Community Health Workers Using Patient Stories to Support Hypertension Managemen

社区卫生工作者利用患者故事来支持高血压管理

• 批准号: 8794278
• 负责人: J LEE HARGRAVES
• 金额: $ 21.07万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2016-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8794278
• 关键词: Accounting; Adherence; Behavioral; Blood Pressure; Cardiovascular Diseases; Cause of Death; Chronic Disease; Communities; Community Health; Community Health Centers; Cultural Backgrounds; Diabetes Mellitus; Federally Qualified Health Center; Goals; Hispanics; Human; Hypertension; Instruction; Intervention; Intervention Studies; Interview; Language; Life; Low income; Minority; Morbidity - disease rate; Participant; Patients; Persons; Physical activity; Recruitment Activity; Regimen; Research; Risk; Risk Factors; Self Management; Testing; Training; United States; Work; base; behavior change; blood pressure reduction; comparison group; diet and exercise; health disparity; health equity; hypertension control; improved; innovation; medication compliance; mortality; motivational enhancement therapy; racial and ethnic; salt intake; skills; social situation; tool; willingness

Cardiovascular disease is the leading cause of death for all persons living in the United States, and hypertension (HTN) is a strong risk factor. Uncontrolled HTN is more likely among Blacks, Hispanics, and the poor. We need new interventions to improve HTN control and narrow persistent racial/ethnic gaps. Community health workers (CHWs) represent patient groups they serve in terms of language, culture, and social situation. While there is tremendous potential for CHWs to assist patients with adherence to chronic disease self-management regimens, this potential has yet to been fully realized. This project builds on our prior research demonstrating that CHWs in community health centers can work directly with people with diabetes to improve self-management goal setting for diet, exercise, and medication adherence. More specifically, we will integrate a new and powerful behavior-change tool in the CHWs' armamentarium: storytelling by "patients like me." CHWs, sharing a common cultural background with their communities, are well-suited to share these stories and use them in discussion grounded in motivational interviewing. Our Specific Aims are to: (1) Based on interviews with patients who have brought previously uncontrolled HTN under control, create four interactive storytelling DVDs, two in English and two in Spanish, to be used as a tool for CHWs to (a) engage participants to make behavioral changes appropriate for HTN management (2 DVDs) and (b) sustain these changes (2 DVDs); (2) Enhance our CHW training to (a) focus on long-term HTN control, (b) use storytelling DVDs by CHWs as a behavior-change tool, and (c) increase motivational interviewing skill building; and (3) At each of two CHCs serving minority and low income patients, recruit and follow for 18 months 126 randomly selected participants (total intervention N=252) to evaluate changes in blood pressure and, secondarily, in self-management goal setting and overall CVD risk attributable to the enhanced CHW intervention. Using propensity score approaches, a comparison group unexposed to the intervention will account for secular changes and willingness to participate in the study. Because storytelling is an innate human ability, our approach is relevant for other conditions and settings.

心血管疾病是所有生活在美国的人的主要死亡原因，高血压（HTN）是一个很强的风险因素。不受控制的HTN在黑人，西班牙裔和穷人中更有可能。我们需要新的干预措施来改善HTN控制和缩小持续的种族/民族差距。 社区卫生工作者（CHW）代表他们所服务的患者群体的语言，文化和社会状况。虽然有巨大的潜力，CHW，以帮助患者坚持慢性病自我管理方案，这种潜力尚未得到充分实现。该项目建立 我们先前的研究表明，社区卫生中心的CHW可以直接与糖尿病患者合作，以改善饮食，运动和药物依从性的自我管理目标设置。更具体地说，我们将在CHW的医疗设备中集成一个新的强大的行为改变工具： 像我这样的病人讲故事。“社区卫生工作者与社区有共同的文化背景， 非常适合分享这些故事，并在基于动机访谈的讨论中使用它们。 我们的具体目标是：（1）根据对以前带过的患者的访谈， 不受控制的HTN在控制之下，创建四个互动讲故事的DVD，两个在英语和西班牙语， 作为CHW的工具，（a）让参与者做出适合HTN的行为改变 管理（2张DVD）和（B）维持这些变化（2张DVD）;（2）加强我们的CHW培训，以（a）关注 关于长期HTN控制，（B）CHW使用讲故事DVD作为行为改变工具，以及（c）增加 动机面试技能建设;（3）在两个服务少数民族和低收入的社区健康中心 招募126名随机选择的参与者并随访18个月（总干预N=252）， 评估血压的变化，其次是自我管理目标设定和总体CVD风险的变化 这是由于加强了CHW干预。使用倾向评分方法，比较组 未暴露于干预将解释长期变化和参与研究的意愿。 因为讲故事是人类与生俱来的能力，我们的方法也适用于其他条件和环境。