人社区造成了不成比例的损失 东南。实施和扩展经证明有效、循证的计划 (EBP) 对于 缩小农村社区之间日益扩大的心血管疾病风险差异。我们之前改编了 PREMIER，一个 EBP， 进入 Heart Matters 并在两个农村地区的七个主办地点进行了随机对照可行性试验 北卡罗来纳州 (NC) 东部的县主要由非裔美国人组成，CVD 负担较高。作为 与 PREMIER 相比，收缩压和自我报告的体力活动和饮食行为显着 6 个月后，与对照组相比，干预组有所改善。然而，Heart Matters 的成功在于 由于组织层面的关键实施障碍而受到抑制，包括准备有限、部分 利益相关者之间的协作以及实施 EBP 的组织效率低，这降低了 心事的保真度和穿透力。为了解决实施障碍，我们的研究团队将 通过扩展到 5 个农村县来调查 Heart Matters EBP 的实施情况和有效性 北卡罗来纳州东部。在实施研究综合框架的指导下，我们的总体目标是 与组织合作，扩大和测试“心脏问题”在其他农村非裔美国人中的实施情况 社区，并支持将证据转化为北卡罗来纳州东部的实践。在第一年，我们将与 我们长期的社区学术联盟从我们的研究中识别和招募合格的组织 县（埃奇科姆县、富兰克林县、纳什县、万斯县和沃伦县）。我们将让组织 (n=60) 参与 使用概念图来识别和绘制影响 EBP 的上下文实施因素的形成性研究 在非洲裔美国农村社区实施。我们将利用这些发现来完善现有的培训 协议并开发一个名为“非洲合作和利用证据”的组织合作 美国农村网络”或 Co-LEARN。在第 2 年，我们将确定 Co-LEARN 站点（n=18）并雇用 参与式系统科学方法通过以下方式制定实施蓝图：1）共享学习 旨在培训和能力建设，2) 旨在持续提高质量的共同行动计划 站点层面的实施策略。 Co-LEARN 的目标是增强组织能力 准备、加强网络协作并提高实施 CVD EBP 的组织效率。 在第 3-4 年，我们将采用混合型 II 实施有效性设计来进行集群 随机对照试验（n=486）。我们将评估实施结果（例如可接受性、采用率、 渗透率）、CVD 生物标志物（例如血压、胆固醇、体力活动）和成本效益 心脏很重要。我们的长期目标是提高农村地区 CVD EBP 的接受度、采用率和渗透率 美国通过建立组织准备和能力来实施可持续和具有成本效益的 EBP 旨在减少 CVD 差异。