Church Wellness Coordinator-led Intervention to Improve Hypertension Control in the Black Community

教会健康协调员主导的干预措施改善黑人社区的高血压控制

• 批准号: 10706422
• 负责人: Keith Copelin Ferdinand
• 金额: $ 152万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-18 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10706422
• 关键词: Adoption; Adult; Antihypertensive Agents; Black Populations; Black church; Black race; Blood Pressure; Cardiovascular Diseases; Case Management; Church; Clinical; Clinical effectiveness; Cluster randomized trial; Communities; Community Health Aides; Community Pharmacy; Control Groups; Cost Effectiveness Analysis; Data; Development; Disparity; Effectiveness; Eligibility Determination; End stage renal failure; Ethnic Population; Evidence based intervention; Exercise; Exploration, Preparation, Implementation, and Sustainment; Faith-based organization; Federally Qualified Health Center; Follow-Up Studies; General Population; Guidelines; Health; Health Food; Health Personnel; Health Policy; Health care facility; Health education; Healthcare Systems; High Prevalence; Home Blood Pressure Monitoring; Hypertension; Individual; Intention; Intervention; Life Style; Life Style Modification; Louisiana; Measurement; Needs Assessment; Outcome; Participant; Patient Care; Patients; Pharmaceutical Preparations; Prevalence; Primary Care; Protocols documentation; Provider; Public Health; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Side; Stroke; Testing; Training; Trust; Visit; Wellness Program; Work; blood pressure control; care coordination; community based participatory research; community engagement; community intervention; community organizations; comparison intervention; cost effectiveness; design; effectiveness outcome; effectiveness testing; effectiveness/implementation design; follow-up; health care quality; health care service organization; health disparity; health training; hypertension control; hypertension treatment; implementation evaluation; implementation outcomes; implementation strategy; improved; intervention program; medication compliance; member; mortality; multi-component intervention; post intervention; primary care provider; primary outcome; racial population; recruit; screening; treatment as usual; treatment comparison

Project Summary/Abstract The prevalence of hypertension in Black people in the US is among the highest in the world. Louisiana is in the epicenter of hypertension and cardiovascular disease health disparities. The overall objective of the proposed study is to test the effectiveness, implementation, and sustainability of a church wellness coordinator (CWC)- led multifaceted intervention compared to enhanced usual care on hypertension control in Black communities. A cluster randomized trial with an effectiveness-implementation hybrid design will be utilized to: 1. test the clinical effectiveness of the multifaceted implementation strategy on blood pressure (BP) control; 2. assess the implementation outcomes (acceptability, adoption, feasibility, fidelity, and cost-effectiveness) of the intervention; 3. study the sustainability of this multifaceted implementation strategy for clinical effectiveness and implementation outcomes in a 6-month post-intervention follow-up study; and 4. examine the community- wide impact of the intervention on mean BP and hypertension control. The Exploration, Preparation, Implementation, and Sustainment framework has been used to guide the development of the multifaceted implementation strategy. We have established a partnership with Black churches and assessed the needs, barriers, and facilitators of hypertension control in Black community members, church leaders, CWCs, and healthcare providers. The intervention is developed using a community-based participatory research approach and is rooted in church-based wellness programs developed by and for Black church congregations. The evidence-based interventions include community-based BP screening, lifestyle modifications, and antihypertensive medication treatment. The CWCs are community health workers who will be trained on BP screening, hypertension care coordination, and health coaching. They will conduct community-based BP screening, coordinate care for patients with hypertension, assist patients with home BP monitoring, deliver discounted and free antihypertensive medications to patients, and conduct health coaching on lifestyle changes and medication adherence. Participation of faith-based organizations, Federally Qualified Health Centers and other primary care organizations, community pharmacies, and local health departments will strengthen this community intervention program. We will recruit 40 Black churches in New Orleans and 30 eligible community members from each church. We will randomly assign 20 churches to the CWC-led multifaceted intervention and 20 to enhanced usual care. The multifaceted intervention program and enhanced usual care will last for 18 months. The primary clinical effectiveness outcome is the proportion of individuals with BP control (<130/80 mmHg) at 18 months and the primary implementation outcome is fidelity to the multifaceted intervention. The proposed cluster randomized trial has 90% statistical power to detect an absolute difference of 15% in the primary effectiveness outcome. This study will generate evidence on an effective, scalable, and sustainable strategy for eliminating hypertension disparities in Black communities.

项目概要/摘要 美国黑人高血压患病率位居世界最高之列。路易斯安那州位于 高血压和心血管疾病健康差异的中心。拟议的总体目标 研究旨在测试教会健康协调员（CWC）的有效性、实施性和可持续性- 与加强黑人社区高血压控制的常规护理相比，领导了多方面的干预。 采用有效性实施混合设计的整群随机试验将用于： 1. 测试 多方面实施血压控制策略的临床效果； 2. 评估 实施结果（可接受性、采用性、可行性、保真度和成本效益） 干涉; 3. 研究这种多方面实施策略的临床有效性的可持续性 以及干预后 6 个月随访研究的实施结果； 4. 检查社区—— 干预对平均血压和高血压控制产生广泛影响。探索、准备、 实施和维持框架已用于指导多方面的发展 实施策略。我们与黑人教会建立了合作伙伴关系并评估了需求， 黑人社区成员、教会领袖、CWC 和社区高血压控制的障碍和促进因素 医疗保健提供者。该干预措施是采用基于社区的参与性研究方法制定的 植根于由黑人教会开发并为黑人教会开发的基于教会的健康计划。这 基于证据的干预措施包括基于社区的血压筛查、生活方式改变和 抗高血压药物治疗。 CWC 是社区卫生工作者，他们将接受 BP 培训 筛查、高血压护理协调和健康指导。他们将进行基于社区的BP 筛查、协调高血压患者的护理、协助患者进行家庭血压监测、交付 为患者提供降压、免费降压药物，并进行生活方式健康辅导 变化和药物依从性。信仰组织的参与、联邦合格健康 中心和其他初级保健组织、社区药房和当地卫生部门将 加强这一社区干预计划。我们将在新奥尔良招募 40 个黑人教会和 30 个 每个教会的合格社区成员。我们将随机分配20个教会给CWC领导的 多方面的干预和20以加强日常护理。多方面的干预计划和强化 常规护理将持续18个月。主要临床有效性结果是个体的比例 18 个月时血压控制（<130/80 mmHg），主要实施结果是忠实于 多方位干预。拟议的整群随机试验具有 90% 的统计功效来检测 主要有效性结果的绝对差异为 15%。这项研究将产生证据 消除黑人社区高血压差异的有效、可扩展和可持续的战略。