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.

项目摘要/摘要尽管高效的药理学和非药理学干预措施降低了血压，但血压仍然是早期死亡率的全球领先危险因素。在坦桑尼亚社区，有28％ 35岁及以上的成年人患有高血压，但只有2％知道自己的诊断，少于1％关于抗高血压治疗。我们的长期目标是改善与高血压相关的健康结果坦桑尼亚社区。该提案的总体目的是调整我们既定的促进模型与备受尊敬的宗教领袖合作进行社区卫生干预措施，以弥合差距农村社区对高血压的意识，预防和控制。我们的中心假设是授权宗教领袖使社区有关高血压将改善健康状况行为并降低成年人的平均血压，无论有没有高血压社区。我们建议的理由是，即使在社区范围内的血压中也很小的降低也可以大幅度降低了该社区过早心血管死亡的风险。为了检验这一假设，我们将追求三个具体目的：1）适应和试验我们先前在健康干预方面的宗教参与在宗教背景下解决血压； 2）确定这种干预对减少的有效性在聚类随机试验中平均社区收缩压； 3）评估覆盖范围，有效性，采用，实施和维护此干预措施24个月。在第一个目标中，我们将使用数据从以前对宗教领袖和社区成员进行的采访以适应，完善和试点测试我们在健康干预方面的宗教参与，以解决高血压的问题顺序自适应-ITT模型。在第二个目标中，我们将进行I型I型有效性 - 实施集群随机试验，以检验干预群社区将实现的假设平均社区收缩压比对照社区的平均社区收缩压最少减少3 mmHg。在第三目的，我们将使用由RE-AIM框架指导的收敛混合方法来衡量覆盖范围宗教领袖和社区成员，对社区血压的影响以及与护理的联系，采用由宗教领袖，忠于计划的干预措施，并在24个月时维持利益。我们将与生物医学和宗教信仰合作，完善传播和实施的干预措施领导者。拟议的研究具有创新性，因为它使用一种新颖的方法来影响社区健康，提供上下文灵活性，以适应宗教领袖或其他值得信赖的社区信使自己的环境，这可能是吸引男性的创造性方式。拟议的研究很重要，因为社区收缩压降低3 mmHg估计会减少过早的心血管该社区的死亡率达到13％。如果成功的话，这种方法可以防止成千上万的死亡坦桑尼亚，可以适用于高血压结果很差的美国社区。