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

项目摘要/摘要 在我们对以下方面的理解上存在着重大差距： 青光眼的检测和治疗以及在高危人群中有效应用这些指南 会继续发展成失明。正如国家医学科学院所概述的那样，存在着巨大的机会 纳入人口健康和社区参与的原则，以结束这一观察到的青光眼 检测间隙。这项研究的总体目标是设计和实施一种基于信仰的社区健康 为青光眼高危人群，特别是美国黑人提供的工人提供(CHW)支持计划。 中心假设是，个性化的基于信仰的支持计划将导致更多的眼睛护理 目前未充分利用眼睛护理的美国黑人青光眼高危人群的使用情况。理由是 提高高危人群的适当眼部护理利用率，并在早期阶段开始治疗 这种疾病将降低无法预防的失明风险。候选人将在以下时间达到总体目标 实现以下2个具体目标：1)使用执行科学框架和社区参与 方法：调整现有的青光眼指导计划并开发多层次干预措施，以解决 成功增加美国黑人眼部护理使用率的关键决定因素；和2)实施和 评价以社区为基础的青光眼治疗方案(战斗)的可行性和可接受性 青光眼)，为美国黑人。在目标1中，针对慢性病的有针对性的实施(TICD) 将使用实施科学框架来指导对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者 在美国黑人中；以及b)使支持、教育和赋权计划(见)适应需要和文化 社区的发展和基于信仰的CHW交付的计划，使用实施战略 以及与社区确定的决定因素相联系的行为改变技术，以实现最佳成功。在目标2中， 对抗青光眼计划将通过与50名布莱克进行单臂飞行员研究来实施 美国人。候选人将使用混合方法来评估战斗的可行性和可接受性 青光眼项目。这项研究具有重要意义，因为它解决了成熟的指导方针与 尽管有这些数据，青光眼和高危人群仍继续失明。它是创新的，因为它 采用实施科学框架、社区参与、基于信仰的定制方法来创建 支持计划，以提高青光眼高危美国黑人的眼部护理利用率。伊兰博士将使用 在这个培训奖项中获得的技能成为少数接受过实施培训的眼科医生之一 科学和社区参与的健康差距研究，以改善全球所有人的青光眼护理 美国。

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.