Increasing Eye Care Utilization in Black Americans At High Risk For Glaucoma Using A Community-Engaged and Faith-Based Intervention

项目总结/摘要 在我们的理解中，在完善的、基于证据的指南之间存在着巨大的差距， 青光眼的检测和治疗，并在高危人群中有效应用这些指南 继续发展为失明。正如美国国家医学院所概述的那样， 结合人口健康和社区参与的原则， 检测差距。本研究的总体目标是设计和实施一个以信仰为基础的社区卫生 工人交付（CHW）支持计划，针对青光眼高危人群，特别是美国黑人。 中心假设是，个性化的信仰为基础的支持计划将导致增加眼睛护理 青光眼高风险的美国黑人目前未充分利用眼科护理。基本原理是 增加高风险个体的适当眼部护理使用，并在早期阶段开始治疗。 这种疾病会降低无法预防的失明的风险。候选人将通过以下方式达到总体目标： 实现以下2个具体目标：1）使用实施科学框架和社区参与 调整现有青光眼指导计划并开发多层次干预的方法， 成功提高美国黑人眼部护理利用率的关键决定因素; 2）实施和 评估青光眼社区治疗计划（ComBaT）的可行性和可接受性 青光眼），美国黑人。目标1：慢性病定制实施（TICD） 实施科学框架将用于指导与社区成员的半结构化访谈， 领导者和当地眼科护理提供者，以确定提高眼科护理利用率的障碍和潜在促进因素 B）使支持、教育和赋权（SEE）计划适应美国黑人的需求和文化。 社区的发展和信仰为基础的CHW提供的方案，使用实施战略 以及与社区确定的最佳成功决定因素相关的行为改变技术。在目标2中， ComBaT青光眼项目将通过对50名黑人进行单组初步研究来实施 美国人候选人将使用混合方法来评估ComBaT的可行性和可接受性 青光眼治疗这项研究意义重大，因为它解决了既定的指导方针之间的差距 青光眼和高风险个体继续失明，尽管这些数据。它是创新的，因为它 采用实施科学框架，这是一种社区参与的，基于信仰的定制方法， 支持计划，以增加青光眼高危美国黑人的眼部护理利用率。埃兰博士将使用 在这次培训中获得的技能奖励，成为少数几个在实施培训眼科医生之一 科学和社区参与的健康差异研究，以改善青光眼护理的所有人在 美国的

PROJECT SUMMARY/ABSTRACT There are significant gaps in our understanding between well-established, evidence-based guidelines for detection and treatment of glaucoma and effectively applying those guidelines within the high-risk populations that continue to develop blindness. As outlined by the National Academy of Medicine, great opportunity exists to incorporate principles of population health and community engagement to close this observed glaucoma detection gap. The overall objective of this study is to design and implement a faith-based, community health worker-delivered (CHW) support program for individuals at high risk for glaucoma, specifically Black Americans. The central hypothesis is that a personalized faith-based support program will result in increased eye care utilization in Black Americans at high risk for glaucoma who currently underutilize eye care. The rationale is that increasing appropriate eye care utilization in high-risk individuals and beginning treatment at earlier stages of the disease will decrease the risk of unpreventable blindness. The candidate will reach the overall objective by achieving the following 2 specific aims: 1) Use implementation science framework and community-engaged methods to adapt an existing glaucoma coaching program and develop a multilevel intervention that addresses the key determinants of successfully increasing eye care utilization in Black Americans; and 2) Implement and evaluate the feasibility and acceptability of the Community-Based Treatment for Glaucoma program (ComBaT Glaucoma), for Black Americans. In Aim 1, the Tailored Implementation for Chronic Diseases (TICD) implementation science framework will be used to guide semi-structured interviews with community members, leaders, and local eye care providers to identify barriers and potential facilitators of increasing eye care utilization in Black Americans; and b) adapt the Support, Educate and Empower (SEE) Program to the needs and culture of the community to develop and the faith-based CHW-delivered program that uses implementation strategies and behavior change techniques linked to community-identified determinants for optimal success. In Aim 2, the ComBaT Glaucoma program will be implemented by conducting a single-arm pilot study with 50 Black Americans. The candidate will use mixed methods to assess the feasibility and acceptability of the ComBaT Glaucoma program. This study is significant because it addresses a gap between well-established guidelines for glaucoma and high-risk individuals that continue to go blind despite these data. It is innovative because it employs implementation science framework, a community-engaged, faith-based tailored approach to create a support program to increase eye care utilization in Black Americans at high risk for glaucoma. Dr. Elam will use the skills acquired during this training award to become one of the few ophthalmologists trained in implementation science and community-engaged health disparities research to improve glaucoma care for all people in the United States.