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)

摘要 心血管疾病(CVD)给美国农村的非裔美国人社区造成了不成比例的损失 东南方向。实施和扩展行之有效的循证计划(EBP)对于 缓解农村社区在心血管疾病风险方面日益扩大的差距。我们之前改编了Premier，一个EBP， 并在两个农村地区的七个寄主地点进行了随机对照可行性试验 北卡罗来纳州(北卡罗来纳州)东部的几个县，人口主要是心血管疾病负担较高的非裔美国人。AS 与总理、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，与对照组相比，干预组的情况有所改善。然而，心脏事务的成功之处在于 受到组织一级的关键实施障碍的影响，包括准备程度有限、部分 利益相关者之间的协作，以及组织实施EBP的低效率，这降低了 心的忠诚度和洞察力很重要。为了解决实施障碍，我们的研究团队将 年扩大到5个农村县调查心事EBP的实施情况和效果 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，向其他农村非裔美国人推广和测试心脏事务的实施 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，从我们的研究中确定和招募符合条件的组织 环境(埃奇科姆、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绘制影响EBP的情境实施因素 在农村非裔美国人社区实施。我们将使用这些调查结果来改进现有的培训 协议，并开发一个组织协作，称为“协作和利用证据在非洲 美国农村网络“或共同学习。在第2年中，我们将确定合作学习站点(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以及2)旨在持续改进质量的共同行动计划 在现场一级实施战略。共同学习的目标是增加组织性 做好准备，加强网络协作，提高组织效能，以实施CVD EBP。 在第三至第四年，我们将采用第二类混合实施效率设计来进行一组 随机对照试验(n=486)。我们将评估实施的结果(例如，可接受性、采用率、 渗透率)、心血管生物标志物(例如，血压、胆固醇、体力活动)和 心很重要。我们的长期目标是提高农村地区CVD EBPS的可接受性、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 EBPS，以减轻心血管疾病的差距。

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.