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

高血压是AA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%的人血压不受控制。在原子吸收光谱仪中改进BP控制是至关重要的 to improve改善health健康equity公平for AA.收缩压降低10 mmHg与风险降低28%相关 心力衰竭，中风风险降低27%，主要心血管事件降低20%，冠心病降低17% 疾病药物治疗和饮食改变是降低血压最有效的策略，但 在AA中对两者的粘附性特别低。信任度低，对不健康食品的文化偏好， 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， 血压不受控制的人有可能增加AA的依从性，因为教会是一个 拥有强大的社会支持。拟议的教会干预包括9个月的 所有参与者的基本干预，辅以3个月的个性化CHW 在3个月和6个月时未达到BP降低里程碑的参与者的干预。基本 干预是一个文化定制的，基于小组的BP教育干预，包括两个组成部分： 由牧师领导的圣经学习，鼓励健康的生活方式和精神价值观之间的联系， 改变小组，由受过训练的教会成员领导，以促进行为改变策略（教育， 目标设定、自我监控、解决问题）。CHW干预包括一对一的会议 参与者和CHW之间每月两次，为期3个月，重点是解决个人障碍， 坚持服药和健康饮食。社区工作者还将把参与者与社区资源联系起来， 根据需要，消除障碍。我们建议进行一项为期24个月的行为群集随机对照试验 其中18个教堂（n=342）被随机分配到两个臂中的一个。干预组将接收Alive 英国石油公司在第一年进行干预，第二年进行金融教育干预。的 比较（对照）组将以相反的顺序接受两种干预。主要目的是比较 非裔美国人教会成员与不受控制的BP在干预教会与那些在 对照组在12个月时收缩压的平均变化。第二个目的是评估效果 饮食质量、服药依从性、自我效能、内在动机、社会支持、 知识，对药物的信念，以及药物使用的障碍。一个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.