Community Health Worker-Led Church-Based Intervention for Eliminating Cardiovascular Health Disparities in African Americans

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PROJECT SUMMARY The “Community Health Worker-Led (CHW) Church-Based Intervention for Eliminating Cardiovascular Health Disparities in African Americans” (CHERISH) study is a clustered randomized control trial to test whether a community health worker-led church-based multifaceted implementation strategy for applying the 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease will reduce cardiovascular health disparities in African Americans in New Orleans and Bogalusa, Louisiana. However, low levels of trust in doctors and researchers among African Americans is often a barrier to participation in research and clinical care. CHWs offer an opportunity to understand how trust is built between communities and health systems, but there is little empirical evidence. The process by which CHWs engender trust among community members is largely anecdotal and theoretical. It is unknown how trust-building occurs, develops, grows, or terminates over time, particularly in interventions to address CVD disparities. Research is needed to understand how CHWs build trust among African Americans and other underserved groups to maximize the effectiveness of interventions to reduce cardiometabolic risk factors for CVD. The purpose of this PA-21-071 Administrative Supplement is to leverage the planning phase of the CHERISH study to identify the role of CHWs in developing trust in providers and researchers. Our central hypothesis is that CHWs can be used to improve trust in providers and researchers. The rationale for the proposed research is that CHWs act as trust intermediaries that increase the likelihood of cooperation (e.g., adherence to physician visit appointments and treatment recommendations) between African Americans and their providers. To test our central hypothesis and, thereby, attain the overall objective, we will pursue the following objectives in parallel with the UH3 planning phase of the CHERISH study: (1) Identify community health worker-led trust-building interventions through a systematic review of the literature. (2) Identify the factors that influence the perceived trustworthiness of community health workers through CHERISH study focus groups. (3) Develop a measurement tool to assess the level of trust between patients and community health workers. The project will provide preliminary data for an application for an R01 to assess the effectiveness of a CHW-led trust-building intervention among African Americans with risk factors for CVD. The design of the intervention will be informed by the systematic review of the literature, focus groups, and the CHW trust measure.