Conquering Hypertension in Vietnam: Solutions at Grassroots level

项目总结/摘要 虽然是一个中低收入国家，越南一直在经历流行病， 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）的主要危险因素要么在上升，要么在下降。 越南的高血压水平令人担忧，特别是高血压（HTN）。因此，CVD的负担将 越南男女继续增加，除非有效预防和控制 措施已经到位。拟议项目的目标是评估 两项以社区和诊所为本的多层面策略的实施情况及成效， 越南成年人血压升高（BP）的控制 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 （8个社区）。符合条件且知情同意的HTN成人研究受试者（n = 600）将 根据他们居住的社区，将他们分配到干预/比较状态。 对照组和干预组都将接受模仿 越南国家高血压计划。该方案的组成部分包括教育和 为卫生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， 以及一个社区意识多媒体节目。 除了越南国家高血压计划外，干预小组只会 接受三个精心挑选的增强集成到常规临床护理：（1）扩大 社区卫生工作者服务;（2）家庭BP自我监测;（3）“讲故事 干预措施，”以前制定和试点测试的可行性和有效性， 研究团队。讲故事的干预包括互动，识字适当， 文化敏感的多媒体讲故事模块，通过 患者用自己的声音说话。基于我们在研究期间出现的偏好， 与我们合作的农村社区的形成工作，讲故事的干预将是 通过DVD交付，在基线和试验后3、6和9个月连续分期 招生将在几个随访时间评估两个研究组的血压变化 点我们将采取多方面的战略，支持实施越南 国家高血压计划和拟议的改进措施。在工作的同时， 在试点可行性研究期间完成，目前越南国家高血压 计划，并提出了调查，该项目解决了严重的临床和公众 通过实施第一个基于社区的研究，使用文化- 对这一人群进行适当的扫盲、保健和营养干预。

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.