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

项目摘要/摘要 美国黑人的高血压患病率位居世界前列。路易斯安那州是 高血压和心血管疾病的震中健康差距。建议的总体目标是 这项研究旨在测试教堂健康协调员(CWC)的有效性、实施情况和可持续性- 在黑人社区中，与加强高血压控制的常规护理相比，LED进行了多方面的干预。 采用有效性-实现混合设计的整群随机试验将被用于：1.测试 多方面实施的血压控制策略的临床效果；2.评估 实施成果(可接受性、采用率、可行性、保真度和成本效益) 干预；3.研究这一临床效果的多方面实施策略的可持续性 和6个月干预后跟踪研究的实施结果；以及4.检查社区- 干预对平均血压和高血压控制的广泛影响。探索、准备、 实施和可持续发展框架一直被用来指导多方面的发展 实施战略。我们已经与黑人教堂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、CWCS和 医疗保健提供者。该干预是使用基于社区的参与式研究方法来开发的 并植根于黑人教会会众制定的以教会为基础的健康计划。这个 循证干预包括基于社区的BP筛查、改变生活方式和 抗高血压药物治疗。CWCS是将接受BP培训的社区卫生工作者 筛查、高血压护理协调和健康指导。他们将以社区为基础进行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，提供 为患者提供折扣和免费的降压药，并对生活方式进行健康指导 改变和服药依从性。信仰组织的参与，联邦合格的健康 中心和其他初级保健组织、社区药店和当地卫生部门将 加强这一社区干预计划。我们将在新奥尔良招募40个黑人教堂和30个 来自每个教会的合格社区成员。我们将随机分配20个教堂给CWC领导的 多方面的干预和20个加强的日常护理。多方面的干预计划和增强 通常的护理将持续18个月。主要的临床疗效结果是个体的比例 在18个月时进行BP控制(&lt；130/80 mm Hg)，主要实施结果是忠于 多方面的干预。建议的整群随机试验具有90%的统计能力来检测 初次有效结果绝对差值15%。这项研究将产生关于 消除黑人社区高血压差距的有效、可扩展和可持续的战略。

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.