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

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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.