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

教会健康协调员主导的干预措施改善黑人社区的高血压控制

• 批准号: 10597338
• 负责人: Keith Copelin Ferdinand
• 金额: $ 152万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-18 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10597338
• 关键词: Adoption; Adult; Antihypertensive Agents; Black Populations; Black race; Blood Pressure; Cardiovascular Diseases; Case Management; Church; Clinical; Clinical effectiveness; Cluster randomized trial; Communities; Community Health Aides; Community Pharmacy; Control Groups; Cost Effectiveness Analysis; Data; Development; Effectiveness; Effectiveness of Interventions; End stage renal failure; Ethnic group; Evidence based intervention; Exercise; Exploration Preparation Implementation and Sustainment; Federally Qualified Health Center; Follow-Up Studies; General Population; Guidelines; Health; Health Food; Health Personnel; Health Policy; Health care facility; Health education; Healthcare Systems; High Prevalence; Home Blood Pressure Monitoring; Hypertension; Individual; Intention; Intervention; Life Style; Life Style Modification; Louisiana; Measurement; Outcome; Participant; Patient Care; Patients; Pharmaceutical Preparations; Plant Roots; Preparation; Prevalence; Primary Health Care; Protocols documentation; Public Health; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Side; Stroke; Testing; Time; Training; Trust; Visit; Wellness Program; Work; base; blood pressure control; care coordination; care providers; clinical implementation; community based participatory research; community intervention; community organizations; comparison intervention; cost effectiveness; design; effectiveness implementation study; effectiveness outcome; effectiveness testing; follow-up; health care quality; health care service organization; health disparity; hypertension control; hypertension treatment; implementation cost; implementation evaluation; implementation framework; implementation outcomes; implementation strategy; improved; intervention program; medication compliance; member; mortality; multi-component intervention; post intervention; primary outcome; racial and ethnic; recruit; screening; sustainability framework; treatment as usual; treatment comparison

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.

项目摘要/摘要 美国黑人的高血压患病率是世界上最高的。路易斯安那州在 高血压和心血管疾病健康差异的中心。提议的总体目标 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 - 与在黑人社区中对高血压控制的平常护理相比，LED多方面干预措施。 具有有效性实施混合设计的簇随机试验将用于：1。测试 多面实施策略对血压（BP）控制的临床有效性； 2。评估 实施结果（可接受性，采用，可行性，忠诚和成本效益） 干涉; 3。研究这种多方面实施策略的临床有效性的可持续性 并在干预后6个月的后续研究中实现结果；和4。检查社区 - 干预对平均BP和高血压控制的广泛影响。探索，准备， 实施和维持框架已被用来指导多方面的开发 实施策略。我们已经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。干预是使用基于社区的参与研究方法开发的 并植根于由黑人教会会众制定的基于教会的健康计划。这 基于证据的干预措施包括基于社区的BP筛查，生活方式修改和 降压药物治疗。 CWC是社区卫生工作者，将接受BP的培训 筛查，高血压护理协调和健康教练。他们将进行基于社区的BP 筛查，为高血压患者进行筛查，协调护理，协助家庭BP监测患者，交付 为患者打折和免费的降压药，并在生活方式上进行健康指导 变化和药物依从性。基于信仰的组织，联邦合格的健康 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个黑人教堂和30个 每个教堂的合格社区成员。我们将随机将20个教堂分配给CWC领导的 多方面的干预措施，20个增强了通常的护理。多方面的干预计划并增强了 通常的护理将持续18个月。主要的临床有效性结果是个体的比例 在18个月时BP对照（<130/80 mmHg），主要的实施结果是忠诚的 多方面干预。拟议的集群随机试验具有90％的统计能力，可检测 主要有效性结果的绝对差异为15％。这项研究将为 有效，可扩展和可持续的战略，以消除黑人社区的高血压差异。