Engaging Religious Leaders to Reduce Blood Pressures in Tanzanian Communities

项目总结/摘要 尽管有非常有效的药物和非药物干预措施来降低血压， 高血压仍然是全球早期死亡的主要风险因素。在坦桑尼亚社区， 35岁及以上的成年人患有高血压，但只有2%的人知道他们的诊断， 进行抗高血压治疗我们的长期目标是改善高血压相关的健康结果， 坦桑尼亚社区。这项建议的总体目标是调整我们的既定模式， 与德高望重的宗教领袖合作，采取社区保健干预措施， 农村社区对高血压的认识、预防和控制。我们的中心假设是 赋予宗教领袖权力，让他们的社区参与高血压问题，将改善健康 行为和降低平均血压的成年人都有和没有高血压， 社区我们建议的理由是，即使是在社区范围内血压的小幅下降， 大大降低了该社区过早心血管死亡的风险。为了验证这个假设，我们将 追求三个具体目标：1）调整和试点测试我们以前的宗教参与健康干预， 在宗教背景下解决血压问题; 2）确定这种干预措施对降低血压的有效性 分组随机试验中的平均社区收缩压;和3）评估覆盖范围，有效性， 采取、实施并维持该干预措施24个月。在第一个目标中，我们将使用数据 从以前进行的采访宗教领袖和社区成员，以适应，完善， 试点测试我们的宗教参与健康干预，以解决高血压问题，使用 序贯ADAPT-ITT模型。在第二个目标中，我们将进行混合I型有效性- 实施群集随机试验，以检验干预社区将实现在 平均社区收缩压比对照社区降低至少3 mmHg。在 第三个目标，我们将使用RE-AIM框架指导下的收敛混合方法来测量达到 宗教领袖和社区成员，对社区血压的影响以及与护理，收养的联系 由宗教领袖，忠实于计划的干预，并保持24个月的福利。我们将 与生物医学和宗教界合作，完善宣传和实施干预措施 领导人的人选信号拟议的研究是创新的，因为它使用了一种新的方法来影响社区健康， 提供了上下文的灵活性，以适应宗教领袖或其他值得信赖的社区使者， 这可能是一个创造性的方式来吸引男人。这项研究意义重大，因为 估计社区收缩压降低3 mmHg可减少早发性心血管疾病 死亡率降低了13%如果成功，这种方法可以防止成千上万的死亡， 坦桑尼亚，并可适用于美国社区，其中高血压的结果是穷人。

Project Summary/Abstract Despite highly effective pharmacologic and non-pharmacologic interventions to lower blood pressure, elevated blood pressure remains the leading global risk factor for early mortality. In Tanzanian communities, 28% of adults aged 35 and above have hypertension, yet only 2% are aware of their diagnosis and less than 1% are on anti-hypertensive treatment. Our long-term goal is to improve hypertension-related health outcomes in Tanzanian communities. The overall objective of this proposal is to adapt our established model of promoting community health interventions in partnership with highly respected religious leaders in order to bridge gaps in rural communities’ awareness, prevention, and control of high blood pressure. Our central hypothesis is that empowering religious leaders to engage their communities about high blood pressure will improve health behavior and reduce the average blood pressure among adults both with and without hypertension in the community. The rationale for our proposal is that even small reductions in community-wide blood pressure can sharply decrease the risk of premature cardiovascular death in that community. To test this hypothesis, we will pursue three specific aims: 1) Adapt and pilot-test our prior Religious Engagement in Health Intervention to address blood pressure in religious contexts; 2) Determine the effectiveness of this intervention on reducing mean community systolic blood pressure in a cluster randomized trial; and 3) Assess reach, effectiveness, adoption, implementation, and maintenance of this intervention for 24 months. In the first aim, we will use data from previously conducted interviews with religious leaders and community members to adapt, refine, and pilot-test our Religious Engagement in Health Intervention to address the problem of high blood pressure using the sequential ADAPT-ITT model. In the second aim, we will conduct a hybrid type I effectiveness- implementation cluster randomized trial to test the hypothesis that the intervention communities will achieve at least a 3 mmHg greater reduction in mean community systolic blood pressure than control communities. In the third aim, we will use convergent mixed methods guided by the RE-AIM framework to measure reach to religious leaders and community members, effect on community blood pressure and linkage to care, adoption by religious leaders, fidelity to the planned intervention, and maintenance of the benefit at 24 months. We will refine the intervention for dissemination and implementation in partnership with biomedical and religious leaders. The proposed research is innovative because it uses a novel approach to impact community health, it offers contextual flexibility to be adapted by religious leaders or other trusted community messengers for their own contexts, and it may be a creative way to engage men. The proposed research is significant because a community systolic blood pressure reduction of 3 mmHg is estimated to decrease premature cardiovascular mortality by 13% in that community. If successful, this approach could prevent many thousands of deaths in Tanzania and could be adapted for use in U.S. communities in which hypertension outcomes are poor.