Alive Blood Pressure Project: A church-based intervention to improve blood pressure

高血压是AA患者比白人少活5.5年的主要原因。超过一半(55%)的AA成年人 现在有高血压，45%的人血压(BP)不受控制。改善腹主动脉系统的BP控制至关重要 致力于改善美国儿科协会的健康公平。收缩压降低10毫米汞柱与风险降低28%相关 心力衰竭，中风风险降低27%，重大心血管事件降低20%，冠心病风险降低17% 疾病。药物治疗和改变饮食是降低血压最有效的策略，但是 美国汽车协会对这两种药物的依从性尤其低。低信任度，对不健康食品的文化偏好，以及物流 由于缺乏机会而造成的障碍是遵守情况不佳的根本原因。基于教会的干预措施 患有不受控制的BP的个人有可能增加AA中的遵从性，因为教会是一个 值得信赖的环境和强大的社会支持。拟议的教会干预包括为期9个月的 为所有参与者提供以小组为基础的基本干预，并辅之以为期3个月的个性化CHW 对在3个月和6个月没有达到降压里程碑的参与者进行干预。最基本的 干预是一种文化定制的、基于群体的BP教育干预，由两个组成部分组成：a 由牧师领导的圣经学习，鼓励健康的生活方式与精神价值观和行为之间的联系 改变小团体，由训练有素的教会成员领导，以促进行为改变策略(教育， 设定目标、自我监控、解决问题)。CHW干预包括一对一的会议 在参与者和CHW之间每月两次，为期3个月，重点解决个人障碍 坚持用药和健康饮食。社区卫生组织还将把参与者与社区资源联系起来， 根据需要解决障碍。我们建议进行一项为期24个月的行为整群随机对照试验 其中18个教堂(n=342)被随机分配到两个手臂中的一个。介入臂将接受活着的 BP在第一年进行干预，Money Smart在第二年进行金融教育干预。这个 比较器(控制)ARM将以相反的顺序接收这两个干预。其主要目的是比较 非裔美国人教会成员与那些在干预教堂中的BP不受控制的人 比较教堂在12个月时收缩压的平均变化。次要目标是评估效果。 饮食质量、服药依从性、自我效能、内在动机、社会支持、 关于药物的知识、信念和药物使用的障碍。探索性的目标是评估 干预组干预后24个月SBP变化的可持续性。

Hypertension is largely responsible for AAs living 5.5 fewer years than whites. Over half (55%) of AA adults now have hypertension and 45% have uncontrolled blood pressure (BP). Improving BP control in AAs is critical to improving health equity for AAs. A reduction of 10 mmHg in systolic BP is associated with 28% reduced risk of heart failure, 27% risk reduction for stroke, 20% for major cardiovascular events, 17% for coronary heart disease. Medication and diet change are the most effective strategies for reducing blood pressure, but adherence to both is especially low in AAs. Low trust, cultural preference for unhealthy foods, and logistical barriers due to poor access are underlying causes of poor adherence. Church-based interventions for individuals with uncontrolled BP have potential to increase adherence among AAs because the church is a trusted setting with strong social support. The proposed church-based intervention consists of a 9-month group-based Basic intervention for all participants, supplemented by a 3-month individualized CHW intervention for participants that do not achieve BP reduction milestones at 3 and 6 months. The Basic intervention is a culturally-tailored, group-based BP education intervention that consists of two components: a Bible study, led by the Pastor, to encourage a link between healthy lifestyle and spiritual values, and Behavior Change small groups, led by a trained church member, to promote behavior change strategies (education, goal-setting, self-monitoring, problem-solving). The CHW intervention consists of one-on-one meetings between participants and a CHW twice per month for 3-months, focused on addressing individual barriers to medication adherence and healthy diet. CHWs will also connect participants to community resources to address barriers, as needed. We propose to conduct a 24-month behavioral cluster randomized controlled trial in which 18 churches (n=342) are randomized to one of two arms. The intervention arm will receive the Alive BP intervention in the first year and Money Smart, a financial education intervention, in the second year. The comparator (control) arm will receive the two interventions in the reverse order. The primary aim is to compare African American church members with uncontrolled BP in the intervention churches with those in the comparator churches on mean change in systolic BP at 12 months. The secondary aim is to evaluate the effect of the intervention on diet quality, medication adherence, self-efficacy, intrinsic motivation, social support, knowledge, beliefs about medications, and barriers to medication use. An exploratory aim is to evaluate sustainability of change in SBP at 24 months post-intervention in the intervention arm.