Conquering Hypertension in Vietnam: Solutions at Grassroots level

项目摘要/摘要 尽管越南是一个中低收入国家，但它一直在经历一场流行病 向非传染性疾病日益流行的发展中国家过渡 疾病。心血管疾病(CVD)的关键危险因素要么在上升，要么在 越南的水平令人担忧，特别是高血压(HTN)。因此，心血管疾病的负担将是 除非进行有效的预防和控制，否则越南男性和女性的人数将继续增加 措施已经到位。拟议项目的目标是评估 两种以社区和诊所为基础的多层面战略的实施和效果 通过整群随机抽样控制越南成年人的血压升高 试验设计。 16个社区将被随机分为干预组(8个社区)或对照组 组(8个社区)。符合条件和同意的患有HTN的成人研究参与者(n=600)将 根据他们所在的社区被分配到干预/比较状态。 对照组和干预组都将接受仿照 越南国家高血压计划。该计划的组成部分包括教育和 为医疗保健提供者提供实践改变模块，为患者提供无障碍阅读材料， 和一个提高社区意识的多媒体节目。 除了越南国家高血压计划，干预组只会 获得集成到常规临床护理中的三项精心挑选的增强功能：(1)扩展 社区卫生工作者服务；(2)家庭BP自我监测；(3)“讲故事” 以前开发的干预措施，并通过试验测试了其可行性和有效性 研究团队。讲故事干预包括互动性、识字性和 具有文化敏感性的多媒体讲故事模块，通过 病人用自己的声音说话的力量。基于在我们的 与我们合作的农村社区一起进行形成性工作，讲故事的干预将是 通过DVD交付，在试用后3个月、6个月和9个月以连续分期付款方式交付 招生。两个研究组将在几个后续时间评估BP的变化 积分。我们将采取多方面的战略，支持越南战略的实施 国家高血压计划和拟议的增强措施。配合这项工作 在试点可行性研究期间完成，越南国家高血压目前的努力 计划和拟议的调查，该项目解决了严重的临床和公众 越南的健康问题，通过实施第一项基于社区的研究，使用文化- 针对这一人群的识字适当的HTN干预。

PROJECT SUMMARY/ABSTRACT Although being a low-middle income country, Vietnam has been experiencing an epidemiologic transition to that of a developing country with an increasing prevalence of non-communicable diseases. The key risk factors for cardiovascular disease (CVD) are either on the rise or at alarming levels in Vietnam, particularly hypertension (HTN). Inasmuch, the burden of CVD will continue to increase in Vietnamese men and women unless effective prevention and control measures are put in place. The objectives of the proposed project are to evaluate the implementation and effectiveness of two multi-faceted community and clinic-based strategies on the control of elevated blood pressure (BP) among adults in Vietnam via a cluster-randomized trial design. Sixteen communities will be randomized to either an intervention (8 communities) or comparison group (8 communities). Eligible and consenting adult study participants with HTN (n = 600) will be assigned to intervention/comparison status based on the community in which they reside. Both comparison and intervention groups will receive a multi-level intervention modeled after the Vietnam National Hypertension Program. Components of this program include education and practice change modules for health care providers, accessible reading materials for patients, and a community awareness multi-media program. In addition to the Vietnam National Hypertension Program, the intervention group only will receive three carefully selected enhancements integrated into routine clinical care: (1) expanded community health worker services; (2) home BP self-monitoring; and (3) a “storytelling intervention,” previously developed and pilot tested for feasibility and effectiveness by the research team. The storytelling intervention consists of interactive, literacy-appropriate, and culturally sensitive multimedia storytelling modules for motivating behavior change through the power of patients speaking in their own voice. Based on preferences that emerged during our formative work with our partnering rural communities, the storytelling intervention will be delivered by DVD, with serial installments at baseline and at 3, 6, and 9 months after trial enrollment. Changes in BP will be assessed in both study groups at several follow-up time points. We will pursue a multi-faceted strategy to support implementation of the Vietnam National Hypertension Program and the proposed enhancements. In conjunction with the work done during the pilot feasibility study, current efforts by the Vietnam National Hypertension Program, and the proposed investigation, this project addresses a serious clinical and public health problem in Vietnam by implementing the first community-based study using a culturally- literacy appropriate HTN intervention for this population.