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

项目总结/摘要 美国黑人的高血压患病率是世界上最高的。路易斯安那州位于 高血压和心血管疾病的健康差距。建议的总体目标 研究是为了测试教会健康协调员（CWC）的有效性，实施和可持续性- 在黑人社区中，与加强常规护理相比，领导多方面的干预措施控制高血压。 一项具有有效性-实施混合设计的整群随机试验将用于：1。测试 多方面实施血压控制策略的临床效果; 2.评估 执行成果（可接受性、采用性、可行性、忠实性和成本效益） 干预; 3.研究这一多方面实施战略的可持续性，以提高临床有效性 和实施结果在6个月的干预后的后续研究;和4.检视社区- 干预对平均血压和高血压控制的广泛影响。探索，准备， 执行和维持框架已被用来指导多方面的发展， 实施战略我们与黑人教会建立了伙伴关系，并评估了需求， 黑人社区成员、教会领袖、CWC和 医疗保健提供者。该干预措施是采用以社区为基础的参与性研究方法制定的 它植根于由黑人教会开发的以教会为基础的健康计划。的 循证干预措施包括基于社区的BP筛查，生活方式的改变， 降压药物治疗。这些社区卫生工作者将接受BP培训 筛查、高血压护理协调和健康指导。他们将开展以社区为基础的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， 为患者提供折扣和免费的降压药物，并进行生活方式的健康指导 变化和药物依从性。信仰组织、联邦合格卫生组织和 中心和其他初级保健组织，社区药房和当地卫生部门将 加强社区干预计划。我们将在新奥尔良招募40个黑人教堂， 每个教会的合格社区成员。我们将随机分配20个教会， 多方面干预和20个加强日常护理。多方面的干预计划，并加强 一般护理期为十八个月。主要临床有效性结局是个体比例 18个月时血压控制（<130/80 mmHg），主要实施结果是忠实于 多方面的干预。拟议的整群随机试验有90%的统计能力来检测 主要有效性结局的绝对差异为15%。这项研究将提供证据， 消除黑人社区高血压差异的有效、可扩展和可持续战略。

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.