Engaging Religious Leaders to Reduce Blood Pressures in Tanzanian Communities

让宗教领袖参与降低坦桑尼亚社区的血压

基本信息

批准号：
10544516
负责人：
Jennifer Alzos Downs
金额：
$ 51.19万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-01-01 至 2026-12-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10544516
关键词：
Address Adoption Adult Africa South of the Sahara Age Antihypertensive Agents Awareness Behavior Blood Pressure Body Weight decreased Cardiovascular Diseases Cardiovascular system Caring Cessation of life Cluster randomized trial Communities Community Health Creativeness Data Diagnosis Diet Dissemination and Implementation Education Educational Curriculum Educational process of instructing Effectiveness of Interventions Exercise Fostering Goals Government Health Health Personnel Health behavior Health system Healthcare Hybrids Hypertension Institution Intervention Interview Knowledge Learning Life Maintenance Male Circumcision Measures Medical Mentorship Methods Mission Modeling Muslim population group National Heart, Lung, and Blood Institute Outcome Persons Premature Mortality Prevalence Prevention Public Health Publishing Random Allocation Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Reduce health disparities Religion Reporting Research Risk Risk Factors Rural Community Sampling Social Environment Spirituality Standardization Tanzania Testing Translating Trust United States National Institutes of Health Weight Woman aged blood pressure control blood pressure elevation blood pressure intervention blood pressure reduction clinical care community engagement community intervention design diet and exercise effectiveness evaluation empowerment evidence base flexibility good diet hypertension control hypertension treatment hypertensive implementation strategy implementation/effectiveness improved innovation intervention refinement meetings member men modifiable risk mortality neighborhood disadvantage novel strategies peer support pharmacologic physical conditioning pilot test post intervention premature prevent primary outcome screening secondary outcome uptake

项目摘要

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.

项目概要/摘要尽管有高效的药物和非药物干预措施来降低血压，但血压仍升高在坦桑尼亚社区，血压仍然是导致早期死亡的主要全球危险因素。 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，并且知道的人不到 1% 我们的长期目标是改善高血压相关的健康结果。该提案的总体目标是调整我们既定的促进模式。与德高望重的宗教领袖合作开展社区健康干预措施，以弥合社区健康方面的差距我们的中心假设是农村社区对高血压的认识、预防和控制。赋予宗教领袖权力，让社区了解高血压问题将改善健康行为并降低患有和不患有高血压的成年人的平均血压我们建议的理由是，即使是社区范围内血压的小幅降低也可以。大幅降低该社区因心血管疾病过早死亡的风险。为了检验这一假设，我们将进行测试。追求三个具体目标：1）调整和试点我们之前的宗教参与健康干预解决宗教背景下的血压问题；2) 确定该干预措施对降低血压的有效性；整群随机试验中的平均社区收缩压；以及 3) 评估范围、有效性、采用、实施和维持该干预措施 24 个月在第一个目标中，我们将使用数据。根据之前对宗教领袖和社区成员进行的采访进行调整、完善和对我们的宗教参与健康干预措施进行试点测试，以解决高血压问题顺序 ADAPT-ITT 模型在第二个目标中，我们将进行混合 I 型有效性- 实施整群随机试验，以检验干预社区将在与对照社区相比，社区平均收缩压至少降低了 3 mmHg。第三个目标，我们将使用 RE-AIM 框架指导下的收敛混合方法来衡量达到宗教领袖和社区成员，对社区血压的影响以及与护理、收养的联系宗教领袖的指导，忠实于计划的干预，并维持 24 个月的福利。与生物医学和宗教领域合作，完善传播和实施干预措施拟议的研究具有创新性，因为它使用了一种新颖的方法来影响社区健康。宗教领袖或其他值得信赖的社区使者可以根据具体情况灵活调整这项研究很重要，因为它可能是一种吸引男性参与的创造性方式。据估计，社区收缩压降低 3 mmHg 可减少心血管疾病的过早发生该社区的死亡率降低 13% 如果成功，这种方法可以避免数千人死亡。坦桑尼亚，可适用于高血压结果不佳的美国社区。