Engaging Religious Leaders to Reduce Blood Pressures in Tanzanian Communities

项目摘要/摘要 尽管高效的药物和非药物干预可以降低血压，但 血压仍然是导致早期死亡的主要全球风险因素。在坦桑尼亚社区，28%的人 35岁及以上的成年人患有高血压，但只有2%的人知道自己的诊断，只有不到1%的人知道 关于抗高血压治疗。我们的长期目标是改善与高血压相关的健康状况 坦桑尼亚社区。这项建议的总体目标是调整我们既定的促进 与备受尊敬的宗教领袖合作进行社区卫生干预，以弥合 农村社区对高血压的认识、预防和控制。我们的中心假设是 授权宗教领袖让他们的社区参与高血压问题将改善健康 有高血压和无高血压的成年人的行为和降低平均血压 社区。我们提议的理由是，即使整个社区的血压略有下降，也可以 大幅降低该社区心血管疾病过早死亡的风险。为了检验这一假设，我们将 追求三个具体目标：1)调整和试行我们先前对卫生干预的宗教参与，以 在宗教背景下解决血压问题；2)确定这一干预措施在降低血压方面的有效性 在一组随机试验中的平均社区收缩压；3)评估覆盖范围、有效性、 采用、实施和维护此干预措施24个月。在第一个目标中，我们将使用数据 来自之前对宗教领袖和社区成员进行的采访，以适应、完善和 试点-测试我们的宗教参与健康干预，以解决高血压问题使用 序贯自适应-ITT模型。在第二个目标中，我们将进行第一类混合有效性- 实施整群随机试验，以检验干预社区将在 社区平均收缩压比对照社区降低至少3毫米汞柱。在 第三个目标，我们将使用RE-AIM框架指导的收敛混合方法来衡量REACH 宗教领袖和社区成员对社区血压的影响以及与照顾、收养的联系 宗教领袖，忠于计划中的干预，并在24个月内维持福利。我们会 与生物医学和宗教合作，完善传播和实施的干预措施 领袖们。这项拟议的研究具有创新性，因为它使用了一种新的方法来影响社区健康，它 为宗教领袖或其他受信任的社区信使提供上下文灵活性，以适应其 这可能是一种创造性的吸引男性的方式。这项拟议的研究意义重大，因为 据估计，社区收缩压降低3毫米汞柱可减少过早心血管事件 该社区的死亡率降低了13%。如果成功，这种方法可以防止成千上万的人在 坦桑尼亚，可以改装用于高血压结果较差的美国社区。

Project Summary/Abstract Despite highly effective pharmacologic and non-pharmacologic interventions to lower blood pressure, elevated blood pressure remains the leading global risk factor for early mortality. In Tanzanian communities, 28% of adults aged 35 and above have hypertension, yet only 2% are aware of their diagnosis and less than 1% are on anti-hypertensive treatment. Our long-term goal is to improve hypertension-related health outcomes in Tanzanian communities. The overall objective of this proposal is to adapt our established model of promoting community health interventions in partnership with highly respected religious leaders in order to bridge gaps in rural communities’ awareness, prevention, and control of high blood pressure. Our central hypothesis is that empowering religious leaders to engage their communities about high blood pressure will improve health behavior and reduce the average blood pressure among adults both with and without hypertension in the community. The rationale for our proposal is that even small reductions in community-wide blood pressure can sharply decrease the risk of premature cardiovascular death in that community. To test this hypothesis, we will pursue three specific aims: 1) Adapt and pilot-test our prior Religious Engagement in Health Intervention to address blood pressure in religious contexts; 2) Determine the effectiveness of this intervention on reducing mean community systolic blood pressure in a cluster randomized trial; and 3) Assess reach, effectiveness, adoption, implementation, and maintenance of this intervention for 24 months. In the first aim, we will use data from previously conducted interviews with religious leaders and community members to adapt, refine, and pilot-test our Religious Engagement in Health Intervention to address the problem of high blood pressure using the sequential ADAPT-ITT model. In the second aim, we will conduct a hybrid type I effectiveness- implementation cluster randomized trial to test the hypothesis that the intervention communities will achieve at least a 3 mmHg greater reduction in mean community systolic blood pressure than control communities. In the third aim, we will use convergent mixed methods guided by the RE-AIM framework to measure reach to religious leaders and community members, effect on community blood pressure and linkage to care, adoption by religious leaders, fidelity to the planned intervention, and maintenance of the benefit at 24 months. We will refine the intervention for dissemination and implementation in partnership with biomedical and religious leaders. The proposed research is innovative because it uses a novel approach to impact community health, it offers contextual flexibility to be adapted by religious leaders or other trusted community messengers for their own contexts, and it may be a creative way to engage men. The proposed research is significant because a community systolic blood pressure reduction of 3 mmHg is estimated to decrease premature cardiovascular mortality by 13% in that community. If successful, this approach could prevent many thousands of deaths in Tanzania and could be adapted for use in U.S. communities in which hypertension outcomes are poor.