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.

摘要 心血管疾病（CVD）对非洲裔美国人的农村社区造成了不成比例的损失， 东南部实施和扩展一个行之有效的循证计划（EBP）是必不可少的， 缓解农村社区心血管疾病风险日益扩大的差距。我们之前改编了PREMIER，一个EBP， 进入心脏问题，并在两个农村地区的七个主机站点进行了随机对照可行性试验。 北卡罗来纳州（NC）东部的几个县，大部分人口为患有高CVD负担的非裔美国人。作为 与PREMIER、收缩压和自我报告的体力活动和饮食行为显著相关 6个月后，干预组与对照组相比有所改善。然而，心脏问题的成功是 由于组织一级的关键实施障碍，包括准备程度有限， 利益相关者之间的合作，以及实施EBP的组织效率低下， 《Heart Matters》的忠实度和穿透力。为了解决实施障碍，我们的研究团队将 通过扩展到五个农村县，调查心脏问题EBP的实施和有效性， 东NC。在实施研究综合框架的指导下，我们的总体目标是 与各组织合作，将Heart Matters的实施范围扩大并测试到其他农村非洲裔美国人 社区，并支持在北卡罗来纳州东部将证据转化为实践。在第一年，我们将与 我们长期的社区学术联盟，以确定和招募合格的组织，从我们的研究 环境（埃奇库姆、富兰克林、纳什、万斯和沃伦县）。我们将让组织（n=60）参与 形成性研究，使用概念图来识别和映射影响EBP的上下文实施因素 在非洲裔美国人的农村社区。我们将利用这些发现来完善现有的培训 协议，并制定一个名为“在非洲合作和利用证据”的组织合作， 美国农村网络”或共同学习。在第2年，我们将确定Co-LEARN研究中心（n=18）， 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）旨在持续改进质量的共同行动规划 在现场一级实施战略。共同学习的目标是提高组织 准备，加强网络合作，提高组织效率，以实施CVD EBP。 在第3-4年，我们将采用混合型第二类实施有效性设计， 随机对照试验（n=486）。我们将评估实施的结果（例如，可接受性，采纳， 渗透），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CVD EBP的可接受性、采用率和普及率。 通过建立组织准备和能力，以实施可持续和具有成本效益的 EBP旨在缓解心血管疾病差异。