Actions to Decrease Disparities in Risk and Engage in Shared Support for Blood Pressure Control (ADDRESS-BP) in Blacks

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PROJECT SUMMARY / ABSTRACT This application is a request for a diversity supplement for Dr. Joyce Gyamfi. The supplement aims to provide mentorship, training, and advance research experience via the recently funded Actions to Decrease Disparities in Risk and Engage in Shared Support for BP Control (ADDRESS-BP) grant (# HL151310), with a focus on scalability, a desired outcome in implementation science. Identifying factors (barriers and facilitators) that impact scalability of multi-level evidence-based interventions (MEBI) is critical to closing the evidence to practice gap in implementation science. Moreover, it is essential to understand the complex interaction between the intervention, environment (context), the facilitation strategy, and continuous stakeholder engagement to promote scalability in various contexts. Currently, there is no comprehensive operational process, roadmap, or logic model for scaling up MEBI; however, it is essential to bring interventions to scale at the population level to ensure significant public health impact. The research proposed as part of this diversity supplement aims to assess the potential scalability of the PACE intervention in the parent grant through active stakeholder engagement, in order to identify barriers and facilitators to the scalability of this MEBI. The Practice support And Community Engagement (PACE) uses practice facilitation (PF) as a sustainable implementation strategy to evaluate three MEBI which include nurse case management (NCM), home blood pressure monitoring (HBPM), and community health workers (CHW), delivered as an integrated community-clinic linkage model in New York City (NYC). Although this MEBI has the core components to be successfully executed in clinical settings, how PACE will be scaled in other urban and/or rural settings needs further research. Scalability, which is an essential implementation outcome must be assessed to ensure the translation of PACE to other clinical and community service systems. The implementation science framework - Promoting Action on Research in Health Services (PARiHS) - and the WHO/ExpandNet Scale -up recommendations- will guide the assessment. The use of the two frameworks via mixed- methodology (semi-structured surveys and focus groups with key stakeholders) and practice capacity data from Aim 2 of the parent grant will allow assessment of the interrelationship between evidence, context, and facilitation; and inform development of a logic model and an operational process for sustaining scale-up of PACE, which is a rational next step for the parent grant to improve population health in other high-burden communities beyond the initial study. Specifically in this diversity supplement, Dr. Gyamfi aims to accomplish the following research and training aims: SPECIFIC AIM 1: RESEARCH: SubAim 1A: Evaluate the context, barriers, and facilitators to implementation of the PACE blood pressure control intervention using the PARIHS framework (Environmental scan) at 20 primary care practices in New York City. SubAim 1B: Assess the potential for scalability of the PACE intervention in SubAim 1A using WHO/ExpandNet Scale-up recommendations. SubAim 1C: Develop robust operational process and logic model that will guide horizontal and vertical scale-up of PACE and assess the feasibility of the model via stakeholder feedback. SPECIFIC AIM 2: CAREER DEVELOPMENT: Engage in coursework, training, and mentorship to increase knowledge in implementation research by participating in the following coursework and training: 1) Training Institute for Dissemination and Implementation in Research and Health (TIDIRH), 2) Designing Interventions to Change Organizational Behavior; 3) Qualitative and Mixed Methods Research, 4) Biostatistics /Statistical Modeling for Implementation Research, 5) Grant writing. SPECIFIC AIM 3: GRANTSMANSHIP: Broaden the scope of knowledge in implementation research by attending conferences, drafting publications, and achieving the ultimate goal of this diversity supplement experience, which is to submit an Early Stage Investigator (ESI) K or R (e.g., R21) application to NIH focused on pilot testing and refining the logic model for scale-up of MEBI before the end of the supplement funding period.