Engaging NHPIs and Activating Communities to Take Steps (ENACTS)

项目3 摘要 高血压是心血管疾病和中风的一个强烈但可改变的危险因素。与白人相比， 夏威夷原住民和太平洋岛民(NHPI)患上这些疾病的可能性是普通人的3到4倍。他们 在NHPI中也表现在较年轻的年龄，并且比在所有种族的人口中更有可能致命。 NHPI的高血压患病率比白人高70%，21岁以上的NHPI中近50% 有高血压。然而，NHPI在很大程度上没有出现在关于这一主题的研究中。许多NHPI高消耗饮食 在钠和糖中。关于减少钠摄入量、增加钾摄入量的自我护理教育，以及 鼓励减肥、戒烟和体力活动可以改善血压。我们会 调整现有的教育干预措施，以解决卫生保健指标中高血压的自我管理问题。多层次的 为期6个月的干预措施--“参与全民健康保险计划和激活社区采取措施”(ACTS)--将发挥作用 使用同伴促进的自我护理BP教育，为期8周，强调健康饮食，传统 NHPI食品，坚持用药，鼓励增加体力活动和戒烟； 发送短信以提高遵从性。我们将在3个社区实施ACTS作为随机对照试验 在华盛顿州普吉特湾地区提供NHPI的网站。我们将随机抽取270名NHPI成人(每个站点90名) 有自我报告的医生诊断为高血压并在注册时测量到血压升高到 制定或通常的照顾。两个小组都将收到一般健康教育手册，外加每周30美元的学分 用于在线杂货购物。我们将使用地理信息系统(GIS)手机应用程序来跟踪 参与者。主要结果是收缩压改变。次要结果是食品购买行为 (在线订购、食品杂货收据)；服药依从性；社会支持；戒烟；地理信息系统数据 每天的能量消耗。结果将在基线、每周和6个月时进行评估。我们还将检查 改变家庭食品购买模式，加强家庭对血压控制的支持，改善血压 在家庭成员中。将邀请一部分干预参与者和家庭成员参加 一项使用个人照片进行叙事艺术项目的计划，以促进当地居民对健康食品的标签 零售店。我们的具体目标是：1)在个人层面，比较人内BP和 干预组和对照组之间的次要结果；2)在家庭水平上，评估ACTS 提供主要支持的家庭成员的人内变化对BP和次要结局的影响， 以及没有直接参与干预的其他成年家庭成员的平均变化；以及3) 政策层面，评估干预对食品杂货店政策的影响能力，明确识别食品 低钠或高钾，其中一些可能不容易与现有的标记识别(例如， 新鲜农产品)。颁布结合了现有计划的经验支持的元素，从而增加了它的 成功的概率。它与美国心脏协会呼吁的多层次预防相一致。

PROJECT 3 Abstract Hypertension is a strong but modifiable risk factor for cardiovascular disease and stroke. Compared to Whites, Native Hawaiians and Pacific Islanders (NHPIs) are 3 to 4 times more likely to develop these conditions. They also manifest at younger ages among NHPIs, and are more likely to be fatal than in the all-races population. Hypertension prevalence is 70% higher in NHPIs than in Whites, and nearly 50% of NHPIs over the age of 21 have hypertension. Yet, NHPIs are largely absent from research on this topic. Many NHPIs consume diets high in sodium and sugar. Education on self-care for reducing sodium intake, increasing potassium intake, and encouraging weight loss, smoking cessation, and physical activity can improve blood pressure (BP). We will adapt an existing educational intervention to address self-management of hypertension in NHPIs. The multilevel 6-month intervention – “Engaging NHPIs and Activating Communities to Take Steps” (ENACTS) – will operate use peer-facilitated, self-care BP education delivered weekly for 8 weeks emphasizing healthy diet, traditional NHPI foods, adherence to medication, and encouragement to increase physical activity and stop smoking; with text messaging to boost adherence. We will implement ENACTS as a randomized controlled trial at 3 community sites serving NHPIs in the Puget Sound area of Washington. We will randomize 270 NHPI adults (90 per site) with a self-reported physician diagnosis of hypertension and elevated BP measured at enrollment to either ENACTS or usual care. Both groups will receive general health education brochures, plus a $30 weekly credit for online grocery shopping. We will use a Geographic Information Systems (GIS) mobile phone app to track participants. The primary outcome is change in systolic BP. Secondary outcomes are food purchasing behaviors (online ordering, grocery receipts); medication adherence; social support; smoking cessation; and GIS data on daily energy expenditure. Outcomes will be measured at baseline, weekly, and at 6 months. We will also examine change in household food purchasing patterns, enhanced family support for BP control, and BP improvement among family members. A subset of intervention participants and family members will be invited to participate in a program that uses personal photographs for narrative art projects to promote labeling of healthy foods by local retail outlets. Our Specific Aims are: 1) at the individual level, to compare within-person change in BP and secondary outcomes between the intervention and control groups; 2) at the family level, to evaluate ENACTS’ effects on BP and secondary outcomes as within-person change in family members who provide primary support, and as mean change in other adult family members who are not directly engaged in the intervention; and 3) at the policy level, to evaluate the intervention’s ability to influence grocery store policy on clearly identifying foods that are low in sodium or high in potassium, some of which might not be easily identified with existing labels (e.g., fresh produce). ENACTS combines empirically supported elements of existing programs, thus increasing its probability of success. It aligns with the American Heart Association’s call for multilevel prevention.