Community Health Workers Using Patient Stories to Support Hypertension Managemen

心血管疾病是生活在美国的所有人的主要死亡原因，高血压(HTN)是一个强烈的危险因素。不受控制的HTN在黑人、西班牙裔和穷人中更有可能发生。我们需要新的干预措施来改善对HTN的控制，缩小长期存在的种族/民族差距。 社区卫生工作者(CHW)代表他们所服务的患者群体的语言、文化和社会状况。虽然社区卫生组织在帮助坚持慢性病自我管理方案的患者方面有巨大的潜力，但这种潜力还没有完全实现。此项目构建 根据我们之前的研究表明，社区卫生中心的社区卫生工作者可以直接与糖尿病患者合作，改善饮食、锻炼和服药依从性的自我管理目标设置。更具体地说，我们将在CHW的医疗机构中集成一个新的强大的行为改变工具： 《像我这样的病人》讲故事。社区妇女与他们的社区有着共同的文化背景， 非常适合分享这些故事，并在基于激励性面试的讨论中使用它们。 我们的具体目标是：(1)基于对先前带来 在失控的HTN的控制下，制作了四张互动讲故事DVD，两张英语版，两张西班牙语版， 作为CHWS的工具，以(A)让参与者参与做出适合HTN的行为改变 管理(2张DVD)和(B)保持这些变化(2张DVD)；(2)加强我们的CHW培训，以(A)为重点 在长期的HTN控制上，(B)使用CHW的讲故事DVD作为改变行为的工具，以及(C)增加 激励性访谈技能培养；以及(3)在两家为少数族裔和低收入人群服务的社区健康中心 患者，招募并随访18个月，随机选择126名参与者(总干预N=252) 评估血压的变化，其次是自我管理目标设定和总体心血管风险 归因于加强CHW干预。使用倾向评分法，对照组 没有受到干预的人会考虑到长期的变化和参与研究的意愿。 因为讲故事是人类与生俱来的能力，我们的方法也适用于其他条件和环境。

Cardiovascular disease is the leading cause of death for all persons living in the United States, and hypertension (HTN) is a strong risk factor. Uncontrolled HTN is more likely among Blacks, Hispanics, and the poor. We need new interventions to improve HTN control and narrow persistent racial/ethnic gaps. Community health workers (CHWs) represent patient groups they serve in terms of language, culture, and social situation. While there is tremendous potential for CHWs to assist patients with adherence to chronic disease self-management regimens, this potential has yet to been fully realized. This project builds on our prior research demonstrating that CHWs in community health centers can work directly with people with diabetes to improve self-management goal setting for diet, exercise, and medication adherence. More specifically, we will integrate a new and powerful behavior-change tool in the CHWs' armamentarium: storytelling by "patients like me." CHWs, sharing a common cultural background with their communities, are well-suited to share these stories and use them in discussion grounded in motivational interviewing. Our Specific Aims are to: (1) Based on interviews with patients who have brought previously uncontrolled HTN under control, create four interactive storytelling DVDs, two in English and two in Spanish, to be used as a tool for CHWs to (a) engage participants to make behavioral changes appropriate for HTN management (2 DVDs) and (b) sustain these changes (2 DVDs); (2) Enhance our CHW training to (a) focus on long-term HTN control, (b) use storytelling DVDs by CHWs as a behavior-change tool, and (c) increase motivational interviewing skill building; and (3) At each of two CHCs serving minority and low income patients, recruit and follow for 18 months 126 randomly selected participants (total intervention N=252) to evaluate changes in blood pressure and, secondarily, in self-management goal setting and overall CVD risk attributable to the enhanced CHW intervention. Using propensity score approaches, a comparison group unexposed to the intervention will account for secular changes and willingness to participate in the study. Because storytelling is an innate human ability, our approach is relevant for other conditions and settings.