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: 10662283
• 负责人: Giselle Corbie
• 金额: $ 59.13万
• 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/10662283
• 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; Disparity; Effectiveness; Eligibility Determination; Enrollment; Evidence based program; Faith; Faith-based organization; 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; Translations; United States; behavioral outcome; burden of illness; cardiometabolism; cardiovascular disorder risk; comparison control; concept mapping; cost effective; cost effectiveness; dietary; disease disparity; effectiveness evaluation; effectiveness/implementation design; effectiveness/implementation study; efficacy testing; feasibility testing; feasibility trial; high risk; implementation barriers; implementation context; 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）严重对艰难的非洲裔美国社区造成了不成比例的损失 东南。实施和缩放可靠的有效的循证计划（EBP）对于 减轻农村社区中CVD风险的分布增长。我们以前改编了总理，EBP， 进入心脏事务，并在两个常规的七个宿主站点进行了随机控制的可行性试验 北卡罗来纳州东部（NC）的县，主要由CVD负担高的非洲裔美国人。作为 使用总理，收缩压和自我报告的体育锻炼和饮食行为显着 与6个月后的对照组相比，干预臂的改善。但是，心脏事务的成功是 在组织层面上受到关键的实施障碍的抑制，包括有限的准备就绪，部分 利益相关者之间的协作以及实施EBP的组织效率低，这减少了 心脏事务的忠诚和渗透。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，调查心脏问题的实施和有效性 东北卡罗来纳州。在实施研究的合并框架的指导下，我们的总体目标是 与组织合作，以扩展和测试心脏事务实施到其他粗糙的非裔美国人 社区，并支持在北卡罗来纳州东部实践的证据翻译。在第一年，我们将与 我们长期以来的社区学术联盟，以确定和招募合格的组织 设置（Edgecombe，Franklin，Nash，Vance和Warren县）。我们将与组织（n = 60）参与 使用概念映射的形成性研究来识别和映射影响EBP的上下文实现因素 在粗糙的非裔美国社区实施。我们将使用这些发现来完善现有的培训 协议并开发一个名为“合作和利用非洲的证据的组织合作者 美国农村网络”或共同学习。在第二年，我们将确定共同学习站点（n = 18）并使用 参与系统科学方法通过以下方式开发实施蓝图：1）共享学习 旨在培训和能力建设以及2）旨在持续质量改进的共享行动计划 站点级别的实施策略。共同学习的目的是增加组织 准备，加强网络协作并提高组织效率以实施CVD EBP。 在3 - 4年中，我们将采用混合II型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， 渗透），CVD生物标志物（例如血压，胆固醇，体育锻炼）和成本效益 心脏很重要。我们的长期目标是增加农村中CVD EBP的可接受性，采用和渗透率 通过建立组织准备和能力来实施可持续和成本效益的能力 EBPS减轻CVD差异。

项目成果

Application of the Expert Recommendations for Implementing Change (ERIC) compilation of strategies to health intervention implementation in low- and middle-income countries: a systematic review.

• DOI: 10.1186/s13012-023-01310-2
• 发表时间: 2023-10-30
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Lovero, Kathryn L.;Kemp, Christopher G.;Wagenaar, Bradley H.;Giusto, Ali;Greene, M. Claire;Powell, Byron J.;Proctor, Enola K.
• 通讯作者: Proctor, Enola K.

Physicians' Perceptions of Race and Engagement in Race-Based Clinical Practice: a Mixed-Methods Systematic Review and Narrative Synthesis.

医生对种族的看法和参与基于种族的临床实践：混合方法系统回顾和叙述综合。

• DOI: 10.1007/s11606-022-07737-5
• 发表时间: 2022
• 期刊: Journal of general internal medicine
• 影响因子: 5.7
• 作者: Okah,Ebiere;Glover,LáShauntá;Donahue,KatrinaE;Corbie-Smith,Giselle;Dave,Gaurav
• 通讯作者: Dave,Gaurav